A Scientific Guide for patients.

Many patients in Australia and across the world have recently become aware of the risks associated with a specific make of Breast Implant, called Poly Implant Prosthese (PIP).

Dr. Bobby Kumar (Cosmetic Surgeon) has never used PIP Breast Implants. He has chosen only to use breast Implants with a proven and trusted safety record, and breast Implants that are recognised and approved by the major medical authorities around the world, such as FDA (Food and drug authority of the US), TGA and NHMRC of Australia as well as UK’s Medicines and Healthcare products Regulatory Agency (MHRA).

Breast Implants that are recommended at the Bare Aesthetics Cosmetic clinics are Eurosilicone (It has one of the lowest rates of all breast Implants for rupture), and for specific cases Polyurethane (“Furry Brazilian” or P-URE) and Mentor Breast Implants.

1. So what are the issues with the PIP breast Implants?

The media and the PIP manufacturing company have released a statement suggesting that PIP Implants have a higher than expected spontaneous rupture rate, at least approximately  4x greater than other types of breast Implants. There is a greater risk of Capsular Contracture and now a suggestion that this particular breast Implant is implicated in the formation of a rare form of NHL tumour (ALCL) of the scar tissue(Capsule) surrounding the Implant.

Of particular concern are textured PIP breast Implants as well as textured titanium coated breast Implants.

Consequently Poly Implant Prosthese(PIP)has advised that patients should consider removal of their PIP breast Implants.

This has caused significant concern amongst patients with PIP Implants or in fact with any breast Implant, as evidenced by the number of calls received at Bare Aesthetics Cosmetic Surgery Clinics. In Australia PIP breast Implants were used largely by Surgeons in South Australia (State where the parent Importing Company of PIP breast Implants resided) and Queensland.

PIP breast Implants were banned for use in Breast Augmentation in the USA by the FDA in the year 2000 when it became evident that there were significant spontaneous rupture rates and capsular contractures. It was also recognised that PIP manufacturing company were using Industrial strength Silicone, not authorised or appropriate for use in medical breast augmentation.

Despite the FDA findings the Australian TGA only banned PIP breast Implants in approximately 2010, when similar concerns were raised by Australian patients reporting adverse outcomes.

2. What are the concerns regarding Breast Implants and the rare ALCL tumour?

Depending on the source of scientific literature and information there are a slightly varying number of ALCL cases in women having undergone breast Implantation.

After a careful review of literature published from January 1997 through May 2010, the FDA identified 34(one study identified only 27) unique cases of ALCL in women with breast implants worldwide. In addition, the FDA has received information from other international regulatory agencies, scientific experts and breast implant manufacturers. Altogether, the agency is aware of approximately 60 cases of ALCL in women with breast implants. Most of these women are mainly in Europe and some in the USA.

However, based on all the evidence available to us at this time, the FDA believes that women with certain types of breast implants may have a very low but increased risk of developing ALCL.

The true cause of ALCL in women with breast Implants is not certain; therefore there is no established causal relationship between breast Implants and ALCL.

3. What is Anaplastic Large Cell Lymphoma (ALCL)?

ALCL is not breast cancer. According to the National Cancer Institute (USA), ALCL is a rare malignant tumor (non-Hodgkin lymphoma) that may appear in several parts of the body including the lymph nodes, skin, bones, soft tissue, lungs or liver.

Also according to the National Cancer Institute, an estimated 1 in 500,000 women per year in the U.S. are diagnosed with ALCL. ALCL in the breast is even rarer. Approximately 3 in 100 million women per year in the U.S. are diagnosed with ALCL in the breast (with or without breast Implants).

Even though ALCL has been found in the breasts of some women with breast implants, it is not breast cancer. ALCL is a type of lymphoma, a cancer of the cells of the immune system.

In fact the type of ALCL that forms in association with some breast Implants, that is, ALCL Kinase negative, is an even rarer form of all the subtypes of ALCL.

ALCL comprises only 2% of all newly diagnosed NHL worldwide. Lymphomas occurring in the breast are even rarer, comprising only 0.04 to 0.5% of all breast cancers and approximately 1-2% of all extranodal (outside of lymph nodes) lymphomas.

The absolute risk of developing ALCL following breast augmentation is extremely small. It is estimated by de Jong et al. to have an incidence of 0.1 to 0.3 per 100,000 women with breast Implants per year.

Following an expert multidisciplinary panel in the USA early last year (2011) regarding ALCL and breast Implants; a proposed aetiological cause is repeated Microtrauma to breast Implant surface via degradation of the Implant surface. This leads to silicone particles to come in contact with native tissue, the silicone particles are taken up by the breasts inflammatory cells. The fibrous capsule surrounding the breast Implant becomes disrupted, causing a re-initiation of the Immune system response and potentially leading to the development of ALCL through a chronic inflammatory reaction.

This is the same mechanism proposed or thought to occur with PIP breast Implants and the potential risk of developing ALCL.

4. Symptoms associated with development of ALCL and women with Breast Implants

The main symptoms of ALCL in women with breast implants were persistent swelling or pain in the vicinity of the breast implant. These symptoms were noted to occur well after the surgical incision had healed, often years after implant placement (published articles estimate 6 months to several years after breast augmentation).

Upon evaluation, evidence of fluid collection around the breast implant (seroma) was observed. Some patient reports indicated that a palpable mass or capsular contracture (thick and noticeable scar capsule around the implant) were present.

5. Where in the breast has ALCL been found in women with breast implants?

In the case studies reported in the literature, the ALCL was found near the breast implant, and contained within the fibrous scar capsule. However, it was not in the breast tissue itself. The illustration below shows the location of the ALCL in these reports. In most cases, the ALCL cells were found in the effusion fluid (seroma) surrounding the implant or contained within the fibrous scar capsule.

6. Prognosis

ALCL disease occurring in women with breast Implants is a clinically indolent disease with a favourable prognosis, as distinct from the systemic ALCL disease type.

Management consists of removal of the involved breast Implant and capsule, which likely on current evidence will prevent local reoccurrence (evaluation for other disease sites needs to be performed).

With capsule confined disease, adjuvant chemotherapy and radiotherapy is not required.

7. Conclusion

Whilst ALCL of the breast and in particular in women with breast Implants is rare, it is believed that there is a positive association between ALCL and breast Implants. There is NO causal link at this stage between breast Implants and ALCL.

However, some scientists now suggest that textured breast Implants (such as PIP breast Implants) are a potential cause for developing ALCL through microtrauma of the Implant surface and chronic inflammation of the scar or fibrous capsule, or capsular contracture formation.

The scientists have suggested that smooth breast Implant surfaces potentially have a lower or no risk of developing ALCL. It is uncertain whether Polyurethane breast Implants are better than textured silicone breast Implants.

The expert panel also believes that there is evidence of an increased risk of developing ALCL in women that have breast augmentation in the Subglandular plane (under the breast) compared to those women with Subpectoral breast augmentation (under the pectoral muscle).

The treatment is removal of the breast Implant and fibrous capsule. It is not clear whether there is still a long term risk of developing ALCL despite removal of the affected breast Implant and capsule.

Bare Aesthetics Cosmetic Surgery Clinics has received many enquiries regarding what to do from patients having had PIP breast Implants by another surgeon. Dr. Bobby Kumar (Cosmetic Surgeon) in his opinion has recommended that the PIP Implants be removed especially if they have ruptured; this is contrary to the recent TGA advice.

Patients with PIP breast Implants are naturally distressed and anxious about developing ALCL and removal of the affected breast Implants which then entails increased risk or morbidity of having further surgery and anaesthesia, especially as it will take longer than a standard breast augmentation. Also there is consideration of cost; it is unclear who will finance further surgery for the removal of the affected PIP Implants.

At this stage patients are expected to finance further surgery, although international authorities are suggesting the government finance patients in cases where breast augmentation with PIP Implants followed corrective surgery for breast cancer; or it be financed by the private clinics and or Surgeons that performed the breast augmentation with PIP breast Implants.

Dr. Bobby Kumar is a board certified Cosmetic Surgeon, experienced and qualified to perform Breast Augmentation or Breast Enlargement surgery. For advice regarding Breast Implants and PIP Implant related issues, please contact us at www.bareaesthetics.com.au or call (02) 9571 4850 or 0430 491 009.

Tummy Tuck is surgically known as Abdominoplasty surgery. The surgery is performed for Cosmetic and legitimate medical and surgical reasons. In Sydney and Adelaide patients can claim part of the procedure on Medicare and their private health insurance. Women following child birth and if they have had a caesarian section can be left with an overhanging lower abdomen. These patients decide to have Tummy Tuck surgery to address the hanging “Pannus” of redundant skin and soft tissues.This is the case for those patients that have succeeded in losing a significant amount of weight. Consequently these patients are left with a large redundant apron of skin and subcutaneous fat and tissues which in themselves are a problem; causing skin fungal infections, aesthetically undesirable lower torso and the patient is left with having to hide the redundant mound in clothing.

Who makes the best candidate for a Tummy Tuck?

Tummy Tuck or abdominoplasty surgery is becoming a popular form of Cosmetic Surgery for men and women. It is considered by patients for a variety of reasons. The most obvious reasons are that patients have a significant redundancy of skin and tissues of the upper and lower abdomen.

The cosmetic considerations are based on patients who may have had previous surgery and or delivered babies via caesarian section and they are left with a flap or “Pannus” of skin and tissues which typically overhang their clothing. These patients often find it unsightly and difficult to find the right clothing to hide the overhanging skin and tissues. They are also reluctant to go to the beach during summertime for fear of embarrassment when wearing a bathing suit.

Some patients may have had a primary abdominal surgery which has left them with an “ugly” scar and a mound of redundant skin and tissues. Often the surgical consideration here is not only scar revision but also an abdominoplasty to refine their abdominal shape and contours.

There are those patients who have been successful in losing a tremendous amount of fat and therefore weight. These patients unfortunately find that despite their heroic weight loss their skin and residual tissues do not retract sufficiently, and so they are left with a large amount of lose hanging skin and subcutaneous tissues.

These patients find that the hanging tissues create many problems such as bacterial and fungal infections as well as discomfort due to rubbing as they continue to exercise to maintain their weight loss. It is for these reasons that massive weight loss patients seek not only a Tummy tuck, they often need to consider a total body lift.

General Cosmetic Surgical overview of Tummy Tuck Surgery

In general a Tummy Tuck will require some Liposuction and or Liposculpture to remove fatty tissues around the flanks so that tailoring the tissues and skin will produce an aesthetic result as opposed to removal by excision of skin and fatty tissues alone. Often many patients will require tightening of their abdominal muscles above and or below the umbilicus (belly button). The effect of tightening the rectus muscle is to repair the separation and weakening of the muscle with weight gain and subsequent weight loss. The tightening procedure will also produce greater definition of the underlying musculature; often referred to as the “six pack”.

Patients requiring a tummy tuck and tightening of their muscle bed may require a relocation of their umbilicus. When the abdominal flap is pulled and the redundancy of skin and fatty tissues are removed, the umbilicus becomes stretched or often displaced to a point too low on the abdomen that the final result is unappealing and unusual.

A total Body lift involves a Tummy Tuck and what is known as a Reverse Tummy Tuck, which means removing skin and tissues of the upper abdomen just below the breasts and the lower abdomen in the traditional fashion for a tummy tuck; as well as a Breast reduction, thigh lift and an arm lift.

Body lifting procedures are often performed in stages as it would be surgically and medically unsafe to perform as a single stage surgical procedure. Most patients will have an inpatient hospital stay following large procedures. Despite the likelihood of obvious scars, most patients who decide to consider body lifting procedures do so with the knowledge that whilst they will have scars, they will however, have a better body shape especially in clothing.

Tummy Tuck surgery should not be considered to be a form of weight loss surgery. Most Cosmetic Plastic surgeons discourage utilising an abdominoplasty in an attempt to facilitate a patient’s weight loss. Patients will need to be sufficiently motivated to lose weight prior to considering any surgery. When seeing their Cosmetic Surgeon they will need to have reached a stable weight loss to be a candidate for consideration of a Tummy Tuck procedure. Often the motivated patient will go on to continue to lose more weight after the Tummy Tuck and this will help with the overall success of the surgery and appearance of the patient.

Potential Complications for Tummy Tuck Cosmetic Surgery

Fortunately with great surgical care and selection of appropriate patients for a Tummy tuck complications are uncommon and if they occur tend to be minor and easily resolved.

Like any surgical procedure complications are always a potential risk and occurrence. Bleeding, Haematomas and Seromas can occur as the tissues are highly vascular. Male patients and smokers tend to have a slightly higher frequency or potential for this type of complication. Drains may be used to gauge bleeding and genera drainage from the wound in the acute phase of the post operative period. However; if the bleeding is significant the patient may need to be returned to the operating theatre to investigate bleeding vessels and to stop excessive bleeding or ooze.

Other complications include wound breakdown and skin and tissue loss. This can occur due to excessive tension of the tissues and vascular compromise to the abdominal flap. Infections postoperatively whilst uncommon as the patient is adequately covered by pre and postoperative antibiotics can still occur due the resistant nature of some bacterial organisms. Skin sensation can be diminished; tissues may be injured due to the lack of pain sensation. Scars are the measure of success of any operation; some patients do scar poorly and as such scar revision may be required.

Postoperative recovery following Tummy Tuck Cosmetic Surgery

Patients will be required to wear a compression garment, in my practice this maybe up to 3 months or more. The garment applies a compressive force to the elevated abdominal flap; the garment facilitates adherence of the flap to the abdomen and therefore healing of the tissues. The garment is required to be worn initially continuously for 24hours per day, and only removed for showers and to wash the garment. Patients will be restricted from carrying out some of their usual activities such as sporting activities and various work commitments. The cosmetic surgeon will discuss your postoperative care and management as the overall final result and success of a tummy tuck will be dependent on wearing the garment and care of the abdominal tissues.

As previously described, complications are low and ensuring that the patient is an appropriate candidate for a Tummy Tuck procedure will ensure success of the operation and realistic expectations of both patient and Cosmetic Surgeon.

For an experienced and skilled Cosmetic Surgeon visit www.bareaesthetics.com.au. Dr. Bobby Kumar performs Tummy Tuck surgery in Sydney and Adelaide,offering a rejuvenated body and youthful definition of your waist. For an appointment today contact us on (02) 9571 4850 or 0430 491 009.

Breast Implant surgery is one of the most common Cosmetic Surgery procedures performed in Australia. Many women are choosing breast augmentation to enhance their breast shape and size, body proportions and contours. Some women have always felt uncomfortable with smaller or uneven breasts; other women seek to restore their breast size and shape after pregnancies and breast feeding or significant weight loss. Whatever your motivation, it is important to research the procedure and seek the opinion of a qualified and experienced Cosmetic Surgeon.

High Profile Breast Implants

Dr. Bobby Kumar, Cosmetic Surgeon, has been performing Breast Enlargement surgery in Sydney for many years and is now offering his considerable skills and experience to patients in Adelaide. Dr. Bobby Kumar performs patient consultations and breast enlargement surgery in Adelaide on a regular basis. He is experienced in a range of Cosmetic Surgery Procedures, including breast augmentation or breast implants cosmetic surgery; tummy tucks or abdominoplasty, face lifts, breast reduction and breast lift surgery.

Breast augmentation involves the use of implants to enhance breast size and shape. There are two main types of breast implants, saline or silicone. Silicone implants have become more popular due to their natural feel. They consist of an outer silicone shell containing silicone gel. The silicone gel stays intact in the rare event that an implant ruptures or breaks. Saline implants also have an outer silicone shell, but are filled with saline, a fluid based on water and salt similar to that naturally occurring in our bodies.

Breast Implant Size

Recently in Adelaide there have been well publicised issues with a particular commonly used brand of breast implant that were manufactured in France. There were reported cases and an increased incidence of breast implants rupturing and leaking. Dr. Bobby Kumar has never used this particular type of implant due to his own concerns and research regarding their negative outcomes. The breast implants he chooses to use come from a manufacturer and supplier that is TGA approved and has the lowest incidence of complications.

Breast implants also vary in their size, shape and volume. The most suitable breast implant to achieve the results you desire will be discussed between you and Dr. Bobby Kumar based on your physical examination and measurements. A breast implant that is suitable for one woman may not be appropriate for another, depending on features such as existing breast tissue, shape or droop of the breast, size of the chest, and body proportions. These issues will all be discussed at length with you by Dr. Bobby Kumar so you are in the best position to make an informed decision about what is right for you.  Many women do not want to have an ‘implanted’ look and Dr. Bobby Kumar strives to achieve the most natural looking results.

The first step in the breast augmentation process is to have a consultation with Dr. Bobby Kumar in Adelaide to discuss your options and obtain all the information you require about breast surgery. If you want to proceed with surgery, there are a few things to bear in mind. Breast surgery is usually performed as a day procedure under either twilight sedation or general anaesthetic. Most women return to work within 1 – 2 weeks depending on their type of work. Heavy lifting is to be avoided after surgery, in order to allow the chest tissues to heal and the implants to settle into position. Usually women are back into their normal routine, including exercise, at about 6 weeks after surgery.

Women who have had breast augmentation typically report a high level of satisfaction with the results including the enhancement to their overall body shape and proportions and often experience a boost in their self confidence.

Natural Breast Augmentation results by Dr Bobby Kumar

Cosmetic Surgeon Dr. Bobby Kumar is an experienced and trusted Breast Augmentation and Breast Enlargement surgeon offering natural and beautiful results for women seeking Breast Implant surgery in Adelaide. For more information visit www.bareaesthetics.com.au or contact for all appointments in Sydney, Port Macquarie and Adelaide today on (02) 9571 4850 or 0430 491 009.

Click on link below to find out more about a Breast Augmentation Consultation in Sydney, Port Macquarie or Adelaide at the Bare Aesthetics Cosmetic Surgery clinics with cosmetic surgeon Dr. Bobby Kumar.

Breast augmentation or Breast enlargement what to expect in your consultation with cosmetic surgeon Dr Bobby Kumar

These are the most common questions asked by women in Sydney, Adelaide and Port Macquarie who are considering Breast Augmentation Surgery:

1. How long does Breast Augmentation surgery take?

Breast Augmentation surgery in total takes between 1.5 and 2 hours

2. Under what type of anaesthetic is Breast Augmentation performed?

Breast Augmentation can be performed under either sedation anaesthesia or general anaesthesia; general anaesthesia is more common.

3.  How do I know what size implants to choose?

At the time of your consultation, you will have the opportunity to view different types of breast implants and “try” them for size. You need to make sure you are wearing a bra that will tolerate the breast implants being placed in the cup and wearing a plain t-shirt top helps to give you the best impression of sizing.

Every woman is different with regard to choosing breast implant size – the size of breast implant in one woman may give a significantly different result in another woman. This is one reason why viewing images of breast augmentation before and after photos should be done bearing in mind that each woman’s result is individual to her.

When choosing breast implant size, there are several factors to take into account, such as existing breast tissue, chest diameter, height and weight, overall body proportions and position of the breasts on the chest wall. The Cosmetic Surgeon will be able to recommend an appropriate breast implant size for you depending on the above factors and your goals and desired result.

Breast Implant Size

4. What happens in a consultation with the Cosmetic Surgeon Dr. Bobby Kumar?

On arrival for your consultation, you will be required to complete a questionnaire asking you information about your medical history and reasons for considering Cosmetic Breast Augmentation Surgery. In your consultation, the Cosmetic Surgeon will discuss your medical history, conduct a thorough medical examination, take measurements and photos of the chest area and discuss in detail breast augmentation surgery. The Cosmetic Surgeon will also discuss what types of breast implants are available and make recommendations as to what type and size of breast implant will achieve the results you desire. As previously mentioned, you will be able to view and try a range of breast implants.

5. How long is recovery time from Breast Augmentation?

Most women take between 1 and 2 weeks off work (depending on the type of work they do) to recover from Breast Augmentation surgery. Any upper body activity, including exercise, lifting or bending over, needs to be avoided for at least 6 weeks to allow for the tissues to heal, swelling to resolve and the breast implants to settle into position. Driving needs to be avoided for 2 weeks after breast augmentation and flying should be avoided for approximately 6-8 weeks due to the breast surgery’s proximity to the chest wall and therefore the lungs.

6. What preparation do I need to do for Breast Augmentation surgery?

The first step is to have a consultation with a fully qualified and experienced Cosmetic Surgeon. From there you are in a position to schedule breast augmentation surgery. Once your surgery is booked, you may want to have a second sizing of breast implants to be sure of the size you want. Prior to your surgery, you will be required to undergo a range of routine blood tests to provide the Cosmetic Surgeon with information necessary about your health status. You will also be required to take antibiotics for approxiamtley 7-10 days after your surgery; this will help to reduce the risk of infection.

Payment for your breast augmentation surgery is usually required in full prior to your surgery.

7. Where is the incision made for the breast implants?

The most common incision site for insertion of breast implants is in the crease under the breast where the scar can be hidden. Other less common locations for the incision are either around the nipples or under the armpits both of which are more complicated and carry more risks.

8. Do you recommend saline or silicone breast implants?

There are two main types of breast implants; saline and silicone. Saline breast implants are essentially an outer silicone shell filled with a saline fluid. These used to be the most common type of breast implant used but have become less liked due to the literal feeling of a “bag of water” rather than natural breast tissue. Silicone breast implants consist of an outer silicone shell containing a silicone gel; these are now more common due to their natural feel similar to breast tissue. In the uncommon event that a silicone breast implant ruptures, the silicone gel stays intact rather than spilling into the surrounding breast tissue.

The Cosmetic Surgeon will discuss both types of breast implants with you, outlining the advantages and disadvantages of each to allow you to make an informed decision.

9. I’ve heard of “furry Brazilian” breast implants – what are these?

The shell of silicone breast implants come in two types; smooth or textured. “Furry Brazilian” or P-URE for PolyUREthane breast implants originated from Brazil and are a textured layer on the outer surface of the breast implant. Breast implants are not a one type suits all; for some women a smooth breast implant will be the best option, for other women a textured breast implant will be the more suitable option. Again, this is something the Cosmetic Surgeon will discuss with you in detail so you can make an informed choice.

10. Will I still be able to breast feed after breast augmentation surgery?

Breast feeding can vary from female to female, irrespective of whether you have surgery for Breast augmentation or not. The instances where breast feeding may be affected is if the Incision is through the armpit or around the nipple areolar complex. Otherwise if the Incision is under the crease of the breast there is no Impact on the breast ductal structures or nerves supplying the, therefore most women should have the same chances of breast feeding as those women not having had the surgery.

11.Can breast cancer still be detected after breast augmentation surgery?

Yes. Various studies have been conducted and no evidence has been found that breast implants increase a woman’s risk of developing breast cancer. However, as the breast tissue volume thins under the influence of the breast Implant it has been found that breast cancer detection may be delayed by about 3 months. This does not change the overall prognosis of breast cancer once detected compared with women never having had breast augmentation surgery.

Whilst MRI scans are recommended in the USA every 2 years for women having had breast Implant surgery, this is not the case for women in Australia. Women are advised to perform routine self breast examinations, and carry out the required radiological investigations such as MRI, mammogram or ultrasound of their breasts. Any unusual lumps or findings should be brought to the attention of your cosmetic surgeon or at the least your family doctor for further Investigation.

Breast Augmentation Bare Aesthetics Video ( Requires Real Player media player)

Consultations with experienced breast augmentation specialist Cosmetic Surgeon Dr. Bobby Kumar in Sydney, Adelaide or Port Macquarie; contact us on (02) 9571 4850 or 0430 491 009.

One of the first questions I am frequently asked in a phone enquiry is what happens in an initial consultation regarding Breast Augmentation with Dr. Bobby Kumar, Cosmetic Surgeon.

1.            Questionnaire; on arrival for your Breast Augmentation consultation, you will be asked to complete a patient questionnaire incorporating biographical information, medical history and lifestyle information.

2.            Meet and consult with Dr. Bobby Kumar, Cosmetic Surgeon; Dr. Kumar will have a comprehensive discussion with you regarding the following:

• what you are seeking to achieve with Breast Augmentation surgery, including your reasons for pursuing surgery and what size and shape you are aiming to achieve
• how Breast Augmentation surgery is performed; different techniques, length of the procedure, planes of dissection
• risks and complications of Breast Augmentation surgery
• recovery from Breast Augmentation surgery and how to optimise results
• choices to make regarding incision site
• choices to make regarding the type of breast implants available (such as smooth vs textured breast implants, saline vs silicone breast implants, the size of breast implant and profile of breast implant)

3.            Medical Examination; Dr. Bobby Kumar will perform a medical examination, discussing with you the current appearance of your breasts and your chest anatomy.

4.            Physical measurements; Dr. Bobby Kumar will take several chest measurements (such as your chest diameter and diameter of your existing breast tissue) in order to provide                 information that aids the decision of what type, size and shape of breast implant will suit your overall size and body proportion, in addition to the appearance you are aiming  to achieve

5.            Sample breast implants; Dr. Bobby Kumar will show you a range of different types of breast implants and discuss what size, shape and profile will suit both your physique and what you are aiming to achieve. You will have the opportunity to place various sizes of breast implants into your bra to give you an idea of what size you would like if you were to pursue breast augmentation surgery.

6.            Photographs; Dr. Bobby Kumar will request your permission to take photographs of your chest area in order for a record of your existing appearance, size and shape and to provide him information necessary in planning your individual breast augmentation surgery.

7.            Answer questions; Dr. Bobby Kumar will be happy to answer any of your questions throughout the consultation and at the end after you have heard all the information. It can  be helpful to come with a list of questions you’ve prepared.

Following your consultation for Breast Augmentation surgery, you will be provided with further information for you to take home and read at your leisure and time to consider all the information you have received.

If you then decide that pursuing Breast Augmentation surgery is right for you, you can contact the Practice Manager and discuss how and when you would like to proceed.

For an experienced Cosmetic Surgeon performing Breast Augmentation in Sydney, Adelaide or Port Macquarie contact us on (02) 9571 4850 or 0430 491 009 for all appointments.

More and more patients in Adelaide, Sydney & Port Macquarie are seeking Tummy Tuck surgery (known medically as an Abdominoplasty) to address their concerns regarding their tummy area. Tummy tuck surgery is available to women and men and usually involves removing excess skin and tissue on the abdomen to achieve a flatter, tighter and more toned tummy. Many people feel self conscious about the tummy area and feel restricted in the type of clothes they can wear. Quite often patients are women who after pregnancy have a residual area or pocket of tissue and fat in the lower abdomen that does not respond to diet and exercise. Other common reasons for seeking Abdominoplasty surgery are patients who have lost a significant amount of weight and have residual excess skin and tissue.

Typically patients enquiring about tummy tucks in Adelaide, Sydney & Port Macquarie want an estimate of how much the procedure will cost. It is important to understand that there are different types of tummy tucks according to the size of the area, the amount of tissue and fat that requires removal and whether the underlying muscle also requires tightening. The complexity of the tummy tuck procedure has a bearing on the time taken to perform the procedure; this then also affects the costs involved, for example a longer operation incurs more theatre and anaesthetic costs. Tummy tuck surgery can take anywhere from 2.5 hours to 4.5 hours depending on the individual procedure and is usually performed under a general anaesthetic.

If you are considering tummy tuck surgery, the best course of action is to have a consultation with a Cosmetic Surgeon who will discuss with you your concerns, goals and your surgical options. The Cosmetic Surgeon will also discuss the incision site (usually placed in the lower abdomen so it can be concealed by underwear) and whether you may require a complimentary procedure, such as liposuction/liposculpture, to fine tune your contours and shape. The Cosmetic Surgeon will provide you with the costs for your procedure, including surgical fees, theatre/hospital fees and anaesthetic fees.

Actual Tummy Tuck Patient

Tummy tuck surgery can be done as a day only surgery, without the need to stay overnight in hospital. Patients are typically up and walking within hours of surgery, though care must be taken not to stand up too straight and stretch or put pressure on the incision site. Patients typically describe feeling like they’ve done a thousand sit ups and quite tight across the abdomen. Usually over the counter pain relief is sufficient and may only be needed for the first couple of days after Abdominoplasty. Most patients choose to take a couple of weeks off work. It is important to avoid any exercise or activity (e.g. lifting) that places the Incision area under any stress. Following surgery patients are required to wear a compression garment for anywhere up to 3 months; this promotes healing and adhering of the tissues for an optimal result.

It is important that tummy tuck surgery not be seen as a weight loss solution. Tummy tuck surgery is most successful when you are close to your optimal and stable weight and want to address residual skin or tissue that is not responsive to diet and exercise. The Cosmetic Surgeon is likely to recommend you lose excess weight prior to surgery with an appropriate diet and exercise plan.

As with any type of surgery, tummy tuck surgery comes with risks (such as infection, bleeding or swelling, skin and tissue loss and scarring) that need to be weighed against the benefits of surgery. The Cosmetic Surgeon will discuss these with you in detail so you can make an informed decision as to whether tummy tuck surgery is right for you.

Dr. Bobby A Kumar is a board certified Cosmetic Surgeon experienced in performing Mini Tummy Tucks to complete Body Lifts following significant weight loss. For more information visit www.bareaesthetics.com.au or call today for an appointment on (02) 9571 4850 or 0430 491 009 for Sydney,Adelaide and Port Macquarie.

Click here for a YouTube Video on Tummy Tuck

Tummy Tucks by Cosmetic Surgeon Dr Bobby Kumar

Breast Augmentation has not had any significant advances for a number of years. The techniques in performing Breast Enlargement surgery may vary slightly, yet the essence of creating a Breast pocket in which to insert an Implant is very much the same across the world.

Breast Enlargement by Cosmetic Surgeon Dr Bobby Kumar

There are potentially regional differences in surgical technique in trying to reduce complications such as Capsular Contracture rates, bleeding, haematoma’s and seromas. In Australia the capsular contracture rates are estimated to be around 3-5%. Whereas worldwide they may be as high as 14-16% as disclosed by recent studies by Allergan® in submission to the FDA.

Cleary there are specific cosmetic surgical nuances in Sydney and Adelaide that have helped reduce the Capsular contracture rates. Recent use of polyurethane breast Implants (“Furry Brazilian”) have for specific patients helped reduce capsular contracture rates down to an estimated 1%.

There is however a new revolution in performing breast augmentation or breast enlargement surgery. A device known as the “Keller Funnel” invented by Dr. Kevin Keller a board certified Cosmetic Plastic Surgeon has been released and used in the USA. It is currently awaiting TGA approval and maybe distributed by Medical Vision Australia.

Keller Funnel used for Breast Augmentation

The Keller Funnel is a cone shaped device similar in appearance and design as the icing sleeve used when preparing a cake. The funnel is designed to facilitate and help cosmetic surgeons insert a Silicone breast Implant into the prepared breast pocket.

The advantages of using the Keller Funnel are that it allows cosmetic surgeons to perform the breast Implantation through smaller incisions, perhaps as small as 3 centimetres. Currently Dr. Bobby Kumar is able to perform most breast augmentations through a 4 centimetre incisions.

The other advantages of this revolutionary device are that the breast Implant can be placed directly into the neck of the funnel without touching the breast Implant. Despite the surgical team working in a sterile environment and wearing sterile gloves, the “No touch” technique in performing breast Implantation with a Keller funnel reduces further any possibility of introducing an Infection into the breast pocket. This will help reduce the risk of Capsular contracture by reducing possibility of bacterial contamination.

No touch technique of Breast Augmentation

Additionally the funnel reduces the stress and trauma to both the patient and the breast Implant during breast enlargement surgery. During Implantation the breast Implant is encouraged into the breast pocket by using a finger to prod and push the Implant into the breast pocket. The potential risk of such an approach is unexpected rupture of the breast Implant or weakening of the Implant shell such that the Implant could rupture within the breast pocket at a later stage.

Also given the difficulty when Implanting certain breast Implants stress maybe placed on the tissues surrounding the Incision and the Cosmetic Surgeon maybe compelled to make the Incision larger to minimise the stress on the breast tissues and the Implant.

The funnel lowers these risks and has been recognised to have lowered the overall risks in breast augmentation surgery and therefore improved the success rates of the Cosmetic Surgeons utilising the Keller Funnel in the US.

The funnel is a cone shaped design; it is lined with a hydrophilic polymer coating which when wet the funnel becomes slippery such that the breast Implant is inserted into the widened neck of the device and by gently squeezing the funnel towards the narrow end which has been inserted into the breast incision the breast Implant squeezes out of the narrow end of the funnel into the breast pocket. This action results in a continuous and evenly distributed compressive force on the breast Implant, one which will not stress or damage the breast Implant itself.

Like Dr. Keller new and younger generation Cosmetic Surgeons like Dr. Bobby Kumar are used to using small incisions to perform breast enlargement surgery. The Keller funnel holds great hope for patients and Cosmetic surgeons alike that it will further improve the Aesthetic outcomes of breast augmentation surgery; minimise complications and long term risks such as capsular contracture and reduce the time taken to perform the breast Implantation.

Click here to watch Dr Kevin Keller talk about the Keller Funnel on YouTube

Patients in Sydney and Adelaide will have to wait till the TGA approves the use of the Keller Funnel. For more information contact us today on (02) 9571 4850 or 0430 491 009 or visit our site at www.bareaesthetics.com.au .

Once a woman has decided to undergo Breast Augmentation, there are several decisions she needs to make. First is selecting a Cosmetic Surgeon with the appropriate qualifications, training and experience. Next is choosing the right size and type of Breast Implant. The main decision regarding Breast Implants has previously been saline vs silicone, however now there are many other options to consider regarding shape and size. Your Cosmetic Surgeon is the best person to work with you to select the Breast Implant that suits your goals, body type and medical history. However, it is always sensible to be an educated consumer, research Breast Augmentation and go to your consultation ready with the questions you need answered. Here is some information to get you started on your research.

Breast Augmentation and Breast Enlargement

Components of a Breast Implant

The main components of a Breast Implant are the shell, the filler and the patch. The shell, also known as the lumen or the envelope, is made of silicone. The filler is the material contained in the shell and may be either saline or silicone. The patch covers where the filler was inserted in the shell.

Silicone Breast Implant - Round

Saline vs Silicone Breast Implants

Saline is sterile saltwater solution similar to the fluid that is naturally present in the body. Saline implants are generally known for being filled during surgery. This means the initial incision can be smaller, and some implants even allow for the volume to be adjusted after surgery through a valve in the implant. In other cases, saline implants come pre-filled at a given size from the manufacturer.

Criticism of saline Breast Implants includes the unnatural feel like a ‘bag of water’ and in some instances the ‘sloshing’ noise once it becomes a part of the body.

Silicone is an organic polymer that has a variety of medical uses including as Breast Implants. Silicone Breast Implants have become increasingly popular due to their resemblance in feel to natural breast tissue. The newer generations of silicone Breast Implants contain silicone that is designed to retain its integrity if the shell ruptures, therefore having less risk of spilling into surrounding tissue.

Polyurethane Breast Implants are also Silicone Implants except they have an outer “furry” coating made of polyurethane which helps with reducing capsular contractures.

Shape

Breast Implants vary in their size, shape and profile. Your Cosmetic Surgeon will discuss with you your goals and expectations, take measurements of your chest and bust, and make recommendations as to what type of Breast Implant will best meet your needs. For women with a smaller frame, Breast Implants with a narrower base may be most appropriate, as opposed to a wider base implant that would be appropriate for a woman with a wider chest. The profile of a Breast Implant impacts on projection and overall shape. You may also have heard of anatomical or teardrop shaped Breast Implants – these are designed to have more volume in the lower portion of the breast like a natural breast. Whilst a textured outside surface is designed to keep an anatomical implant in the right position, they often rotate and then require corrective surgery. Round implants are as they sound, with the same appearance from any angle even if their position changes. However; round Breast Implants can have a tear drop shape if placed under the muscle.

This is just some brief information about Breast Implants. For more thorough information, see our website at www.bareaesthetics.com.au or contact us to make a consultation on (02) 9571 4850 or 0430 491 009.

Dr. Bobby A Kumar is an experienced Cosmetic Surgeon who is experienced in performing Breast Augmentations or Breast Enlargement surgery.

Breast Augmentation by Dr. Bobby A Kumar Cosmetic Surgeon

Breast implants are most commonly used as an aesthetic enhancement in an individual who is lacking in natural breast tissue due to genetically predisposition or environmentally induced factors. Because breast tissue is primarily composed of fat cells, physicians in the past have attempted to inject fat (obtained through liposuction) into the breast. However, today, this is completely unacceptable due to calcification (complete hardening of the breast). Hormonal therapy may increase the natural breast size, slightly, but not enough for the majority of women.

Currently, the most common procedure to increase breast size is via breast implants. A breast implant is a sac of silicone elastomer that is either filled with saline or silicone, and is surgically implanted under the breast tissue. The proportion of the breast to body height and weight is taken into consideration, as is the chest width, location of nipple/areola complex, and cleavage. Because the concepts of aesthetics are constantly changing, there are many factors such as implant type, size, and site that should be tailored to the individuals’ specificity.

TYPE OF BREAST IMPLANT (Saline,Silicone or “Furry Brazilian”):
Silicone vs. saline? This discussion is going to remain for many years. The advantage of silicone implants is that it is softer and appears more natural. However, leaks may be found in secondary tissue. Generally, saline is a bit firmer, but it is without the supposed health risks because a leak is simply absorbed by the body. There has recently been the use of another type of Silicone Implant known as the “Furry Brazilian” or Polyurethane Implant. These Breast Implants are specifically designed for a small group of women. The decision should be made after consultation with an experienced Cosmetic surgeon.

LOCATION OF BREAST IMPLANT:
The breast implant can be placed either under the pectoralis major muscle (sub muscular) or on top of the muscle and under the breast glands (sub glandular). Sub muscular implants are more popular because they are less palpable, have lower risk of capsular contracture, and do not inhibit mammography. However, it requires more invasive surgery and longer healing time. Bodybuilders prefer sub-glandular insertion because the heavily developed pectoralis muscle might flatten the implant and there will be less projection of the breast. Women with sagging or drooping breasts may opt for a sub glandular placement to utilise the increased projection. Disadvantages of sub glandular implants include impairment of adequate mammography and an increased risk of capsular contraction.

Subglandular or Subpectoral

LOCATION OF INCISIONS:
There are four areas of incision:

1. Periareolar (lower part of areola 1-1/2 inches)

2. Inframammary (on the lower breast crease)

3. Axillary (armpits)

4. Transumbilical (from the bellybutton)

Each has advantages and disadvantages but the preferred incision is Inframammary because it is less noticeable. Arguments against the other approaches are that they are harder to perform; there is decreased sensation of the areola and violation of the breast tissue when approached via the Periareolar technique, there is increased risk of rupture, Infection and Capsular contracture with these other techniques.

SHAPE OF THE BREAST IMPLANT:
Most surgeons have experience with teardrop (natural implants) and with the round implants. Preference is toward the round implant because it appears more natural. Previously, there were high profile implants (which projected more) and low profile implants (less projection). Recently, medium profile implants were introduced.

HOW LONG DO BREAST IMPLANTS LAST:
There is no expiration date for implants. You should be checked by your Cosmetic Surgeon if there are any symptoms or changes that are not expected including deflation, infection, change of location, etc. Mammography, ultrasound, or MRI should be performed if any of these symptoms or signs occurs. Patients over the age of 50 years of age should have their standard Breast checks. Typically many women will consider replacing their Implants or having revisional surgery for breast changes that have occurred by 10-12 years; such as breast droop or a change in Implant size.

RISKS (not common but possible):
1. Capsular contraction: Scar tissue forms around the implant to form a hard shell. There are several steps to prevent it, such as, size and location of the implant.

2.Infection.

3. Shifting (moving) of the implant. The pocket for the implant should be adjusted for the patient (this will usually, prevent shifting).

4. Scars: Less conspicuous in the Inframammary incision.

5. Sensation: May be initially decreased. Usually 90% of sensation will return within 1-2 years of surgery.

6. Breast Feeding: About 50% of women won’t be able to successfully breast feed, particularly those with Periareolar incision.

7. Synmastia (also known as “kissing breast”), sometimes related to technique.

Synmastia or "Uni boob"

In general complications occur less when using an experienced and certified Cosmetic surgeon.

RESULTS:
Cosmetic Surgery is an art form in combination with science. Each patient and surgeon has a different sense of what is aesthetically pleasing (although the basics are common). During a consultation with a Cosmetic Surgeon, the goals of both the patient and surgeon should coincide and be realistic. The results are not entirely dependent on the surgeon. It is important to understand that everybody starts with differing anatomical breasts (some patients are better candidates than others) and there are always unforeseen factors.

Dr. Bobby A Kumar is a board certified cosmetic surgeon and he specialises in Breast Augmentation surgery. He has used all types of Breast Implants and is skilled in choosing the appropriate Implant to provide the optimal and aesthetically pleasing result for each patient and therefore does not prescribe to the “one size fits all” approach.

Bare Aesthetic Cosmetic Surgery Clinics are located in Sydney,Port Macquarie and Adelaide. For an appointment today contact our friendly practice manager Wendy on (02) 9571 4850 or 0430 491 009.

Bare Aesthetics Cosmetic Surgery Clinics

Breast Lift with Breast Implants

A woman’s breasts often define her femininity, and with the vast differences in shape, size, and appearance, breasts further help to define a woman’s individualism. The breasts undergo changes in response to factors such as genetics, aging, pregnancy and breast feeding, weight gain or loss, and hormonal fluctuations. All of these factors can cause the breast size and shape to change. These changes can be dissatisfying and can make women feel as if they are losing some of their femininity and youthful vitality.

Breast augmentation alone cannot restore the shape of the breasts for those women who have significantly “droopy” breasts. For those women who would like to have a breast enlargement to increase the size of their breasts as well as restore a firm, more upright position, a breast augmentation in combination with a breast lift can improve body contours and revitalize their appearance.

Incisions for the breast lift and breast augmentation are typically around the Nipple, or the Nipple and down the vertical part of the lower breast.

Mastopexy augmentation, or a breast lift augmentation, tightens the breast skin, lifts the nipple to a better height and increases the size for better upper chest fullness. My preference is a partial sub pectoral implant plane so the recovery from this surgery is a bit lengthier than just a breast lift. Most patients are able to return to work after two weeks and to the gym after 6-8 weeks.

Breast Lift and Breast Enlargement

Breast Lift/ Mastopexy Surgery (No Breast Implants)

Many patients complain to me about the droopiness of their breasts. Some are happy with the overall volume or size of their breasts, but feel they tend to wrinkle and fold in a bra. Mastopexy, or breast lift surgery, can reduce the skin excess and lift the saggy nipple to a more acceptable level. No breast implant is necessary if a patient is happy with her overall size. The surgery takes about 2-3 hours to perform and the recovery is about one week off from work.

Breast Reduction Surgery

Many women complain of back, shoulder and neck discomfort due to the large size of their breasts. Most Medical Insurance companies will cover some if not most of the cost of breast reduction surgery. I use my judgment along with the patient’s request to come up with the most proportional breast size.

Reduction mammaplasty can improve the shape and size of the breasts allowing one to wear lighter bras and camisoles. I prefer the Hall Findlay modification of a vertical scar breast reduction as I feel it gives the best projection and shape of the breast. Standard anchor reduction mammaplasty procedures result in flattening (“bottoming out”) and widening of the breast with time. I have found the vertical breast reduction retains a better shape over the years.

The surgery takes me about 3 hours to perform under general anesthesia. I usually combine some liposuction of the lateral chest to reduce the width of the breasts as well. The recovery is about one to 2 weeks off from work and 6-8 weeks away from the gym. The size change is apparent immediately; however postoperative swelling can take 6-8 weeks to settle after which patients can shop for a bra appropriate to their new breast size.

Breast Reduction Hall Findlay Vertical Reduction Technique

Male Breast Reduction/ Gynaecomastia Surgery

Some boys and men are bothered by excess fat and breast tissue known as Gynaecomastia. They are frequently very self conscious and will not take off their shirts at the beach. A solution is male breast reduction surgery, or subcutaneous mastectomy, a procedure that removes extra breast tissue and fat to give a more sculpted look to the male chest.

There are several techniques used such as liposuction alone, direct areolar tissue reduction surgery with a short peri areolar scar (Scar around the Nipple only), and full breast reduction surgery with scars around the nipple and along the chest (for very droopy breasts such as those in massive weight loss patients).

The full result is usually seen in a few weeks however scars take 6-12 months to completely mature and fade with time.

Male Breast Reduction Surgery (Gynaecomastia)

Cosmetic Surgeon Dr. Bobby Kumar performs all of these procedures. For a Consultation today in Sydney, Adelaide or Port Macquarie Contact us on (02) 9571 4850 or 0430 491 009. Otherwise visit www.bareaesthetics.com.au for more details.