Before you decide to pursue breast implant surgery, there are some important factors you should consider. As with any type of surgery, it is imperative that you completely understand the entire process, from your initial consultation and preoperative planning, to the operation itself and post operative care and follow up. The first step is to have a consultation with a qualified and experienced Cosmetic Surgeon. During your initial consultation, your Cosmetic Surgeon will discuss and explain to you everything you need to know about the surgery. You will be provided with information about what will happen before, during and after your breast implant surgery. Your Cosmetic Surgeon will make recommendations about what you can achieve in light of your desires and expectations.

Part of your discussion with your Cosmetic surgeon is choosing the breast implant that is right for you. There are two main types of breast implants; saline and silicone. Saline breast implants are a silicone elastomer shell filled with sterile saline liquid. Their main advantage is that the saline is consistent with normal bodily fluid in the case of shell rupture or leakage. A disadvantage is that saline implants have a less natural feel, like a bag of water rather than soft breast tissue. In contrast, silicone implants have a silicone shell filled with a viscous silicone gel and women tend to prefer the softer, more natural feel of silicone implants. Other variations in implant include size, shape and profile. Factors that will be discussed by the Cosmetic Surgeon regarding the choice of breast implant include your skin type, amount of existing breast tissue, position of the breasts, and the size of the chest and your overall body type and shape. In the end, the type of breast implant that you choose for breast surgery should be based on your desires and needs in addition to the recommendation and advice of your Cosmetic Surgeon.

Prior to breast implant surgery, you will be required to undergo a medical examination in addition to blood tests to inform the Cosmetic Surgeon as to your existing health and plan for surgery. The tests are also done to identify any possible complicating factors or risks that can affect the procedure, your recovery and the eventual result. As for the surgery itself, it usually takes one to two hours. This will be influenced by the complexity of your particular surgery, the surgical technique required and incision types. Following breast implant surgery, you will be required to return to your Cosmetic Surgeon for post operative follow ups for monitoring of your recovery and results. Women are generally able to return to normal activities in 1 to 2 weeks, with avoidance of some activities such as lifting or upper body exercise for 6 weeks. Scars will gradually heal and fade with time.

Breast implants vary in terms of their shape, size, projection, structure, composition and shell. All the different types of implants have a basic structure of a shell and filler. The breast implant shell can vary in its composition, surface and thickness; for example a smooth shell compared with a textured or ‘fuzzy’ shell. Textured breast implants have been heavily promoted in recent years. They are a suitable option for some women but not usually appropriate for everyone.

The filler inside the shell can include the following; saline, silicone gel, silicone-saline combination. The most commonly used breast implants consist of either saline or silicone. A saline breast implant is composed of a silicone elastomer shell filled with saline solution. The saline solution is similar in composition to body fluids and this is the main reason that it is considered ‘safer’; in the unfortunate event that the breast implant ruptures or leaks; the saline solution is simply absorbed by the body without serious health risks. Saline breast implants are inserted into the breast tissue empty (thus potentially resulting in a smaller incision and scar) and once secured in place, the breast implant is then filled with the sterile saline solution. The main disadvantage of saline breast implants is that they feel like a bag of water rather than the feel of natural breast tissue.

Silicone breast implants consist of an elastomer silicone outer shell filled with silicone gel. The advantage of this type of implant is that they look and feel more natural, like breast tissue, compared to other types of breast implants. Over the years, silicone breast implants have significantly improved. For example, a more cohesive silicone gel is used. This increased cohesiveness means the implant is less susceptible to losing its shape and ‘rippling’.

The size of breast implants is measured in various ways. Firstly the volume is measured in cc’s, for example a 300cc implant v’s a 400cc implant. Another important measurement is the diameter of the breast implants; that is, the width of the base of the implant. Breast implants can also differ in terms of their projection and resulting profile. There are some occasions where a higher profile may be used to achieve a degree of breast lift.

There are two main shapes of breast implant, round v’s anatomical or tear drop. Round breast implants are the more common, with a risk and drawback of anatomical breast implants is their potential to shift and rotate in the breast, an issue that can then only be corrected by further surgery.

As you would imagine, breast implants are certainly not a ‘one size fits all’ scenario. For one, women have different ideas of what they want according to size and shape. It is also important to understand the role your Cosmetic Surgeon plays in helping you decide what type of breast implant you choose. In your consultation, the Cosmetic Surgeon will perform a thorough medical examination of your chest, including taking a range of measurements. These measurements provide the Cosmetic Surgeon with information as to what diameter, size and projection may be appropriate for your body size and shape in light of what look you want to achieve. It is always advisable to seek expert advice to enable you to make an informed decision, such as from a fully qualified and experienced Cosmetic Surgeon. Finding a Cosmetic Surgeon whom you trust and with whom you can have open and candid discussions is crucial to you obtaining the information you require and ultimately the most satisfying result.

Like any surgery, breast Implant surgery has risks and complications. Potential issues may include hardening of the breasts, uneven breasts, infection and rippling. These risks are minimised when surgery is performed by an experienced and fully qualified Cosmetic Surgeon.

Many women undergo breast augmentation after deciding the potential benefits outweigh the potential risks. These benefits may include:

• Restoration of breast shape/size; factors such as age, weight loss, pregnancy and breastfeeding can result in loss of breast volume or sagging of the breasts. Breast Implants can be used to restore and enhance breast volume and shape.
• Balancing body proportion; many women choose breast augmentation surgery to create body contours and a “bust line” in proportion to their overall body shape
• Increased self-confidence, including confidence dressing and shopping for clothes

There are also many myths and misconceptions about breast Implants. The prestigious MAYO clinic in the USA have dispelled the myths and misconceptions surrounding breast Implants, these include;

• Higher risks of breast cancer – there is no evidence that breast Implants increases the risks of breast cancer. A large retrospective study could find no increased incidence of breast cancer in women with breast Implants. The Silicone of the Implants does not promote breast cancer disease in women. However; Women should always continue to have their breasts checked. Mammograms can be performed with breast Implants.

• There is no higher risk of inducing autoimmune diseases in women with breast Implants. The silicone of breast Implants that have ruptured, leaked or bled does not pose a systemic risk and therefore has not been found to induce autoimmune diseases such as rheumatoid arthritis, SLE or DLE.

• If breast augmentation is correctly performed, with minimal tissue trauma then the loss of nipple sensation and the ability to breast feed is uncommon.

• Breast Implants do not have an Infinite shelf life. Women will require further surgery at some stage of their life (usually 10-12 years or more) for various reasons. Typically the reasons may include change in size of breast Implants as women age, breast lift due to eventual sagging of the breasts. Occurrence of capsular contracture around the breast Implant, and in a few cases complete removal of the breast Implants.

All these issues can be discussed in full in a consultation with a Cosmetic Surgeon. Most women seek a natural appearance as opposed to the ‘Implanted’ look often seen in America or among celebrity “boob jobs”. Creating a natural appearance is also a skill of an experienced Cosmetic Surgeon, both in evaluating and recommending the type and size of Implants based on your size, shape and goals, and in performing the surgery.

Breast augmentation using breast implants, typically silicone implants, is currently the most popular and common cosmetic surgery performed in Sydney. This procedure involves the insertion of implants to enlarge and enhance a woman’s breasts. This requires only a few days of recovery and has very good rates of success and high satisfaction.

Liposuction has been so far the most popular cosmetic surgery procedure in Sydney to achieve immediate sculptured and defined bodies, particularly following weight loss programs. It is not surprising therefore, that both men and women consider Cosmetic Surgery to improve their self confidence and more importantly for some, for health reasons. Sydney patients importantly consider the length of time to recover and any possible adverse effects and consequently they achieve realistic and desired results. Liposuction as a form of cosmetic surgery is commonly performed on women and men on their abdomen, buttocks, hips, thighs, and upper arms.

Another procedure in Sydney that is very popular among women following weight loss and pregnancy and men after significant weight loss is a tummy tuck (Abdominoplasty). This is performed when liposuction or other cosmetic surgery, weight loss or exercise alone will not address the sagging abdominal skin and spreading abdominal muscles. A Tummy Tuck tightens the lax skin and abdominal muscles, creating a defined abdomen. The scar is located below the underwear line and is easily hidden by clothing. Tummy Tuck scars typically fade to a fine scar with care and appropriate scar management.

Rhinoplasty, commonly called a “nose job”, is another popular cosmetic surgery in Sydney where the nose is reshaped, producing an aesthetic and attractive nose and therefore facial features. The nose is an important and central feature of the face. Trauma or normal aberrations of the nose can result in a loss of self confidence by patients seeking Rhinoplasty surgery. Patients in Sydney who undergo Rhinoplasty either want to enhance, change the shape or augment their nose.  Rhinoplasty alone may not correct breathing problems; these patients will need to seek the advice from an Ear, Nose and Throat surgeon to help improve breathing difficulties.

Other common cosmetic surgeries in Sydney are face and neck lift and breast reduction (reduction mammaplasty). Face and neck lift surgery are performed for patients seeking a longer term result while breast reduction decreases the breast volume and shape to a natural, perky shape. It removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body weight.

For most patients in Sydney, the decision to undergo cosmetic surgery is a significant and important step. Often it is an attempt to enhance, improve or correct a patient’s self image but it could also be to resolve an underlying medical condition. More importantly, the patient makes an informed decision and is under the care of a professional who is qualified to perform cosmetic surgery be it in Sydney or elsewhere in Australia.

Patients often find they appear rejuvenated to others, with final results being aesthetic and natural. Unlike the excesses of Cosmetic Surgery performed overseas in countries such as the USA, patients in Sydney and Australia prefer an enhanced, rejuvenated, beautiful and natural result.

Women who are considering Breast lift surgery must bear in mind that its overall success and safety depends on complete candidness during the initial consultation. The Cosmetic Surgeon will ask you a number of questions regarding your health and lifestyle. Other pertinent questions that you may need to answer include why you want the surgery, your expectations and desired outcome. Prior to the surgery, you may be required to undergo a medical examination or get pathology testing, quit smoking, refrain from taking aspirin and anti-inflammatory drugs as these increase the risk of bleeding.

As for the breast lift procedure itself, the surgery can be done by several techniques and incision patterns, such as the “ice cream cone” or “lollipop” incisions. However, the appropriate technique will depend on your breast size and shape, the degree of sagging, the position of your areolas (coloured part of the Nipple) as well as the skin quality and elasticity, which will have been discussed with you in your consultation. The initial step in surgery involves the use of intravenous sedation or general anaesthesia. Once you are properly sedated, the Cosmetic Surgeon makes the necessary incisions. Then the underlying breast tissue is lifted and reshaped, and the nipple and the areola are repositioned to a normal height. Excess skin is removed to address the loss of elasticity. Then the incisions are closed.

The incision lines are usually concealed in the natural breast contours but others may be visible on the surface of the breast. Incision lines are permanent but in the majority of cases, they tend to fade and improve over time. The Cosmetic Surgeon will advise you on the best post operative care of scars for the best results. After the breast lift procedure is completed, dressings or bandages will be applied to the incisions. Your Cosmetic Surgeon will advise you to wear either an elastic bandage or a support bra to minimize the swelling and support the tissues as they heal. In some cases, there may be a small tube placed temporarily under the skin to drain any excess blood or fluid that may accumulate.

Prior to your discharge from hospital, your Cosmetic Surgeon will give you specific instructions on how to care for your breasts for optimum healing; you will also be prescribed certain medications to aid the healing process and to minimize the risk of infection. Usually most women recover from surgery within 1-2 weeks. The final outcome of your breast lift will be evident over the next couple of months as breast shape and position continue to settle. The results of your breast lift surgery of uplifted and shapely breasts will be long-lasting.

Before surgery

As with any surgical procedure, the certified Cosmetic Surgeon will see you for a consultation to evaluate your needs and goals. This includes a physical examination and a thorough review of your medical history and status. In your consultation, your Cosmetic Surgeon will discuss and describe the appropriate technique and plan for you. The amount of skin and fatty tissue requiring removal and underlying muscle weakness can be determined through a physical examination. The Matarasso Classification is used to identify the types of tummy tuck required. The presence of underlying hernias may also be investigated with referral for an ultrasound. An ideal and stable weight is desirable prior to surgery with a history of a healthy diet and regular exercise. Tummy tuck surgery should not be viewed as a weight loss strategy.

During the surgery

Tummy tucks are performed by a certified Cosmetic Surgeon under general anaesthetic. The incision will be made a few inches below the belly button; for women an old caesarian incision can be utilized. Excess skin and fatty tissue between the incision and the belly button is then removed. To produce a tighter appearance, the muscle from each side of the tummy will be pulled and stitched together. Depending on the amount of skin and fatty tissue removed, the belly button may be reshaped and created to fit the newly tightened stomach. The tummy tuck procedure can take between 2 and 4 hours depending on the complexity and extent of the surgery.

After the surgery

Recovery from tummy tuck surgery usually takes up to 6 to 8 weeks. Usually patients take a couple of weeks off work. It is important to rest following surgery. It is also important not to place the incision and stitches under any tension or pressure. The wound and tummy may be painful and tight (often described as if you had just done a thousand sit ups) and cause the patient to bend at the hips to sleep and walk. It may take a couple of weeks for this pain to subside and the patient to feel comfortable standing up straight. Following surgery, a compression garment is to be worn for 6 to 8 weeks (or more) to provide support to the tummy and provide maximum adherence of the skin and underlying tissue; this facilitates a successful result. The incision scars are placed in areas usually covered by underwear. Eventually these scars will lighten.

Typically patients who have had a tummy tuck describe a high degree of satisfaction with their new body shape and tone, giving them increased confidence in their appearance and choosing flattering clothes.

For more information, contact a certified Cosmetic Surgeon.

Men and women have different reasons for pursuing Cosmetic Surgery, whether it is to achieve a more youthful appearance to reflect one’s outlook and personality, to achieve a certain body proportion or shape, or to restore or rejuvenate one’s appearance. Often patients are everyday people seeking to restore their body shape, sometimes after significant weight loss or often mums who want their bodies to return to their pre-pregnancy shape and size. What is important for a person considering Cosmetic Surgery is that the individual is doing it for himself or herself and not for other people. It is also vital to have realistic goals and expectations of what Cosmetic Surgery can achieve, and a certified Cosmetic Surgeon will discuss your goals and potential outcomes of Cosmetic Surgery with you in detail.

People who have had successful Cosmetic Surgery describe an increase in their self-esteem and self confidence, which has a positive impact on their everyday interactions in work and social situations.

Types of Cosmetic Surgery

There are various types of Cosmetic Surgery. These include:

• Breast augmentation – also known as breast implants or breast enlargement. This surgery involves insertion of breast implants into the breast tissue to enhance the size and shape of the breasts. Breast augmentation may be sought by women wishing to increase the size of their breasts or restore previous volume and shape prior to weight loss or pregnancy and breast feeding.

• Breast lift – involves lifting of the breast to address sagging or drooping and may be performed in conjunction with a breast augmentation. Again, this surgery may be appropriate for women seeking to restore previous shape prior to pregnancy and breast feeding or weight loss.

• Breast reduction – surgery to reduce the size and reshape the breast, often pursued by women who are suffering back and neck pain and general discomfort. This is also pursued by men to address “man boobs”. This procedure may also involve liposuction.

• Face lift and/or Neck lift – surgery sought by men and women to rejuvenate the face and neck area by tightening, lifting and redraping skin and the underlying tissue. Good technique and surgical skill ensures a natural looking result rather than a ‘windswept’ appearance.

• Eyelid surgery – technically known as blepharoplasty. This procedure for men or women is used to address excess skin and tissue in the eye area, either on the upper eyelid or lower eyelid.

• Abdominoplasty – commonly known as tummy tuck. This surgery addresses the shape and tone of the tummy area, typically sought by men and women who have lost a significant amount of weight and require removal of excess skin and tissue, or by mums who have residual skin and tissue after pregnancy. This surgery may also include liposuction.

• Liposuction – also known as liposculpture. This surgery involves removal of fatty tissue through a process of suctioning and is particularly useful for men and women who have achieved an optimal and stable weight and have residual areas of fatty tissue not resolved through diet or exercise. Liposuction may be performed in the tummy area, flanks, thighs or arms.

• Rhinoplasty – this is nose surgery sought by men and women for either aesthetic or structural repair reasons. Balancing the size and shape of the nose to the face is the common motivation to pursue Rhinoplasty.

• Otoplasty – ear surgery for either men or women, primarily addressing the size, shape and prominence of the ears in proportion to the head.

• Labiaplasty – also known as Labioplasty. This is a surgical procedure to reduce the size and enhance the shape and appearance of the labia.

There are also a range of non-surgical procedures to rejuvenate and freshen the appearance of the face. These include use of anti-wrinkle injections, such as Botox® or dermal fillers, such as Juvederm®.

Whether through pursuing Cosmetic Surgery or non-surgical Cosmetic procedures, there are many ways to rejuvenate and refresh your appearance. Your certified Cosmetic Surgeon will provide you with more information in a consultation.

Skin changes with age in the following ways:

• the skin becomes thinner, making it more fragile and vulnerable to damage and irritation from environmental factors
• the skin loses strength and elasticity due to the breakdown of collagen and elastin
• the skin’s ability to hold moisture reduces resulting in skin becoming drier and looser
• the skin loses underlying fat, reducing skin tone and smoothness
• blood vessels decrease, causing a loss in colour and glow
• sebaceous glands are less active, reducing the skin’s natural protective oily layer and making it more dry

How your skin ages is related to your genetics, your repetitive facial movements and gravity. The skins aging process is also caused and exacerbated by a number of environmental factors, including:

• sun and UV radiation exposure
• cigarette smoking
• stress
• poor nutrition
• extreme changes in temperature

Most premature aging is caused by sun exposure, with visible signs including wrinkles, freckles, age spots, spider veins, rough and leathery skin, loose skin and a blotchy complexion. Cigarette smoking causes biochemical changes in the body that accelerate aging, increasing the development of wrinkles, leathery skin and a yellowish complexion. Smokers often have tell-tale signs of their habit written on their face, including increased and deep lines around the mouth.

For women and men wanting to address the visible signs of aging, there are a range of treatments available. These range from short term treatments using products such as Botox ® and dermal fillers, (such as Juvederm® and Restylane®) to more longer lasting results from Cosmetic Surgery such as Facelift, Necklift, Browlift or Blepharoplasty (eyelid surgery).

Botox ® is used to smooth mild to moderate lines and wrinkles, such as glabellar lines (vertical frown lines between the eyebrows that look like the number “11”), crowsfeet (wrinkles around the outer corners of the eyes) or forehead worry lines. Botox ® works by inhibiting the activity of a given muscle by blocking nerve impulses that cause the muscle to contract and create a wrinkle, resulting in a smoother appearance. Optimal results are usually visible within 2 weeks of treatment and last up to 4 months.

The exact number of units of Botox ® required varies from person to person, as well as, being a male or female. It is not unusual for adjustment doses after the 2 week period as there is no exact formula when injecting Botox ®.

Dermal fillers, such as Juvederm® and Restylane®, are also used to reverse the effects of aging by adding volume to specific areas to either eliminate wrinkles or enhance features. Many women and men choose to have Juvederm® and Restylane® to smooth and soften the nasolabial folds, the creases that extend from the edges of the nose to the corners of the mouth. Alternatively, people choose to enhance features, such as their lips or cheek bones. Dermal fillers may also be used under the eye area to address a gaunt appearance due to fat or tissue loss by using thicker forms of Juvederm® and Restylane® . Dermal fillers work by lifting and adding volume to an area, therefore lifting and smoothing lines and wrinkles.

For longer lasting results, many women and men choose a surgical option, such as Face lift, Neck lift, Brow lift and/or Blepharoplasty (eyelid surgery). These Cosmetic Surgery procedures essentially seek to create a more youthful appearance by addressing wrinkles, lines and loose skin and underlying soft tissue.

You can help to prevent the visible signs of aging by avoiding sun and UV damage by always wearing sun protection and wearing a hat, and avoiding cigarette smoking.

The Cosmetic Surgeon

• Is the Cosmetic Surgeon a fellow of and certified by the Australasian College of Cosmetic Surgery?
• What is the Cosmetic Surgeon’s background and experience in Cosmetic Surgery?
• Where did the Cosmetic Surgeon undergo his Cosmetic Surgery training?
• What are typical results the Cosmetic Surgeon has achieved?
• Where does the Cosmetic Surgeon operate and conduct procedures, particularly with regard to the quality of the facility and the team taking care of you?
• Does he have a nice practice staff?

Your needs

• Does the Cosmetic Surgeon make an effort to discuss with you your goals, what a Cosmetic procedure can achieve and what are realistic expectations?
• Does the Cosmetic Surgeon discuss whether you are an appropriate candidate for Cosmetic Surgery?
• Do you feel comfortable asking questions? Does the Cosmetic Surgeon seek to answer all your questions and explain your options?
• What kind of post operative follow up is available?

You will find that different Cosmetic Surgeon’s will have different fees and costs. Some Cosmetic Surgeons choose not to give prices over the phone. This should not necessarily be viewed as being evasive as there are various reasons why a quote without a consultation may not be appropriate. For example, you may be enquiring about one procedure when in fact another different procedure may be more appropriate. A good Cosmetic Surgeon will recommend a face to face consultation where you can discuss what you are seeking to achieve and what your options may be. Only based on this information and the recommendations of the Cosmetic Surgeon can an accurate quote for Cosmetic Surgery be provided to you.

There are Cosmetic Surgeon’s who will be offering surgery at cheaper prices. Just bare in mind that you get what you pay for.

Are you a good candidate for Cosmetic Surgery?

The best candidate for Cosmetic Surgery is informed – informed about their body, their goals, their options, and benefits and risks of Cosmetic Surgery. A person who is indecisive and just getting an idea or satisfying their curiosity about Cosmetic Surgery is not a good candidate. Having Cosmetic Surgery, as with any surgery, is a major commitment. An informed candidate understands what to expect and their responsibilities after the surgery. It is also important that a person considering Cosmetic Surgery has realistic expectations. A good Cosmetic Surgeon will discuss your goals and what can realistically be achieved by surgery in your consultation.

A person with underlying emotional issues is not a good candidate for Cosmetic Surgery. A good Cosmetic Surgeon will ask you questions in the consultation to evaluate your goals and reasons to pursue Cosmetic Surgery. An individual should elect to have Cosmetic Surgery to look and feel healthier and not as a means of fixing underlying emotional issues.

Prior to pursuing Face Lift surgery, there are various things to consider.

It is important to seek a consultation with a certified practicing Cosmetic Surgeon who is experienced in performing Face Lift surgery and can provide information about the various techniques available. Face lift surgery should not be a ‘one size fits all’ approach. Each individual’s characteristics and concerns should be evaluated by the Cosmetic Surgeon. For example, for one person a brow lift and blepharoplasty (eyelid surgery) may be recommended to address a heavy brow and sagging eye tissues. For another person, a face lift including a neck lift might be more appropriate to address sagging cheeks and jowls. For yet another person, the Cosmetic Surgeon may recommend a face lift with a blepharoplasty.

Face lift surgery should not result in a wind swept, stretched or tight look. An experienced Cosmetic Surgeon will seek a natural looking result that addresses lines and wrinkles without over stretching or pulling the facial tissues. It is also important to discuss with the surgeon where the incisions are placed. Again, an experienced Cosmetic surgeon will seek to hide the incision, for example behind the ear.

The use of ‘thread lift’ surgery is becoming more common. This type of procedure should be approached with caution as it is only suitable for a very limited range of patients and only addresses the sagging skin not the underlying soft tissue. Often patients who have had threads later seek face lift surgery, describing dissatisfaction with short term or minimal effect of the threads. Alternatively thread lifts can produce the “windswept” appearance and injure underlying nerves and structures.

This then presents complications for face lift surgery as the Cosmetic Surgeon has to work around or remove the threads, a difficult and complicated procedure. Patients seeking to address lines and wrinkles on their face with a surgical option need to carefully consider the available options, remembering to evaluate the potential effects and duration.

Some people choose to address lines and wrinkles through less invasive, non surgical options. These include anti wrinkle injections such as Botox® or dermal fillers such as Juvederm® or Restylane®. The effects of these products can be up to 3 months for Botox® or up to 12 months for dermal fillers like Juvederm® or Restylane®. These products may also be used by a Cosmetic Surgeon to enhance Face Lift surgery.