Breast procedures
Bernard is happy to offer a range of breast surgeries, including augmentation, reconstruction, reduction and lift (mastopexy), as well as male breast reduction (gynaecomastia).
Augmentation
People present for breast augmentation for many reasons. Lack of breast development, breast asymmetry and glandular loss, combined with excess skin following breast feeding or after massive weight loss. Workup for the procedure requires the patient, the surgeon and his staff to work in close collaboration to get the best outcome and usually takes 2 or 3 pre-operative appointments of at least half hour duration to work out the best plan.
The questions that need to be answered during these consultations are things such as:
- size and shape of implant
- whether the implant is textured or smooth
- whether the implant needs to be placed below or on top of the pectoralis muscle
- whether there needs to be removal of excess skin.
Breast augmentation is usually safely performed as a day surgery procedure. Occasionally, patients may go home with a surgical drain that requires a return to the rooms the next day for removal. It usually takes 6 weeks to get back to normal activity, for example exercise, Pilates or Yoga. The final breast shape and size is usually apparent once soft tissue swelling has settled. This can be anywhere between 6 weeks and 6 months, depending on individual patient factors.
Occasionally the surgery is performed in 2 stages, 3 months apart, if other techniques such as tissue expansion are required or if there is a significant issue with excess skin or breast shape.
While breast implants have historically been considered very safe with no association with breast cancer or other diseases, in the last 15 years there have been some significant issues which surgeons need to discuss with patients. Chiefly, these are implant safety and quality and the discovery of breast implants being associated with a rare lymphoma (BIA-ALCL). All patients in Bernard’s practice with breast implants or tissue expanders are placed on the Australian Breast Device Registry so that future issues with devices can be tracked and related back to patients.
Reduction and lift
Breast reduction is a commonly performed plastic surgical procedure with a very high rate of satisfaction. It is routinely performed on a wide variety of patients of all ages, from teenagers to 80-year-olds. There are many indications for breast reduction surgery, most commonly shoulder, upper back and neck discomfort, as well as for improvement of posture.
There are 2 main styles of reduction, one using a Wise (anchor or T-shaped) pattern, the other being a vertical scar pattern (Hall Findlay). Which technique is used depends on patient preference, breast size and breast shape.
It is routinely performed with a 1 or 2 night stay in hospital but can sometimes also be performed as day surgery. Healing time and a return to normal activity takes about 6 weeks with the biggest investment in healing and resting being in the first fortnight.
Post operatively, there can be issues with wound healing and sensation changes in both the skin of the breast and the nipple/areola, which will be discussed at length beforehand. Occasionally, revision surgery may be required, which can range from scar correction to correction of asymmetry.
Breast lift (mastopexy) is usually performed at the same time but breast lift alone, without reduction, is not usually covered by Medicare and health funds. However, breast lift is usually a shorter procedure and may be able to be performed as day surgery.
Reconstruction
Breast reconstruction can be offered in an immediate reconstructive setting (at the time of mastectomy) or as a delayed procedure, once the initial disease has been managed and the patient is ready to proceed. It can consist of using autologous tissue (soft tissue from other parts of the body) or prosthetic material or a combination of both.
The decisions on these paths are usually a considered approach between the patient, the plastic surgeon and surgical and medical oncology teams. Factors that may determine this include:
- disease factors, such as need for radiotherapy and chemotherapy
- patient factors, such as underlying health, work and lifestyle factors.
Work, lifestyle and family factors tend to create the basis from which the most important treatment decisions are based on. The process to make these decisions usually requires 2 to 3 consultations and the reconstruction can take 2-3 operations over 3-6 months.
These are decisions that require a great deal of support for the patient and it is recommended that a family member or support person attends consultations with the patient. There is a great deal of information to go through at each consultation. Notes and drawings made during the consultation are usually provided to the patient as well as information pamphlets. If a patient undergoes a procedure requiring tissue expansion or placement of a permanent implant, the device is registered on the Australian Breast Device Registry.
Male breast
Male breast reduction is a commonly performed procedure for boys and men at many stages of life. Typically, boys present early puberty with breast growth but changes in breast soft tissue can occur at various times of hormonal change in men’s lives.
Up until 15 years ago, significant glandular/fatty development was often addressed with gland excision and skin reduction surgery. However, in view of the scarring associated with this, it has become more accepted to perform liposuction followed by excision of gland through an incision hidden on the edge of the areola.
This can be done quite safely as day surgery. It is commonplace for the surgeon to leave a drain in situ for removal the next day and it takes a minimum of 6 weeks wearing a compression garment to achieve the final result.
Sometimes, when major skin retraction is required, the garment may be required for longer. Sometimes skin excision is required, leaving a scar on the chest wall, which requires a period of observation until both surgeon and patient are happy.
