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Dr Goh performs several types of breast surgery, each one designed for a specific set of circumstances. For women who would like to have fuller, more voluptuous breasts that are more proportional to their bodies, a breast augmentation with implants may provide the perfect solution. A breast lift, on the other hand, may help restore a more youthful and perky appearance to breasts that have sagged with age or as a result of breast feeding. Women with large, heavy breasts that cause physical discomfort and emotional distress will greatly benefit from a breast reduction.
This is particularly relevant if you have some degree of ptosis (droopiness) of the breasts. When we analyse ptosis, we must consider it in two parts: 1. nipple ptosis and 2. glandular ptosis.
Nipple ptosis refers to where the nipple lies in relation to the inframammary fold. Glandular ptosis refers to where the majority of the underlying breast tissue lies in relation to the fold. When the nipple is below the fold, it generally means that a lift is required. When the nipple is above the fold, a lift is generally not required. A more difficult decision arises when the nipple is at the fold. This is when the pros and cons of a lift versus implants alone need to be discussed. With glandular ptosis an implant of sufficient size may occasionally be used to fill and push out the breast.
With this said, other factors must be considered including skin quality and breast tissue composition, so the best way to determine what procedure is required to achieve your desired outcome is to book in for a consultation with your Specialist Plastic Surgeon.
The issue of breast implant safety has been a hot topic throughout the last few decades. As a result, more stringent standards have emerged in order to protect patients. Current breast implant procedures by Dr Goh primarily use silicone shell implants filled with silicone gel.
Special studies have been done and have determined that much higher levels of silicone have been found in cows’ milk and commercially available infant formula than are found in the breast milk of women with implants. The Institute of Medicine concluded that “There is no evidence that silicone implants are responsible for any major diseases of the whole body. Women are exposed to silicone constantly in their daily lives (National Academies Press (US), 2000)”.
Rarely, an implant will rupture or leak. The effect of silicone-gel leaking into the body is still being researched, although modern advancements in breast implant technology have come a long way in minimizing the potential side effects of any rupture or leakage. If a silicone implant ruptures, the new cohesive gel should remain within the outer shell and not harm your body. It is hard to detect a rupture so an ultrasound may be necessary if suspected.
Other possible complications from breast implant surgery may include blood clotting or pooling (haematoma), overly sensitive breasts or loss of sensation in the breasts, and capsular contracture (a hardening of the tissues surrounding the implant). Dr Goh’s expert team is dedicated to making your operation a smooth one. We take every precaution necessary to reduce the possibility of any complications.
This depends on the type of breast surgery and the location of the incision, the peri-areolar incision site is more likely to affect this ability. Many women with breast implants have successfully breast fed their babies.
In terms of safety, current studies indicate that women with breast implants do not have any higher levels of silicone in their milk than women without breast implants.
During your consultation, Dr Goh will outline the benefits as well as the risks, side effects, and potential complications of the procedure you are interested in.
Despite major advancements in breast implant technology, all implants have a limited lifetime, and may need to be removed or replaced sometime in your life. The time period of breast implants can vary from woman to woman. Some women need replacement surgery in only a few years while others may go 10-20 years or longer. There are several reasons why a woman might need replacement surgery. Sometimes it is a matter of choice, such as a size change or an implant style change, and sometimes removal and replacement is necessary because of a complication, such as deflation, or shifting of the implant.
In essence, there are two pocket planes that a breast implant can be put into: OVER the muscle (sub-glandular, sub-fascial) and UNDER the muscle (sub-pectoral, sub-muscular). A further refinement of the under-the-muscle pocket plane is the DUAL-PLANE technique.
There are advantages and disadvantages to each pocket plane, and indications for each are dependent on your body type and clinical findings. In general, most patients seeking breast augmentation are best suited to having their implants placed under the muscle in a dual-plane fashion.
In the dual-plane technique, having breast and skin over the lower part of the implant allows the implant to more effectively expand out the lower pole of the breast, thus creating a more pleasing aesthetic result. A customised dual-plane technique allows the surgeon to tailor the areas of the implant we want to be covered by muscle, and also define the areas where we want the breast and skin to be expanded by the implant.
However, there is no one-size-fits all technique. Dr Goh employs a customised approach, taking into consideration your existing anatomy to select the most appropriate size, shape, type of implant and technique for you.
Plastic Surgery FAQs
For your surgery, the entire procedure or parts of it will fall into either of these categories
|Cosmetic Surgery||Reconstructive Surgery|
|Performed to reshape normal structures||Performed to reconstruct abnormal body structures|
|Goal is to improve patient’s appearance and self-esteem||Goal is to improve function and at times to approximate a normal appearance|
|Elective procedure||Essential procedure|
|Not covered by health insurance||Usually covered by health insurance|
Medicare rebates will generally contribute to the cost of to any procedure that is deemed medical. Specific requirements usually have to be met, which can only be evaluated after you have had a consultation with Dr Goh.
For your consultation, although not required, it is preferable to have a referral. Members of ASPS are specialists and will need your medical history. A referral will also be required should there be a Medicare rebate for the cost of your consultation.
Any doctor can call themselves a cosmetic surgeon, so the importance of finding a properly trained and certified specialist surgeon to undertake your treatment cannot be stressed too much.
Choosing a doctor who’s a member of the Australian Society of Plastic Surgeons (ASPS) is the first step. ASPS Member Surgeons are certified by the Board of Plastic and Reconstructive Surgery, are Fellows of the Royal Australasian College of Surgeons and are recognised as specialists by the Australian Medical Council and Medicare Australia.
- Are certified by The Board of Plastic and Reconstructive Surgery or The Royal Australasian College of Surgeons (RACS).
- Have completed specialist surgeon training in plastic surgery. Operate only in accredited medical facilities.
- Adhere to a strict code of ethics.
- Fulfil continuing professional development requirements, including standards and innovations in patient safety.
- Are your partners in cosmetic and reconstructive plastic surgery.
- Answer all of your questions thoroughly and clearly.
- Ask about your thoughts to recommended treatment.
- Offer alternatives, where appropriate.
- Welcome questions about your procedure and his or her professional qualifications, experience, costs and payment policies.
- Make clear the risks of surgery and possible outcomes.
- Give you information about the procedure you want.
- Leave the final decision to you.
Dr Goh will require you to refrain from smoking for a period before and after your surgery. Smoking causes the blood vessels to constrict, reducing blood supply and oxygen carried by the blood to the surgical area. When blood supply is reduced, the tissues heal more slowly.
In terms of your diet, garlic, ginger, and herbal teas (including green tea), as well as many over-the-counter supplements including vitamins, primrose oil, cod liver oil, garlic tablets, fish oil, krill oil, and omega 3 can have an aspirin-like effect. They increase the clotting time of the blood that may lead to more bleeding in the area of surgery, which may in turn increase postoperative swelling. Dr Goh suggests that the above-mentioned dietary factors and supplements be ceased 2 weeks prior to surgery. In addition, plenty of fresh fruits, vegetables, and a high-water intake will ensure that your body is well hydrated, in optimal condition to undergo surgery, and primed for a rapid recovery.
Having a positive mindset and realistic expectations leading up to your surgery will help you to recover optimally.
If you decide to proceed with surgery, specific instructions, requirements and suggestions will be discussed with you during your consultations with Dr Goh and the Valley Plastic Surgery clinic nurses.
Every cut on the skin will result in some kind of a scar. The aim with every surgical procedure, of course, is to produce a scar that over time becomes faint and, if possible, hidden in a naturally occurring skin crease.
Every effort is put in place when closing a wound to avoid an adverse scar. These include gentle tissue handling, precise wound approximation, and placing multiple layers of sutures to hold tension off the wound. Post-surgery measures such as taping, moisturising, sun protection, and silicone therapy also play important roles in scar management. Scars are always going to be slightly red and “lumpy” in the first few weeks after surgery. Massaging the scar after this initial healing period can help to reduce swelling and to soften the scar line.
There are rare occasions when an unfavourable scar occurs. There are no firm explanations as to why these types of abnormal scarring occur in some people and not in others. It is often unpredictable and can occur weeks to months after the surgery. When adverse scarring occurs, it must be actively treated in order to halt the abnormal scarring process and to prevent it from getting worse.
The vast majority of wounds will, over time, heal up without any concerns whatsoever. It is the rare and often unpredictable occasion when an adverse scar occurs which necessitates the mention of scarring as a possible risk factor for all surgeries that involve knife to skin.
There are some procedures that are commonly combined:
Breast surgery (breast augmentation, breast reduction, breast lift) and Abdominoplasty
Septoplasty and Rhinoplasty
Browlift and Upper Eyelid Reduction
As a general rule for combining procedures is that they should be in the same area of the body. However, even these combinations may not be appropriate and safe for everyone. The best way to ascertain what is best for you, your desired outcome, recovery time and safety is to consult with your Specialist Plastic Surgeon.
Before you have plastic surgery, you meet Dr Goh for a consultation. During the consultation, you will be able to discuss your desired changes, goals, and expectation. Dr Goh may undertake a thorough examination and, if surgery is appropriate, advise the best procedure to achieve your desired results. Your medical history and current health will be reviewed, and an assessment on whether the procedure in question is right for you. This is a good time to ask specific questions about the procedure so that you are fully prepared, mentally and emotionally, for surgery. We will discuss the results that can be achieved, with the aid of photos and/or computer imaging. When a final decision is made, you will need to sign an informed consent stating that you are fully aware and understand what is entailed by your pending operation, including the potential complications and secondary effects.
Dr Goh will assess the extent of your excess skin and tissue to determine whether an abdominoplasty or belt lipectomy will be required to adequately address your area of concern. Generally, if you would like to elevate outer hip and buttock tissue as well as the tissue below your navel, you may benefit from a belt lipectomy.
There are often functional concerns that accompany the cosmetic concerns associated with excess skin and tissue in the abdominal region. These include rashes and issues with skin integrity, particularly during the summer months.
For women in particular, post-pregnancy changes can result in irreversible stretching of the “six pack” muscle (rectus abdominis) and abdominal skin, despite rigorous exercise. In fact, the best candidates for an abdominoplasty, and those who will attain the best results, are often women with minimal fat and plenty of loose skin!
A standard abdominoplasty should always include repair of the underlying musculature. Failure to repair the muscle back to an anatomical position risks giving a less than optimal result after an abdominoplasty.
Abdominoplasty or belt lipectomy surgery extends beyond enhancing the contour of the waist by not just removing excess skin and tissue, but also tightening the underlying musculature.
Your weight should be stable for at least 6 months, as weight fluctuation after body contouring surgery can lead to shape change as well as recurrence of loose skin.
In terms of other lifestyle factors, Dr Goh requires patients to cease smoking in the preoperative period (6 weeks before and 6 weeks after surgery), as smoking can significantly affect would healing. A healthy lifestyle in general, including good protein intake, will help with wound healing and recovery.
Septoplasty surgery aims to correct a deviated septum, which is the cartilage in your nose that separates the nostrils. In individuals who have a deviated septum, one side of the nose is wider than the other, which can negatively affect airflow through the nose. Dr Goh will examine your nasal anatomy to determine if you would benefit from a septoplasty.
A rhinoplasty can be performed in conjunction with a septoplasty.
Essentially a spreader graft is a small (and usually long) block of material (usually cartilage) placed in the middle portion of the nose. It is placed between the septum (the midline structure of the nose) and the side of the nose, and usually as a pair, although occasionally only one may be used. The cartilage used in spreader grafts can be taken from the non-essential portion of the septum, the ear, or the rib. Spreader grafts are not necessary in all rhinoplasties.
In secondary rhinoplasties (re-operations), grafts are almost inevitably required, because of distortion and/or lack of existing tissue as a result of previous surgery. The best source of graft material in rhinoplasty remains autologous (own tissue), including the septum, ear, and rib as a source of cartilage.
In general, Dr Goh likes to wait 12 months after rhinoplasty before considering revision surgery. This is the time required for internal scar tissue to fully mature. To operate earlier may risk exacerbating adverse healing and scar formation.
A rhinoplasty in general is an operation to fix/alter the structures of the nose that gives it its appearance/form. A septoplasty is an operation performed on the nasal septum, which is the midline cartilaginous support structure of the nose. A septoplasty is usually performed for nasal obstruction due to septal deviation. A septorhinoplasty therefore is a procedure where we perform surgery on the septum (usually for functional reasons), as well as make changes to the external appearance of the nose (rhinoplasty)
Dr Goh offers a variety of facial procedures which serve to improve different concerns. Addressing signs of aging and functional concerns with wrinkles and skin laxity in your upper forehead or upper eyelid regions can be achieved with browlift and upper eyelid reduction procedures respectively. Improving facial balance is possible with rhinoplasty, genioplasty and facial implant procedures.
During your consultation Dr Goh will take your concerns and unique anatomy into consideration to suggest the best approach for you.
As with upper blepharoplasty, facelift, and other facial rejuvenation procedures, the effects of a brow lift will not be permanent. How long will the results last? This will depend on technique used, the patient’s skin quality, and the effects of aging.
There is no right age for any facial procedure. Age on its own is never an indication.
Facial aesthetics are dependent on the principles of balance and proportions. An easy way of considering vertical facial proportions is to break it up into thirds: the upper third, made up of the forehead and eyes; the middle third, dominated by the nose; and the lower third, composed of the mouth and chin. Given that there is generally minimal variation in forehead size, vertical facial balance is essentially determined by the size of the nose and the chin.
While it may seem like a reduction rhinoplasty is the only solution to a prominent nose, sometimes the source of the imbalance is chin deficiency. The impact that the chin plays in facial balance is often underplayed. It is often the sole cause of facial imbalance and will frequently make the nose appear larger and more prominent than it actually is.
In Dr Goh’s assessment, he will first examine the nose and the chin on their own, and then the two structures together in unison to determine the best way to manage your concerns. The next step in deciding whether Dr Goh performs a reduction rhinoplasty, a chin augmentation, or both will be governed by the outcome of this assessment.
Let’s take an example of a patient who comes in with a deficient chin. Examination may reveal that their chin is deficient more so in vertical height and just a little deficient in terms of projection. They may already have a well- defined labial-mental fold (the fold between the lower lip and the chin). If we used a chin implant in this case, it will only increase the projection of the chin, and not address the height of the chin. Doing this runs the risk of resulting in a “witch’s chin”. This is a situation whereby the patient is better suited to an osseous genioplasty, where we can adjust the height as well as the projection of the chin. The ability to define the chin three-dimensionally is one advantage of an osseous genioplasty. The other advantage is the absence of foreign materials, which reduces the risk of infection.
Subtle improvement is the key to chin surgery. Enhancing it such that it no longer is a point of deficiency but, at the same time, not so much that it becomes a point of attention.
During your consultation, Dr Goh will examine your anatomy and consider your concerns and desired outcome to plan the best approach for you.
A surgical procedure to improve chin aesthetics is called a genioplasty, and these can include augmentation genioplasty (increasing prominence) and reduction genioplasty (reducing prominence). An augmentation genioplasty can be performed with either artificial implants (alloplastic genioplasty) or by physically altering the position of the chin (osseous genioplasty). Each have their associated risks and benefits. A reduction genioplasty can be performed only by physically altering the position or size of the chin (osseous genioplasty).