NEWCASTLE BREAST SURGEON

Breast cancer is the most common cancer in Australian women, affecting one in eight by the age of 85. The treatment process can be fraught with anxiety for both patients and their families. The fear of disfigurement by mastectomy surgery often weighs heavily, but may be pushed aside to face greater challenges.

Breast reconstruction is surgery that restores breast shape. For many breast cancer survivors, or those undergoing risk-reducing mastectomy, this greatly facilitates the healing process both emotionally and physically. There are a variety of options available for breast reconstruction surgery, and many decisions to be made. This can be overwhelming and must be navigated with the assistance of an experienced team. Reconstruction may be performed either immediately following mastectomy, after completion of treatment, or even years later. Breast reconstruction techniques fall into four main categories:
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·  Implant-based reconstruction, using a silicone implant to create the breast shape. This may or may not require the use of an expander to first create the skin shape.
·  Autologous reconstructions, using the bodies’ own tissue to create the breast. This may include tissue from the lower abdomen (TRAM/DIEP flaps), the thighs (TUG flaps) or the back (LD flaps) – wherever there is a little to give.
·  A combination of autologous tissue and implants.
·  Supportive techniques, such as lipofilling to improve contours, breast reductions or lifts to the other side for improved symmetry and nipple reconstructions. 

The best technique – or combination of techniques – will be different for every woman and will depend on the cancer treatment required, their body, their lifestyle and their personal preferences. When considering breast reconstruction it is extremely important to entrust your surgery to a specialist who is able to offer all options, so that the best combination may be tailored to you and not governed by the surgeon’s preferences or skill set. 

I am a plastic surgeon with a special interest in breast reconstruction and aesthetics. I am able to offer all types of reconstruction. The best time to start understanding your options is before mastectomy, though it is never too late. If you have recently been diagnosed with breast cancer, or had a mastectomy years ago and are interested to know what is possible, I would love to have a conversation with you.

Breast augmentation is one of the most sought-after plastic surgery procedures. Whether your breasts never really developed, or have changed with pregnancy, breastfeeding, weight loss or age, a well planned and performed augmentation can give you the shape and confidence you desire.

The single most important question when considering breast augmentation is: what kind of result do you want? Are you looking for a subtle change that only you and those closest to you will notice? Do you want a full but extremely natural result? Or are you looking for a dramatic enhancement? With this information I can tailor a procedure that will consider your body shape, exact measurements, skin and tissue type. We can discuss all available options for implant type and shape, incision placement and implant position. Advanced techniques such as liposculpture, fat grafting and internal bra support will be offered if needed. 

It is important to note that only a minor amount of breast drooping can be corrected by augmentation alone. To achieve the desired result in sagging breasts (as is common after breastfeeding or weight loss) a breast lift may be required, either alone or with implants. 
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Very asymmetrical breasts can be the result of differences in development between sides, or can be caused by tuberous breast deformity. This is a condition in which a tight ring of tissue at the base of the breast produces a constricted shape, often with a larger areolar and sometimes a drooping appearance. Many young women with this condition seek breast augmentation, without knowing they have it. Correct diagnosis prior to surgery is critical, as standard augmentation techniques alone will only exacerbate the abnormal appearance. Releasing tight connective tissue, correcting the size of the areolar and lifting the breast may all be required. Importantly, this is a medical condition, for which Medicare and insurance coverage is available to assist with treatment costs.
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Like all surgical procedures, there are possible complications. Many of these can be reduced or eliminated by careful planning and meticulous technique. During your consultation I would be happy to discuss the various ways in which I minimise the risk of problems such as visible implant edges or rippling, implant displacement, capsular contracture, double-bubble deformities, BIA-ALCL and more. By acknowledging the potential for these complications and using the most up-to-date strategies to reduce them, the best outcome can be achieved.

Breast Reduction surgery can be absolutely life changing. Benefits reported by women who have undergone this procedure include resolution of back and neck pain, elimination of skin irritation in the breast creases, improvement in posture, the ability to exercise again with resultant weight loss, the ability to better fit into bras and clothes and improved self-confidence.

A good breast reduction does not only decrease breast volume. It also lifts the breast, repositions the nipple and creates a beautiful breast shape. I perform breast reduction surgery using techniques that lift and reshape the breast tissue, using the shortest scar possible. 
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There are many different ways to perform breast reduction surgery. Small lifts and reductions can be achieved using only a scar around the margin of the areola. This gives a minimal effect only. For the majority of patients I use a vertical short scar technique, which lifts, reduces and reshapes the breast through a periareolar and short vertical scar on the underside of the breast. I always tailor the surgery to the particular requirements of every patient, using additional techniques such as liposuction to refine the result. 
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In women with exceptionally large breasts or significant excess of breast skin, a longer incision extending into the crease under the breast may be required to achieve the best shape. Whatever your shape, I would love the opportunity to discuss the ideal solution for you and tailor a breast reduction to your needs.
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I am often asked about the impact of breast reduction surgery on breastfeeding. Depending on which study you refer to the numbers vary, but approximately one third of women are unable to breastfeed without having had any breast surgery. In women with very large breasts, difficulties with latching or milk delivery may contribute to this problem. After breast reduction surgery, if the milk ducts are protected, approximately one third of patients are unable to breastfeed, and two thirds can. This does not mean that breast reduction surgery never affects breastfeeding. In some women the surgery may prevent breastfeeding, but in others it may assist. No individual guarantees can be given, but generally speaking there is no evidence that breast reduction surgery routinely prevents breastfeeding.

Breastfeeding, gravity, time and weight loss can all naturally lead to sagging, deflated breasts. A breast lift – or mastopexy – is a procedure to lift and reshape the breasts, creating a more youthful appearance. Not only can this restore confidence, it can also bring health benefits by reducing back, neck and shoulder pain, making exercise more enjoyable and eliminating skin irritation under the breasts.

There are a variety of mastopexy techniques used by different surgeons. All have the goal of returning the nipple-areolar back into the correct position, lifting and reshaping breast tissue and reducing stretched skin.

Depending on the size of your breasts and the degree of sagging, different approaches will be best suited to achieve the look you want. As a plastic surgeon with a special interest in cosmetic breast surgery, I am experienced in a range of techniques and specialise in short-scar lifts. I would love the opportunity to hear about your goals and discuss how we could achieve them. 

If you wish to lift and enlarge your breasts, a mastopexy with implants may be the best option. Alternatively you may wish to combine a lift with fat transfer.

Combining a lift with implants can completely transform breasts that have been severely affected by weight loss, breastfeeding, time and gravity.

A breast lift alone – also known as a mastopexy – rejuvenates sagging breasts by reshaping breast tissue, correcting the position of the nipple-areola, and if necessary repositioning the breast higher on the chest. Health benefits of this procedure can include relief from back, neck and shoulder pain and elimination of rashes from the folds under the breast. Clothes fit better and exercise becomes easier.

If you desire breasts that are not only more youthful but also augmented, then a mastopexy can be combined with implants. Volume increases can be anything from very subtle to more dramatic, depending on the look you want.

As with all plastic surgery of the breast, the procedure must be tailored to your body and your goals, by a surgeon who is proficient in a broad range of techniques. Combining a mastopexy and augmentation can be very complex surgery. Placement of an implant puts downwards and outwards pressure on breast tissue. This is in direct conflict with the mastopexy goals of lifting and tightening. Both processes of repositioning the nipple-areola and placing an implant underneath reduce the blood supply to the nipple. When combined this can be dangerous if not done cautiously.

As a plastic surgeon with a special interest in breast surgery, I am well positioned to provide a safe pathway to your goals. Mastopexy with augmentation may be possible in a single stage surgery. For more dramatic lifts or volume increases, a multistage approach may be preferable. For size increases that are even more natural and don’t require an implant, you may wish to consider fat transfer. If you would like to discover what is possible for you, please come in for a consultation.

It is normal to have two breasts that are a slightly different size or shape. In fact, exactly matching breasts are exceedingly rare. However, when one breast is under or overdeveloped, the resulting asymmetry can result in poor posture, pain in the back, neck and shoulders, poor self-esteem and difficulty finding bras and clothes that fit correctly. In teenagers and young women this can be particularly damaging if they are teased by peers and develop poor body image.

Significant size differences are often described as more than a 10% difference, or more than one cup size. However I believe a meaningful difference is any that causes physical or emotional symptoms. 

There are many causes of breast asymmetry. These include abnormalities present from birth, chest trauma, or hormonal fluctuations during puberty or pregnancy. Specific congenital conditions that may cause underdevelopment and asymmetry include tuberous beast deformity and Poland’s Syndrome. Tuberous breast deformity causes a complex combination of problems, which may be present with varying severity. These include:
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·  A constricted and tubular shape of part, or all, of the breast.
·  A high infra-mammary fold (the crease under the breast).
·  Enlarged, protruding nipple-areola.

Poland’s syndrome is a condition that causes underdevelopment of the breast with absence of part of the pectoralis major chest muscle and is also associated with other chest and hand deformities. It is unclear how common these problems are, as many women never seek treatment for their different appearance. Others turn to breast augmentation as a treatment, however implant augmentation alone may accentuate the abnormal appearance in these conditions. 

Treatment of breast asymmetry may involve differential breast augmentation, lifts, reductions or a combination of these. Nipple-areolar correction may also be needed. In severe cases of tuberous breast deformity – where there is insufficient breast skin, a high fold and protruding nipple – a two-stage correction is required. First an expander is placed to create an improved shape, and then this is exchanged for an implant with breast reshaping performed. Severe forms of Poland’s syndrome, with absent muscle and chest wall deformity, may require muscle transfer to achieve a good appearance. 

As a plastic surgeon with a special interest in cosmetic and reconstructive breast surgery, I know how complex breast asymmetry correction can be. Poorly planned or executed surgery risks exacerbating the problem. If you have asymmetrical breasts that cause you concern, please seek a doctor’s referral and book a consultation.

Reasons for wanting nipple correction include having inverted nipples or large or asymmetrical nipples and areola. This can be congenital, or form after breastfeeding, injury or disease. The areola around the nipple may become stretched following pregnancy or fluctuations in weight. These problems can lead to self-consciousness, particularly in swimwear.

Inverted nipples are relatively common, affecting around 10% of women. This is usually caused by short or retracted milk ducts, which hold the nipple in as the breasts develop. This can cause irritation, infection and difficulty with breastfeeding. Please note that nipples suddenly becoming inverted in later life can be a sign of breast cancer. If you have always had inverted nipples this is not a cause for concern, but if this is newly developed then please see your doctor.

Fat transfer utilises your own fat, harvested by liposuction, to augment other areas. It is a powerful technique that can be used for breast augmentation, breast reconstruction and rejuvenation of other areas such as the face or hands.

Fat transfer is also sometimes referred to as autologous fat grafting, lipofilling or lipomodelling. It is a relatively new technique that has been refined significantly in the past few years. Fat is harvested using liposuction, gently washed and processed, then re-injected into the desired area. This must be done with great precision in tiny amounts, as only the outer cells receive nutrition from the surrounding tissues and survive. Fat survival has previously been estimated between 30-90%. With current techniques 80-90% can be expected. 

In addition to providing natural filler, fat transfer provides adipose stem cells that rejuvenate the surrounding tissues and overlying skin. And of course there is the advantage of removing stubborn hip, tummy or thigh fat with liposuction! 

I use fat transfer techniques extensively in breast reconstruction procedures. This allows the creation of soft, natural curves as well as rejuvenating skin that has suffered from previous surgery or radiation therapy. 

In cosmetic breast surgery, fat transfer may be combined with an implant augmentation, to accentuate the cleavage or correct pre-existing asymmetry, or reduce the size of the implant required. Augmentation by fat transfer alone is possible, creating a softer, more naturally enhanced breast. The main disadvantage to this technique is unpredictable fat survival and potentially limited size increase. More than one procedure may be required to achieve the desired result. 

Fat transfer may also be used to rejuvenate the skin of the hands, décolletage, or face. It provides natural and long lasting facial filler that may be used in isolation, or combined with a range of facial cosmetic procedures. 

If you are interested in learning more about how fat transfer may be of value to you, either alone or combined with another procedure you had in mind, please don’t hesitate to ask.