Got questions about Tummy Tucks? (FAQ)

We frequently get all sorts of questions when patients first inquire about Abdominoplasty surgery, more commonly known as a Tummy Tuck. In this Q&A article, we will be answering many of the questions you might have regarding tummy tuck surgery. Of Course, if you are considering having a tummy tuck, the best way to answer all of your specific questions is to book a consultation with Dr Dona. Everyone’s body is different, and every tummy tuck procedure can differ depending on the person. During your consultation, Dr Dona will provide you with all the relevant information for your specific tummy tuck procedure and answer any questions you have. There is also a complimenting video if you would prefer to watch Dr Dona answer all of the below questions in video format. For more information, please call us on 1300 373 662 or email us at [email protected], and we will be happy to answer any further queries that you may have.

Tummy Tuck Frequently Asked Questions

How much does Tummy Tuck surgery cost?

Unlike more standardised fee operations, such as breast augmentation. We do not have a standard fee for tummy tuck procedures since there are so many variables that need to be taken into account. The time taken to perform a tummy tuck for Dr Dona can vary anywhere from 2 to 5 hours, depending on the individual. Of course the more complex procedures will cost more. Secondly, the total costs can vary significantly whether you have private health cover and if they will cover your hospital costs. Which is a substantial part of the total out of pocket costs for a tummy tuck. Unfortunately, without assessing someone with an in-person consultation, we are unable to provide them with a precise quote. By booking a formal consultation, Dr Dona can assess your specific situation to provide you with an exact cost for your tummy tuck surgery based on your body and private health insurance status. There is also a medicare rebate available providing that you meet their specific criteria. For more information regarding the cost of tummy tuck surgery, please take a look at our article on Tummy Tuck Pricing.

Can you have a tummy tuck if you have other scars on your tummy? (e.g. caesarean scar, other tummy surgery)

Post-pregnancy is one of the most common reasons why a patient may want a tummy tuck. Dr Dona removes the caesarean scar by making the incision along or below the scar when performing a tummy tuck. Many people have asked Dr Dona if having a caesarean scar complicates the surgery. Scar tissue makes the surgery a fraction more difficult but will not complicate the surgery. The same is for any other scars along the belly, such as those from previous abdominal surgeries. Removing these unappealing scars is also a great bonus to a having tummy tuck.

What is the difference between a tummy tuck and liposuction? Which is better?

There is no better, they both have different applications. A tummy tuck removes excess skin and the associated excess fatty tissue. Liposuction is classically known as liposculpture, which is used surgically for removing stubborn pockets of fat. Liposuction can be very beneficial, providing that it does not create an excess skin problem. Dr Dona often makes the analogy of tummy tuck surgery like tailoring a dress. “When your body goes through a change such as pregnancy or extreme weight loss. Your skin does not always shrink back down to your new shape, leaving you with excess skin. We tailor your skin to suit your new body by removing the excess skin just like you would tailoring a dress or a suit”.

Will you get liposuction at the same time as your tummy tuck?

For many tummy tuck procedures, Dr Dona uses liposuction along the sides of the stomach to help sculpt and enhance the waste line. Dr Dona usually will apply minimal liposuction along the front of the belly during a tummy tuck procedure. Performing liposuction too close to an incision can damage the blood vessel needed to support the wound in the healing process and significantly increases the risk of postoperative wound complications. After six months, it is perfectly safe to further enhance the sculpting from the tummy tuck procedure using liposuction.

Are stretch marks removed with a tummy tuck?

Stretch marks are scars caused by the skin being stretched faster than what it can keep up with. Stretch mark scarring is often a result of pregnancy or weight gain. Depending on their genetic makeup, some women can gain a moderate amount of weight and may not experience any stretch mark scarring. Whereas some women may get stretch marks from only amount small weight gain. A tummy tuck procedure will remove many, if not all stretch mark scarring around the abdominal area.

Will a tummy tuck correct muscle separation (Diastasis recti)?

Tightening the abdominal muscles is a routine part of most tummy tuck procedures. During pregnancy, the abdominal muscles are forced apart, and they don’t always spring back together post-pregnancy. During your operation, the abdominal muscles will be brought together and tightened from top to bottom. In some cases, the sides will also be tightened up. Tightening the abdominal muscles will help flatten the belly and tighten the waistline.

When repairing muscle separation, how tight can you make it?

While Dr Dona does tighten up the abdominal muscles quite tightly with several layers of internal stitching, there is a limit to how much the abdominal muscles can be tightened safely. Large amounts of visceral fat, which is the internal fat around your internal organs in the abdominal area, can restrict the amount of muscle tightening that can be performed. The only way to lose visceral fat is through exercise and healthy eating.

Can a hernia be repaired during tummy tuck surgery?

Abdominal wall hernias, especially around or within the belly button are extremely common. In most cases, they are noted before surgery. Dr Dona will repair any abdominal wall hernias during surgery by closing up the hernia and tightening the muscles around it.

Should you get a belly button hernia repaired before a tummy tuck?

In most cases, Dr Dona will recommend against getting a hernia repaired beforehand if you are planning to have tummy tuck surgery. The most common way that a general surgeon repairs a hernia can significantly increase the risk of a belly button not surviving a tummy tuck procedure. We would recommend that Dr Dona repairs your hernia during your tummy tuck procedure.

What is the ideal weight before having a tummy tuck?

The ideal weight for a tummy tuck is the weight that you are. Given that your weight is stable and not going to fluctuate. When a larger person has extra weight and a more prominent fatty apron, this can be a debilitating medical problem. They need to be treated and surgically reconstructed accordingly to resolve the issue. It does need to be considered that performing surgery on someone with a heavier weight can increase the risk of anesthetic and surgical complications. Dr Dona will not reject or make a larger patient go off and lose a bunch of weight before performing surgery if they are in surgical need of a tummy tuck procedure. There is no “perfect” weight for tummy tuck surgery.

Why do some people still have a “big belly” after a Tummy Tuck?

One of the most common reasons why someone might still have a “big belly”, especially around the top of the stomach, is that they still have quite a lot of visceral fat. Visceral fat is the internal fat around the organs in the abdominal area. Unfortunately, this fat can only be lost through lifestyle changes such as healthier eating and exercise. Whilst a tummy tuck procedure will make a significant difference to the top and bottom of the abdominal area. Heavier patients may still have quite a lot of visceral fat. This can result in the top of the belly still looking larger. Before & After surgery, it is also important to maintain posture and exercise your abdominal wall muscles to achieve the best look from your tummy tuck procedure.

Is the pubic area lifted during a Tummy Tuck (Men & Women)?

Lifting the pubic area is a standard part of most tummy tuck procedures. Having a lot of excess fatty tissue can cause the genitals to sag down relatively low in both men and women. A tummy tuck procedure will also pull up your genital area (Penis or Vagina) back up to where it is supposed to be in its prominent position.

Will you go home with drains after a Tummy Tuck?

No! You won’t be going home from hospital with any drains still attached. When you wake up from surgery, there will be two plastic tubes going into your abdominal wall, which are drains.

What is the pain like after a tummy tuck?

Tummy tuck operations are a major procedure. Like any major procedure, you will experience a moderate amount of pain postoperative. Whilst you are in hospital, you will be monitored and given as much medication as required to keep on top of the pain. When you go home, you will be given some strong prescription medication to keep you as comfortable as possible in the early stages of the recovery process.

What is the recovery like post-tummy tuck?

You will go home two to three days after surgery with waterproof bandages protecting the incision wound and wearing a compression garment. Since everything has been tightened, including the abdominal muscles. You will find that you are pretty hunched over for the first few weeks after surgery. You can expect to be resting around the house for the first two to three weeks, but by six weeks, life will be starting to return to normal. At six months, life will have returned to normal, and you will be able to enjoy your transformed body completely.

When can you start driving after a tummy tuck?

Unfortunately, you won’t be driving anytime in the first two weeks following your procedure. After two weeks following your tummy tuck surgery, you will be able to start driving again if you feel safe to do so. You may still be quite hunched over at this point, so it might take an extra week or two.

When can you get back to work after a tummy tuck?

If you are doing light office duties, you will be able to return to work after three weeks. You will need to wait at least six weeks for more strenuous workloads. After six weeks, your body will have settled into its new form more, and you will be able to attempt most things. Likely, you will still experience some pain at this stage, but you will be able to test the waters to determine what you are able and unable to do. After some more time and gradual progression, you will be able to return to a more strenuous workload. Dr Dona will advise you when you should return to work depending on the level of strenuous activity you undertake.

When can you start exercising/sport after a tummy tuck?

You will need to wait at least six weeks before returning to exercise, besides light walking. At the six week mark, you will be able to begin returning to exercise by starting slowly and gradually building up intensity week by week.

When can you have sex after a tummy tuck?

One of the biggest questions that everyone is curious to know but too shy to ask is how long after surgery can you have sex again? You can have sex again whenever you like. But for the first six weeks following surgery you will need to avoid any active movements involving your abdominal muscles or having your abdominal area grabbed/touched. This means that you will need to be taking a very passive role in sex during the first six weeks.

How long does swelling last after a tummy tuck?

Swelling after surgery is completely normal, especially after a major operation such as a tummy tuck. This will take a while to go down. You will be wearing a compression garment for the first six weeks, which will assist in reducing swelling. From three to six months following surgery, you will have a degree of swelling which will go down with time.

Why do some patients (from other surgeons) end up with ugly belly buttons after a tummy tuck?

Getting a belly button to look natural after a tummy tuck can be quite challenging for many surgeons. There are some techniques that other surgeons may use which result in the belly button looking fake or deformed. Dr Dona has perfected his own technique to achieve a natural-looking belly button during tummy tuck procedures. While saying this, a small number of patients may scar badly or have issues with the wounds healing around the belly button. With Dr Dona’s technique, the vast majority of patients Dr Dona has performed surgery on over the years have ended up with a great looking belly button.

Happy Anniversary & About Dr Dona 🎉

On the 29 June 2009, I proudly opened my private plastic surgery clinic in the Sydney suburb of Bella Vista. So today we celebrate 11 amazing years! During that time, my clinic has basically been my home and the only place where people can come and have a formal consultation with me. I have patients travel from all over Australia to see me for treatment, and this is where they come for that all important first consultation and subsequent care.

So today I thought I’d use this moment to answer some of the questions about myself I’m frequently asked.

I was born, raised, educated and trained in Sydney.

I graduated in Medicine from the university of Sydney and became I doctor in 1996. I thenspent a further 11 years of training until I finally became a specialist plastic surgeon in January 2007.

I often get asked about my background – where does “Dona” come from? It’s a Lebanese surname with both my parents originating from Lebanon. In fact, I was the very first doctor of Lebanese heritage in NSW, and possibly Australia, to become a specialist plastic surgeon! With my background, including attending Public Schools in Sydney’s western suburbs, it was quite a challenge to be the first to try and get onto the plastic surgical training programme where the hierarchy back then was primarily anglo-saxon or private school boys surgeons – but I did!

And whilst my name has been used by a number of clinics since 2007, here in Bella Vista is the only clinic that I have owned, it is the only clinic that I’ve ever run, it is my name, it is my life, and I manage it to the high standards that my private patients deserve.

As a specialist plastic surgeon, I operate out of several private hospitals around Sydney.

Despite running a busy private plastic surgery clinic, I still dedicate part of my time to one of Sydney’s largest teaching public hospitals. It is here that I often look after all the non-cosmetic plastic surgery problems such as hand and skin cancer surgery, including trauma and reconstructive microsurgery. It is also here that I provide training and mentoring to the future generation of plastic surgeons. And over the years I have provided training to over 50 plastic surgeons. I’ve also provided some training to many other doctors including those practicing cosmetic surgery.

Over the last 5 years I have established Australia’s leading plastic surgery YouTube channel. It is here that I happily showcase all manner of plastic surgery cases including extensive explanatory videos. This is primarily designed for the general public to help better understand plastic surgery and appreciate what it can achieve. However, it is also used as an educational platform for the numerous surgeon followers to help them up-skill.

Finally, I want to take this opportunity to thank all my patients that have chosen me as their surgeon. I seriously do consider it a privilege when someone chooses me to look after them. I’m always grateful and humbled by every patient that has placed their health and well-being in my hands.

Myself, along with my team at our Bella Vista clinic will always strive to do our very best to deliver you the very best of care. Ensuring you have a smooth, stress free transformation journey and treating everyone like a WORKofART is what we love to do. Hopefully, we’ll be able to continue doing exactly that for at least another 11 years.

Breast Surgery Q&A time – Dr Dona answers all your questions

Dr Dona answers all your questions on breast surgery, including:

  • How much does breast implant surgery cost?
  • Are silicone or saline implants better?
  • Round or teardrop implants – what’s better?
  • Do breast implants need to be changed every 10 years?
  • Which patients get the best long term results after breast implant surgery?
  • What implant pocket is best? Under or over the muscle?
  • What is a dual plane pocket?
  • What’s recovery like after breast implant surgery?
  • Will you have drains in after breast implant surgery?
  • How painful is breast implant surgery?
  • When can you drive after breast implant surgery?
  • When can you go back to work after breast enhancement surgery?
  • When can you exercise and go back to the gym after breast enhancement surgery?
  • What post-op appointments do you need after breast enhancement surgery?
  • When will most of the swelling be gone after breast surgery?
  • When can you get fitted for new bras and clothing after breast enhancement surgery?
  • Are implants fragile? Can you treat your breasts normally and do normal sporting activities after breast implant surgery?
  • Do you have to wear a bra after breast implant surgery?
  • Can you experience long term pain after breast surgery?
  • Can you breast feed after breast implant surgery?
  • Will the implants affect your breast milk?
  • Should you have breast implants before at after having children?
  • Will pregnancy and/or breastfeeding change your breasts and will you need surgery afterwards?
  • What can you do to ensure your breast implant results last as long as possible?
  • Will nipple sensation change after breast enhancement surgery?
  • Do breast implants cause breast cancer?
  • Can you still perform breast self examination after having breast implants?
  • Will breast implants make it more difficult for you to feel any changes in your breasts during self examination?
  • Can you still undergo normal breast cancer screening (ultrasounds and mammograms) after breast implant surgery?
  • Do you need to wear a bra when sleeping after breast implant surgery?
  • Will nipple areolar size increase after breast implant surgery?
  • If you have large areolars should they be reduced in size when having breast implant surgery?
  • What is a scarless breast lift?
  • What are the different types of breast lifts?
  • What happens if your implants pockets are too big and the implant moves around too much?
  • Do we treat interstate patients?
  • Can fuller figured women have breast implant surgery?
  • How long do you have to wait if you wanted more surgery to change your implants?
  • Is fat transfer surgery an option for breast enhancement?
  • Why are breast implants better than fat transfers for enhancing breasts?
  • Can you have fat transfers to the breasts that already have implants?
  • Can you breast feed after breast lift or breast reduction surgery?
  • What is capsular contracture?
  • What is the rare cancer associated with some implants – ALCL?
  • Should you get implants if you suffer from multiple allergies?
  • What is Breast Implant Illness?

Plastic Surgery After Massive Weight Loss

Although plastic surgery has many subspecialties—including craniofacial and maxillofacial surgery, microsurgery, reconstructive surgery, cosmetic surgery and surgery that address issues of burns and skin cancers—a large subspecialty is the plastic surgery required after massive weight loss. The term ‘reconstructive surgery’ applies to all the subspecialty within plastic surgery, including some ‘cosmetic surgery’ procedures. In Australia, all plastic surgeons are classified as Plastic and Reconstructive surgeons. Personally, I am a member of the Australian Society of Plastic Surgeons, whose motto is Corpore Mens Melior Refecto (‘the mind is better when the body has been restored’). Reconstruction means to restore to a state or to create a state that is ‘normal’; ‘normal’ means something that is functional or acceptable to an individual’s race, sex and age. ‘Normal’ is also in the eye of the beholder and the mathematical definition of average cannot be applied to the human form when defining normal.

The most common cause of massive weight change is pregnancy. Another common occurrence of massive weight loss exists in individuals who are carrying a great deal extra weight and who lose weight through diet and exercise. Finally, individuals who require surgical assistance to lose weight—such as lap band, gastric sleeve and gastric bypass surgery—represent another common occurrence of massive weight loss. No matter the cause, individuals who have lost a massive amount of weight experience the same issue—their bodies become smaller but their skin does not. Skin does not contract, shrink or wrap around a smaller body. Metaphorically, excess skin represents the former self—or an old dress. Individuals who have lost a massive amount of weight become smaller, fitter and healthier but they are essentially wearing a dress that is too big. The bigger the loss, the baggier the dress.

This can often cause or contribute to ‘yo-yo’ dieting habits—a vicious cycle of weight loss and weight gain. Individuals who lose massive amounts of weight do so through discipline, diet and exercise. However, when they look in the mirror they often still view themselves negatively due to the excess skin that hangs from their bodies. This can lead to individuals not only giving up and reverting to their old dietary habits but also developing a more concerning issue—depression. So, what do you do when you have a dress that is too big for you? You cannot throw away your skin but you can have it tailored. As your surgeon, I can tailor your skin to fit your body.

I like to compare the surgery required after massive weight loss to dressmaking. In dressmaking, you remove material and run a seam; in surgery, you remove skin and create scars. Creating scars improves contours. Therefore, creating more scars can create better contours. Of course, reconstruction involves far more than skin, but this is the simple way in which I explain reconstructive surgery to my patients—that surgeons tailor their patients’ skin to fit their body.

Actual tailoring involves materials that do not have much stretch. When you purchase a custom-made dress, you typically have a fitting so adjustments can be made to ensure that the dress fits perfectly. Although surgery after massive weight loss can be compared to dressmaking, it is much more complex. Skin and tissues are not rigid—they swell, stretch, shrink and sag. Additionally, the body beneath the skin also changes, which is especially true during the first few months after surgery. Therefore, as a surgeon, I craft, sculpt and reshape things that are 3D, and not static. I also ensure that I do not make things too tight because that can result in serious problems with how a wound heals and breaks down. After the initial post-surgery swelling starts to decrease and the skin settles into position, it is normal for your skin to not feel as tight as it did initially. Therefore, it is not uncommon to require further minor surgery to fine-tune the results.

Although massive weight loss affects skin in every area of the body, the four common areas are the arms, the breasts and chest area, the stomach and the thighs. However, there is a limit to how much can be achieved in one day so you typically cannot have every procedure done at one time. Combinations that can occur in the same surgery are the breasts and stomach and the breasts and the arms. For some individuals, I might combine the arms, the breasts and the stomach. However, operating on the thighs is something I never combine with another area because it is a big operation with its own potential and significant issues. Basically, we start with the areas that most concern an individual and then we continue in stages depending on the degree of concern and other considerations such as lifestyle and financial constraints. The minimum time period between each surgery is three months.

My job is to educate my patients. We have real discussions about what they are dealing with and what needs to happen to ensure they reach their goals. I have a YouTube channel with an extensive video library showcasing all my surgeries. Many of my patients have observed my surgeries and followed my YouTube channel for a long period so they are familiar with the surgeries and know what is involved. I also never trivialise an operation. Although it would be easy to simply show before and after pictures, every surgery carries risks that patients need to understand. Regarding consenting, although all operations have similar post-op course issues and potential complications, each operation has a unique post-op course and potential complications that I must bring to my patients’ attention, which are things we discuss during our consultation. I also clarify any issues they may have.

Do patients who have lost a massive amount of weight experience medical or cosmetic issues? Although there are explicitly physical problems associated with having excess skin, other issues are implicitly physical. Can psychological problems be physical? The body and mind are intertwined and while psychology and psychiatry are large fields of medicine, where is the distinction? When do we say that the surgery to address these concerns is purely cosmetic? Referring to my earlier definition of ‘reconstruction’, all surgery required to address these patients’ concerns is without question reconstructive surgery. As a secondary benefit, they are going to look better. However, the primary purpose of the surgery is not cosmetic but reconstructive.

Any form of reconstructive surgery is complex and carries risks. However, to compound these risks, the skin and tissue quality of many of these patients is poor, which increases the potential for issues such as poor wound healing. This leads to a higher risk of wounds breaking down with skin and tissue loss. Therefore, there is a high risk of further surgery being required in the postoperative stage to address these issues. Higher-risk patients must accept the possibility of experiencing wound healing issues that will warrant further surgeries and downtime. This is all part of the consent process discussed at length prior to surgery.

Overall, the surgery required to address the issues experienced by patients who have undergone massive weight loss is total-body reconstruction. For a surgeon to succeed at this type of surgery, they must appreciate anatomy and ‘normal’ aesthetics. However, many surgeons avoid these patients because they are considered difficult and ‘not worth the risk’. Such surgeons typically chose ‘easy’ surgical problems to address. Additionally, many surgeons lack the technical and artistic skill set to manage these patients, which is another reason why they choose to not treat them. Any surgeon can cut and sew. However, to be a master reconstructive surgeon requires an artistic flare to sculpt, reshape, restore and reconstruct a living work of art.

 

BREAST LIFTS Part 3 – Combined Breast Lift-Augmentation Surgery

This is part three of my series of breast lift surgery videos where I’m going to discuss breast lift/augmentation surgery.

A combined breast lift/augmentation surgery (which means performing a breast lift and inserting implants during the same operation) is far more complex than either one of the procedures done separately. It is the most difficult of all cosmetic breast surgery procedures performed and because of this many plastic surgeons choose not to do them.

And whilst some are much easier than others, in general they are extremely challenging.

So prior to undergoing surgery patients need to be made aware of the complexity of this combination procedure, have realistic expectations, and understand that additional surgery (along with the additional recovery time, time off work, stress, expenses etc) may be necessary in the short or long-term.

So why is it so complex?

There are numerous things that a surgeon must (or at least should) assess and consider before contemplating and planning a surgical breast lift (with or without an augmentation).

They include:

  • Skin quality
  • Degree of sag
  • The nipple direction
  • The skin distance from the nipple to the lower breast fold
  • Nipple areolar size
  • Breast tissue quality
  • Breast tissue volume
  • How “detached” the breast tissue is from the chest wall muscles
  • The patients’ desired look
  • And finally, Time, and how that will impact on the results.

A concept that one needs to understand is that a breast lift/augmentation surgery requires the surgeon to increase the breast size with breast implants, whilst at the same time reducing the breast envelope (that is, removing skin and breast tissue in order to achieve the breast lift). These two potentially counterproductive actions must be balanced as perfectly as possible in order to achieve the desired results.

Ultimately, the surgeon needs to lift the nipple and breast tissue to ensure a uniform and “tight” distribution of the natural breast tissue over the chosen implant to create a uniform appearing and feeling breast mound.

During breast lift procedures the nipples remain attached to their blood and nerve supply while they are repositioned. Some of the technical difficulties and limitations of a breast lift surgery is related to ensuring that you surgically don’t completely cut off all the blood supply to the nipple, which would basically mean the nipple would literally die and fall off!

Performing a breast lift without an implant allows the surgeon to apply more surgical “manoeuvres” designed to lift up the breast tissue to maximise the chance of the breast tissue remaining high. Every surgical step involved in a breast lift does to some degree cut off part of the blood supply to the nipple. When an implant is added to the equation, many of the steps involved in creating a pocket for the implant, and the pressure effect from the implant, further compromises the blood supply to the nipple. Therefore, the surgeon often needs to limit the “manoeuvres” required to maximally lift the breast tissue. They also need to reduce the “maximal size” of the implant that could otherwise be used for a simple breast augmentation. These limitations can add to the potential issue of the breast tissue re-sagging early after surgery.

The potential for “re-sagging” is even greater with breast tissue problems such as:

– large volumes

– breast tissue that is very soft and lost its elasticity

– breast tissue that is “detached” from the underlying muscle and slides around

– skin that is thin and has lost its elasticity

Given that women wanting a breast lift typically have one or more of these problems, then you can appreciate that one of the main issues with a breast lift/augmentations is that the breast tissue doesn’t stay where we want it to stay.

Essentially the patient is needing a breast lift because they have weak and soft breast tissue quality which has sagged – yet that same breast tissue and skin still exists after surgery, and it’s therefore still wanting to sag. No surgery and no surgeon can change the quality or consistency of the breast tissue and skin. All the surgeon can do is try to reposition and sculpt the breast tissue.

In addition to breast tissue that doesn’t necessarily stay where it’s meant too, breast implants don’t necessarily stay where we wish they would. Therefore, breast implant related problems such as positioning (too low, lateral slide etc.) can occur and may be a reason for returning to the operating room for further surgery. This is especially the case in those women needing a breast lift because there breast tissue envelope is typically soft without any structural support so it easily stretches again resulting in a very mobile implant.

In the end, often the “full perky” look that many women want is simply not achievable due to the persons chest wall shape, breast footprint, and nature of the persons natural breast tissue.

If you need a breast lift and also want implants, then the surgical options I’ll recommend will depend on the state of your pre-existing breasts and the look you’re after. The two possible options include: the single combined lift/augmentation operation, or two separate operations.

The single operation approach basically means having a combined breast lift and augmentation. Many variables are considered before I decide who is suitable for this, and it is decided on a case by case basis. As a very general guide the ideal candidate for this is someone who has minimal breast tissue, mild to moderate sag and still has relativity firm tissue and elasticity. However, even in the ideal candidate, I would quote about a 20% chance of the patient requiring further surgery to “fine tune” the results.

The Two Staged (or two operations) Approach means performing a breast lift first, and an augmentation as the second operation at a later date. This is the option taken for those when I believe it is too risky to attempt a combined lift augmentation. Who that may be is decided on a case by case basis, but generally speaking the typical patient who is offered this option has significant sagging and/or has a large volume of soft breast tissue. Trying to do a lift and augment in one operation for this group of patients would be risky and has a high chance of significant complications and a much greater chance (more than 50%) of requiring further surgery. That is, whilst you could offer a single combined lift augmentation operation to this group of women, more often than not a second unplanned surgery is required to fix problems.

The rationale for a two staged approach in such women is simple:

  • The breast lift alone is designed to create an improved breast shape with the nipples sitting at the correct level. Then approximately 6 months later a well planned breast augmentation is performed as it is easy to make what is now a good breast shape into a bigger good breast shape. However, many patients don’t proceed with this augmentation as they are just happy to have a good breast shape!

An important aspect of the breast lift alone is that such patients will most likely not achieve a long-lasting upper pole fullness as the breast tissue will settle into a lower position. Hence most of these women do want augments to address this problem. 

I will briefly mention here that upper pole fullness can also be achieved to a lesser degree with fat transfers but that’s a separate topic that I’ll cover another day.

So basically you opt to do two well scheduled and well planned operations – a lift first then an augmentation later – to have the best chance of achieving a great long term result. This is far better than doing one planned operation, a combined lift augmentation, where we have a high chance of needing further unplanned surgery to try fix problems, patients not happy, surgeons not happy and we are less likely to get the best long term outcome.

Basically, we want to choose the best pathway, safest pathway, least potential problems pathway to achieve the best long term results, and if that means two planned operations, then that’s how it needs to be.

And finally, with a planned two stage approach, the surgeon could potentially, and safely, use a larger implant than would otherwise be possible with a combined lift augmentation.

Anyway, I hope you’ve enjoyed my 3 part breast lift series  (see part 1 and part 2), and that it’s shed some light on the complexity of breast lift surgery.

In the end, do your homework, always consider second opinions, and if you want my opinion, give my office a call to schedule a one on one consultation with myself.

BREAST LIFTS Part 2 – THE SURGERY with or without implants

A breast lift procedure simply means lifting up the breast tissue and nipple area to create a better breast shape. This can be done with or without the use of an implant.

Whether an implant is required or not, there are three types of scar patterns that can be used for breast lift surgery.

Circumareolar or “doughnut” technique  or Benelli technique – this involves a circular incision made around the areola. This technique is a minimally invasive procedure that achieves a small degree of lift. It results in a scar around the areolar and is also suitable for reducing the size of the areolar. However there is a limit to how much the areolar can be reduced as they typically tend to stretch back out again especially when implants are also used. It can also create a very flat looking breast.

Vertical or lollipop technique – this is named a lollipop because of the type of scar it leaves. It results in a scar that extends around the areola and down the midline of the breast to the lower breast fold. Although this procedure is slightly more invasive, it achieves a larger degree of lift with some slight reduction in natural breast tissue volume.

Anchor technique – involves an anchor-shaped scar that extends around the areola, down the lower midline of the breast and along the lower breast fold. This is required in those who require a significant lift and possibly need a reduction in natural breast tissue volume.

Often extra volume is required as well as a lift of the breast tissue – therefore implants are used.

When performing a breast lift with implants, the basic principle means that the surgeon must use the correct technique for that patient to ensure that the breast tissue is lifted in such a way that there is a uniform distribution of breast tissue over the implant to create a uniform breast shape.

There are a number of options available when someone needs a breast lift and also desires extra volume. These include:

First option – if a mild or borderline sagging problem exists, sometimes a good result can be achieved with an appropriately planned augmentation alone. In other words, no formal breast lift scar, just a routine augmentation scar. Of course once things have settled and if the results are not ideal, then you can still proceed with a lift at a later date.

The second option is to perform a combined breast lift and Augmentation* – The ideal candidate for this is someone who has minimal breast tissue. However, there are some technical limitations with the implant size that can be used with such an operation. Furthermore, even in the ideal candidate, I would typically quote around a 20% chance of patients requiring further surgery to “fine tune” the results. However, you would need to wait a minimum of 6 months to allow the results to settle before contemplating and planning this.

*Specialist Surgery – it is important to note that a combined breast lift with implants, otherwise known as mastopexy augmentations, is the most difficult cosmetic breast surgical procedures to perform. Therefore they should only be performed by specialist plastic surgeons that have an expertise in these cases.
However, many plastic surgeons opt to not perform this operation because of the inherent difficulties in doing it.

The third and final option for those needing a lift and wanting extra volume is to have a two staged approach – in other words, two planned operations. This typically means performing a breast lift first, and an augmentation as the second operation at a later date. There are a number of issues that I use to determine is this is the best option, however the typical patient who is offered this is someone who has a significant amount of natural breast tissue that has softened and sagged. Trying to do a lift and augment in one operation in these patients generally has a greater risk of complications and a very high chance (often greater than 50%) of requiring further surgery. That is, whilst only one combined breast lift augmentation surgery is planned, more often than not a second unplanned surgery is required to fix problems and improve the results.

Therefore, in these patients a two planned surgeries approach is preferred. The first operation is to perform a lift and create a good breast shape. The second operation, performed a minimum of 6 months after the first, is to make that new good breast shape larger with a carefully planned augmentation. However, many patients don’t proceed with this augmentation as they are just happy to have a better breast shape with the nipples sitting at a better level.

Not to confuse the issue, but some surgeons may opt to do the two stage approach in reverse – doing an augmentation first, and then performing the lift at a later date and there is nothing wrong with this approach.

Finally, many women who need a lift don’t want to pay the additional costs and/or have the scarring associated with a breast lift. Therefore, they only want an augmentation so that they have the fullness they desire in lingerie and clothing. And whilst they will not look great naked with breast tissue hanging from an implant type look, this is not a concern to them because they simply state that everyone sees them in clothing and extremely few people see them naked. Of course, if at a later date it does bother them, then they can have a formal lift then with no problems.

In Part 3 of my Breast Lift Surgery series I’ll discuss the technical aspects and reasoning behind some of the surgical decision making in more detail.

BREAST LIFTS Part 1 – The Assessment

This is Part 1 of 3 in my series covering breast lift surgery. In Part 1 I’m going to discuss the assessment and things I need to consider when planning your surgery. 

A breast lift, especially if combined with an implant, is the most difficult cosmetic breast procedure to perform and junior or inexperienced surgeons have troubles performing this surgery well because there are so many issues, or variables, that need to be considered. And the greater the number of variables you have in an equation, then the greater the difficulty in solving that problem.

A breast lift procedure simply means lifting up the breast tissue and nipple area to create a better breast shape. This can be done with or without the use of an implant.

There are numerous things that I must consider before contemplating and planning a surgical breast lift. In addition to all the planning typically required for a breast augmentation, other vital issues need to be considered to determine how to work with those variables to give you the best result, and to determine what results are realistically possible.

Breast issues:

  • Your Skin quality– is the skin loose with many stretch marks or thick and firm without stretch marks. Often the skin in someone requiring a lift has lost much of its elasticity. Thin skin with loss of elasticity means things have a much greater risk of re sagging
  • Degree of sagging of the breast and how much does the nipple need to be lifted. Is it sitting below the level of the lower breast fold and by how much? The lower they are sitting, the greater the degree of difficulty in lifting it and keeping it up.
  • The nipple direction – is it pointing downwards or just droopy but still pointing forwards.
  • The skin distance from the nipple to the lower breast fold – if it’s too long that’s a slight problem. But if it’s very short then that’s potentially a greater problem.
  • Nipple areolar size – a very large areolar size can be a potential problem with surgery.
  • Breast tissue quality – is it firm or soft. Soft breast tissue is very difficult to handle and typically always wants to sag! Another extremely important thing to understand is that soft breast tissue will always be soft – nothing can be done to make soft breast tissue firm again. Surgery simply redistributes or repositions the breast tissue. Even with an implant it will still be soft, and it has a much greater risk of re-sagging.
  • Breast tissue volume– the greater the amount of natural breast tissue the greater the degree of difficulty with the surgery. Lifting a large volume of breast tissue and trying to keep it up is difficult and indeed often not possible. The more natural weight the more that gravity is going to affect it!

Furthermore, the greater the amount of natural breast tissue the greater the amount of changes that occur over time. Having a lot of breast tissue can be considered a blessing when it’s all sitting right, but over time it’s going to change far more compared to those with minimal breast tissue.

  • How “detached” your breast tissue is from the chest wall muscles is another issue that’s often difficult to explain. Sometimes the breast tissue is very mobile with loose attachments to the underlying muscle and effectively your breast tissue is sliding around over your chest wall. This makes the breast tissue extremely difficult to handle and therefore difficult to effectively lift.
  • Your desires – what look is the person wanting?
  • Time – the final variable which is impossible to work with is time. How much your natural breast tissue changes after surgery based on your genetics and personal circumstances is impossible to know. Often times women will achieve an excellent result early after surgery, but within a relatively short period of time their breast have continued to sag or change. This can be due to natural breast tissue volume fluctuations, weight changes, hormonal changes etc, and these things will negatively affect the results.

As stated previously, the greater the number of variables an equation has, the harder it is to solve the problem, and that is why the problem of breast lift surgery is so very difficult.

Perhaps the hardest thing for patients to accept is that they are needing a breast lift because they have weak and poor-quality breast tissue which has sagged – yet that same breast tissue and skin still exists after surgery, and it’s therefore still wanting to sag. No surgery and no surgeon can change the quality or consistency of the breast tissue and skin. All the surgeon can do is try to reposition and sculpt the breast tissue on that day of surgery.

As you can appreciate, there are numerous natural anatomical variables that I must assess and work with when planning your breast lift surgery. Of course, due to the persons pre-existing breast state, it’s often not possible to achieve the results that person desires. This is when painting a clear picture of realistic expectations is required.

In Part 2 of my Breast Lift Series, I’ll cover the different types of surgical options available.

Implant Removal & En Bloc Capsulectomy

As a specialist plastic surgeon, I have spent many years performing breast enhancement surgery with implants. During this time, I have also performed countless breast implant removal procedures, with or without replacing implants. However, in recent years I am receiving more and more requests to have implants removed.

The desire to have implants removed is being driven by many factors:

  • Breast Implant Illness
  • BIA-ALCL
  • Implant related complications – eg. rupture, capsular contracture
  • Change in aesthetic preference

What is the Implant Capsule?

When breast implants are initially placed, the body’s natural healing process means that it forms a scar sac around the entire implant. It is a normal process for the body to form a scar tissue layer (sac) around any foreign object. This normal scar tissue lining is the capsule. The capsule effectively seals off the implant from the rest of the body. A normal implant capsule is tissue paper thin and soft and can’t be felt.

In capsular contracture, a problem that occurs in over 5% of women with implants, this capsule layer becomes abnormally hard and thickened for reasons largely unknown. Basically, the capsule becomes thickened and tightens up around the implant, making the breast implant feel hard, become distorted and even painful. So, when a patient is being treated for capsular contracture, the surgeon needs to remove the entire capsule. This is referred to as a total capsulectomy.

A total capsulectomy, or at the very least a near total capsulectomy, also needs to be performed after a woman has decided that for aesthetic reasons, she no longer wants implants. Removing the capsule in this situation allows the breast tissue to “stick back down” to the chest wall and seal up the empty space left by the now absent implant.

 How is a Total Capsulectomy performed?

As previously stated, a total capsulectomy involves removing both the implant and the entire capsule. However, it often involves opening the capsule to do so. This can be done in two ways:

  • Method 1 – Due to the implant size and general technical difficulties, it is sometimes not possible to completely free the entire capsule from the breast tissue whilst the implant is still inside. This is especially the case along the upper part of the capsule which is effectively behind the implant that’s accessible via the small incision. In this situation, I’ll free up as much of the capsule as I can safely do so. Whilst I could make a much larger incision to get access to the top end of the implant, this is usually not an acceptable solution. Therefore, I’ll make a small incision in the capsule just big enough the remove the implant completely. With the capsule now fully deflated I can comfortably free up any remaining attachments it has to the normal breast tissue and then remove the capsule. All this is done via the original smaller incision.
  • Method 2 – If it is possible to free the entire capsule from the breast tissue via the initial small incision, I then need to remove it via that small incision. However, an implant with an intact surrounding capsule cannot be compressed and squeezed through the typically small scar that was used to originally insert the implant. I’ll therefore make a small incision in the capsule just big enough the partially remove the implant from the capsule. By partially removing the implant from the capsule allows the capsule sac to decompress and partially deflate and thus allow me to remove both the implant and capsule together from the small breast incision.

These two different methods of Total Capsulectomy results in both the implant and capsule being completely removed from your body in one operation.

What is “en bloc capsulectomy” and when did it become so important?

The actual term “en bloc” means “as one”, and when referred to breast implants and capsules, it means removing the implant and associated capsule as one whole, without opening the capsule and exposing the implant during the procedure.

As far as the end result is concerned, it is a form of total capsulectomy, but performed in a more complicated manner than a routine total capsulectomy.

This is typically an operation requested by those who have breast implant illness (BII), but it also necessary for those with ALCL.

Regarding those with BII, the actual origins of why an en bloc capsulectomy became necessary is hard to determine. However not exposing the body to the “contaminating” implant during the explantation surgery is considered to be one of the keys to success in the treatment of BII.

Unfortunately, it has become a somewhat “hot topic” amongst women wanting implants removed. Furthermore, it is being marketed by some surgeons who often don’t fully understand the precise nature of the surgery and the significant potential complications associated with it – or if they do understand it, they are not discussing these with there patients.

What are the DANGERS & PROBLEMS of en bloc capsulectomy?

A total capsulectomy is typically a far more complex and difficult operation than a routine breast augmentation operation. It involves removing the implant and capsule during the same operation, although often not removing them as one whole.

As stated, an en bloc capsulectomy is a Total Capsulectomy, but performed in a more complex manner. It involves removing the scar tissue and the breast implant in one piece without opening the capsule. In other words, the capsule is not opened at any stage and the capsule is removed completely intact with the implant still inside. However, this is often not even possible. Whilst I would always intend to remove implants en bloc, certain issues that you can only determine during surgery make it sometimes impossible to do.

Bigger scar – as stated previously, to do an en bloc capsulectomy typically requires a MUCH LARGER incision than the usual incision required for a breast augmentation or normal total capsulectomy. The larger the implant, the larger the incision. That is, an en bloc capsulectomy warrants a very large scar – 3 or more times longer than my usual scar! Of course, when performing a capsulectomy as part of say a breast reduction or breast lift, that’s not an issue because you have large wounds that you can use, but without that then it’s a little bit too much to expect a women to accept a very large scar.

It is often not technically possible to perform a total capsulectomy, let alone an en bloc capsulectomy – If a surgeon claims they ALWAYS performs en bloc capsulectomy, then that simply means they have never done one, or they are being dishonest!

  • The normal capsule is typically very thin and with an implant placed under the muscle, often the capsule attached to the chest wall is typically fused to the chest wall ribs and muscles. To remove the capsule here would involve serious risk. It would involve damaging the ribs, significant bleeding with a high risk of puncturing a lung which lies just beneath the capsule lining here. This issue is something that can only be determined during the surgery. These patients will end up having a Sub-Total Capsulectomy.
  • Another example where it would not be possible and safe to perform an en bloc capsulectomy would be when the breast tissue and skin is extremely thin. To remove capsule in this situation could cause a number of complications, including causing the overlying skin to die. These patients will also end up having a Sub-Total Capsulectomy.

If I am doing a capsulectomy and cannot remove the entire capsule, I will cauterize any remaining capsule left in the body. I do this for several reasons, including to make it “rough” so the area can seal and close up the empty space left by the now absent implant.

Does breast implant removal “cure” BII symptoms?

No scientific evidence exists to support that BII exists. Therefore, no scientific evidence exists to demonstrate that removing implants cures BII. However, for many women removing their implants have resolved symptoms. To complicate matters, zero scientific evidence exists to show that any difference exists in “curing BII” between:

  • Implant only removal
  • Implant removal with Sub-Total Capsulectomy
  • Implant removal with Total Capsulectomy
  • En Bloc Capsulectomy/implant removal

But even in the cases where symptoms persist, at the very least implant removal typically provides peace of mind, and this appears to be especially the case in those who have had an en bloc capsulectomy.

Ultimately, breast implant removal is performed to see if breast implants are a factor in your BII symptoms.

Your surgeon of choice very important!

As stated earlier, it is easier to do a routine breast augmentation then it is to do a total capsulectomy. So, if you think it’s difficult finding a good surgeon to do breast augmentation, then it will be far more difficult to find a quality surgeon who can remove them properly and safely. You need to choose a surgeon with extensive experience in implant removal.

If you have only one goal in mind – an en bloc capsulectomy – and you “go shopping” for a surgeon who performs and guarantees you en bloc capsulectomy, then you’re probably not going to find the right doctor!

As a Sydney Specialist Plastic Surgeon, I’ve treated many women over the years removing breast implants for all manner of reasons. Many of these cases we have recorded with our patients consent and some of these videos can be found on our YouTube Channel, so if you’re watching this on our YouTube channel check out the links below to some of those videos.

If you no longer want your breast implants or have health concerns related to them, contact my office to schedule a one on one consultation with myself, and let’s talk about it.

 

BREAST IMPLANT ILLNESS

Breast implant illness (BII) is a very interesting and controversial topic.

Many people believe it is a real condition, whilst many others say it doesn’t exist.

What is BII?

Quite simply, as its name implies, it is an illness that many women with implants experience. However it is not an easy to define illness. It is characterised by numerous conditions and complaints. Some of the commoner complaints include: fatigue/low energy, cognitive dysfunction (brain fog, memory loss), headaches, joint and muscle pain, hair loss, recurring infections, skin rashes, swollen lymph nodes and glands, IBS, problems with thyroid and adrenals, autoimmune conditions etc.

How is BII Diagnosed?

No scientific tests exist to confirm an individual is suffering from BII.

In simplistic terms, it is largely a diagnosis of exclusion. In other words, all tests are undertaken to try and find a diagnosis or cause for the conditions experienced, none is found, and because the patient has implants then that is considered to be the cause of the complaints or problems that have developed.

Thousands of women worldwide believe they are suffering with BII.

Many women are having implants removed in an attempt to cure it, and many of those are feeling much better after the implants are removed.

Why do Implants “Cause” BII?

Implants are a foreign object, and what I tell all my patients is that the body forms a scar tissue capsule around every foreign material – this is a normal process.

Believers in BII claim that one of the reasons implants cause BII is due to the body’s ongoing response to try and rid the body of this foreign object (which many also claim to be “toxic”), that physiological immune response causes all the ailments associated with BII.

This is sensible logic!

Do Other Surgical Patients Suffer Similar Problems?

However, silicone is a highly inert substance and used in many medical devices. Whether it’s a silicone or saline implant, the shell is always the same silicone product.

And an argument against BII is that in medicine countless devices are permanently implanted in the body that would illicit an immune response, and logically a much greater immune response. For example, various types of meshes used for hernias, stents and grafts used in vascular surgery and neurosurgery, metallic plates and screws used in orthopaedic surgery, joint replacements which contain all manner of metals, plastics, glues and bone cements. All these products are far more “toxic” and immune-reactive than simple silicone.

However, to the best of my knowledge no other groups of patients experience anything similar to BII patients.

Where is the Evidence?

Many things are done in medicine and surgery without any level 1 evidence to support it as being correct. Without getting too technical, Level 1 evidence is considered the highest form of scientific evidence to prove that something works or doesn’t work.

Many things are done in surgery based purely on anecdotal evidence and personal experience, and that’s why you can go to a conference and 10 different surgeons will get on stage and explain 10 different ways they do the same operation! Furthermore, each of them will believe the way they do it is the best.

So given that many things are done in medicine without any level 1 scientific evidence to prove it’s correct, or the best way of doing it, then it goes without saying that we shouldn’t dismiss anything just because we don’t have any scientific evidence to support it.

In the end, who am I, or who is any surgeon, to deny that what another person is experiencing is not real to them?

Do People Without Implants Experience Similar Problems?

As initially stated, the symptoms of BII are very non-specific.

If you had a group of 1000 women with implants and documented how many of them had symptoms found in BII, then studied another 1000 women of similar demographics without implants, then you’d find a similar number of women in this group with BII symptoms. So this is another major issue in establishing the condition that is labelled BII.

Why Is BII Such a Difficult Problem for Many to Accept?

  • No test exists to confirm a person has BII
  • Multiple medical devices are implanted in the bodies without any other apparent problem or condition similar to BII
  • The complaints experienced are common amongst women with and without implants

However, I am a specialist plastic surgeon, and many plastic surgical societies around the world will acknowledge BII women, but simply just can’t confirm they have the condition whilst at the same time also acknowledging that more research is needed.

One day I might be saying that we now have scientific evidence to support it is a real thing, but for now, I can’t say that, nor can anyone in the medical community.

What is the Treatment For Women Who Believe They Have BII?

If a person firmly believes they have BII, then the only treatment option is to remove the implant and implant capsule (we have another article coming up to discuss implant removal with total capsulectomy, including en bloc capsulectomy). However, this is performed with the very clear understanding that the problems they are experiencing may not go away. But at the very least not having implants is one less thing for them to think about and worry about, and if the problems do go away, then that’s perfect.

I hope that sheds some light on the difficult topic of BII.

Breast Implants cause Cancer? Dr Dona discusses ALCL

Anaplastic Large Cell Lymphoma (ALCL) is a rare type of cancer that is associated with textured implants.

Implants have been around for over 50 years but ALCL is relatively new.

Breast Cancer

  • Breast implants do not cause breast cancer
  • With or without implants, the risk of women developing breast cancer during their lifetime is unfortunately 1 in 8
  • If you are 40 years old, the risk of developing breast cancer over the next 10 years with or without implants is 1 in 69
  • If you are 30 years old, the risk of developing breast cancer over the next 10 years with or without implants is 1 in 230
  • Because of this, every women is encouraged to undertake routine monthly breast self-examination, and having implants does not stop you from performing breast self-examination nor does it make it more difficult to detect changes in your breasts.
  • If you detect a change in your breasts, then you see your doctor to have it further investigated.
  • Depending on your family history, the current recommended age to undertake routine breast cancer screening, ultrasounds and mammograms, is from 50years of age. This is the same, implants or not.

What is ALCL?

Implants come in both smooth and textured. This basically refers to the outer lining of the implants. Smooth means it’s exactly that, a smooth surface. Textured means the surface is rough like sandpaper. Regardless of the shell, the contents, or what’s inside, is the same silicone gel.

Smooth shell implants are not associated with ALCL. ALCL is only associated with textured implants and the rate varies depending on the type of texturing.

ALCL is basically a cancer associated with the scar tissue that naturally forms around implants. It is not a cancer of the breast tissue which is breast cancer, and once again, implants do not cause breast cancer.

The risk of developing ALCL based on the most recent published data from May 2019 varies from 1 in 2,800 to 1 in 86,000, depending on the type of textured implant.

What Are Textured Implants?

Textured implants were introduced many years ago and they provide several benefits including reducing the risk of capsular contracture or hardening of the implant. Capsular contracture is one of the well-established potential problems that can occur with implants, and texturing has been thought to reduce the risk of this occurring. Due to this believed benefit, up until relatively recently the majority of surgeons have preferred textured implants.

Texturing also helps the implants stay in position which is why teardrop implants are only textured. This is because the texturing effectively acts like Velcro and helps stabilise the implant position and thus reduce the risk of them rotating, which is one of the possible problems with teardrop implants. So if you have teardrop implants, then that means you have textured implants.

Round implants come in both smooth and textured variety, because if they spin around it does not distort the breast appearance.

Were Implants Recalled?

  • Up until recently the two leading implant suppliers worldwide were Allergan and Mentor. Allergan macro-textured implants have an ALCL risk of 1 in 3,300, whilst Mentor textured implants have a risk of 1 in 86,000.
  • In late 2018 Allergan macro-textured implants were taken off the market in Europe.
  • Based on these issues, the TGA made an announcement in July 2019 that they were considering removing ALL textured implants from the market. They have yet to make a decision on this.
  • However, on the back of this possible decision, Allergan decided to voluntarily remove its macro-textured implants from the Australian market on 2 August 2019.
  • Unfortunately they used the “recalled” when simply explaining they were no longer going to sell the implants. The implants were being recalled from shelves and stock. Absolutely no patients are being recalled!
  • Just to clarify this important point that has caused a great deal of anxiety amongst thousands of women, absolutely no patient is being recalled.
  • Absolutely no recommendations exist to remove implants.
  • The TGA does not recommend any patient have implants removed.
  • No responsible surgeon is recommending removing implants.

How Do You Know If You Have ALCL?

The average time of developing ALCL from the time of original surgery is approximately 8 years.

The signs of ALCL are usually very obvious. In approximately 90% of the cases the breast swells up. It swells up because fluid collects around the implant – this is called a seroma.

However, whilst seromas are relatively common, it is extremely rare for this to mean the person has ALCL.

I have been in private practice for many years and I’ve seen many late onset seromas, and as of this date, I’ve never seen a case of ALCL.

So if you notice an obvious swelling, you see your doctor, and you’ll get an ultrasound and have the fluid drained and tested. On the rare occasion, that fluid will show that the person has ALCL.

Other ways it can manifest in the breast include breast lumps or skin changes.

So essentially, the signs of ALCL are typically very obvious. Also, because of the unfortunately high rates of breast cancer, every women should be performing routine monthly breast self-examinations because the signs of breast cancer are typically far less obvious than that of ALCL.

The treatment of ALCL is relatively straight forward and it involves removing the implant and the breast implant capsule – this is typically curative. In fact, when detected early the treatment of ALCL is generally far easier than treatment of breast cancer, far more successful, and the condition is far rarer. However, if diagnosed late then other adjuvant treatments may be required. Due to the sometimes late diagnosis of ALCL, a number of deaths have occurred due to its spread beyond the breasts.

Which Implants Do I Use?

Australia, like everywhere else in the world, have a number of different implant brands available all of which are of course TGA approved.

The implants with the greatest risk of ALCL are the polyurethane coated or Brazilian furry type, which many surgeons have of course used but it’s not a brand I have ever used.

Like the majority of busy plastic surgeons, I too have used the Allergan textured implants. However, for a number of years the main brand of choice for myself has been Mentor. It turns out that Mentor is the brand that was subsequently shown to have the least risk of developing ALCL, and based on current data only 1 in 86,000.

What Do You Do If You Have Textured Implants?

The commonest question that has been raised is “if I have textured implants, should I have them removed?” At present, there are zero recommendations to have implants removed regardless of the type of textured implants that you may have. However, many women are advocating for the complete removal of implants irrespective of any signs of disease. However, this is not the official recommendation by the implant company’s, the TGA or by any responsible surgeon.

Once again, implants or not, routine monthly breast self-examinations are required and if any concerns arise you have them reviewed appropriately.

Also, despite the fact that it carries an extremely small risk, some women with textured implants just want them out so they don’t have to think about it. This is not unreasonable. If having the implants is causing significant anxiety then removing the implants effectively cures the anxiety. Of course, removing them completely or exchanging them for smooth implants are the options to consider here.

You Want to Get Implants but Are Scared of ALCL

Another comment made by those wanting to have implants is that “I only want smooth implants so I don’t have to worry about ALCL”. This is also perfectly reasonable, but this would be done with the understanding that the person can only have round smooth implants, which have a higher risk of developing capsular contracture and possibly a higher risk of dropping.

For many surgeons this will not change their practice or what they offer their patients a great deal because most surgeons have spent their entire career only using round implants. But for those surgeons that use anatomical implants, and for those patients wanting anatomical implants, then this will be an issue. Those patients will have to be prepared to accept the look only achievable with round implants.

How Regularly Should You Check Your Breasts?

The formal recommendations to every women, with or without implants, is to continue routine monthly breast self-examinations and if any concerns at any time, see your doctor or surgeon for further review.

And remember, breast cancer has a risk of 1 in 8, and that usually manifests as a small lump that you may or may not be able to feel. In contrast, ALCL has a worst case scenario risk of 1 in 2,800, and the person typically develops an obvious visible breast swelling that is easy to detect and therefore easy to have treated early.

In other words, as long as you are always reviewing your breasts normally every month, as you should be doing with or without implants, then you are given yourself the best chance of detecting ANY issues that may arise early, and therefore being treated early.

Ultimately, regardless of the type of implants you may have, nothing needs to change. Breast cancer is many times more common than ALCL, and for that reason you must always be “self-aware” and perform routine monthly breast self-examinations.

If the reasons you originally got implants still remains, and they are not causing you any problems, then why would you have them removed.

I Also Suffered From Cancer!

Finally, it is my intention that this content sheds light on a very important topic that has had some media attention with poorly worded press. As many of my regular followers will be aware, I too suffered from cancer earlier this year and had to undergo two significant operations.

It was an absolutely terrible experience and even as a doctor myself, the word “cancer” is terrifying! And it is that reason I am creating this content, so those countless thousands of women with textured implants DO NOT WORRY! Yes it does occur. It is rare. It is curable. Breast cancer has a risk of 1 in 8. For that reason and that reason alone, you should ALWAYS perform monthly breast self-examinations. I said this when I first discussed my own personal medical problems. I urged everyone, that you must always be self-aware. You know your body better than anyone else, including your doctor. So if anything ever changes, that is when you get that investigated by the appropriate doctor. And whilst most of the times everyone will be normal, on those small occasions it is a problem, then it has been picked up early, so it can be treated early, so you give yourself the best chance of the best outcome.