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.

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

First impressions make a difference in our society and our faces convey much about who we are. Many men and women seek to enhance or restore their facial appearance to a more youthful and rejuvenated look in step with who they are on the inside.

The following are questions that I am frequently asked by men and women considering Facelift Surgery.

1. I don’t want to look strange or unnatural – is this avoidable in Facelift surgery?

In the hands of an experienced and talented Cosmetic Surgeon, natural and rejuvenated results are achievable with Facelift surgery.

Often the images that spring to mind when thinking about facelift surgery are the well known celebrities that look like they’ve spent a month in a wind tunnel and have distorted and unbalanced faces pulled too tightly and unnaturally. Other looks most patients wish to avoid are known as “moonface” or “catwoman”.

A skilled and knowledgeable Cosmetic Surgeon is able to deliver results that are natural and long lasting, taking potentially 10-15 years from your apparent age. Thorough preparation involving repeated consultations between the Cosmetic Surgeon and the patient are crucial in establishing a positive rapport, trust and a consensus as to appropriate expectations regarding the results and a foundation for an optimal outcome.

2. What should I expect from the recovery process from Facelift surgery?

Immediately after surgery, the Cosmetic Surgeon will apply dressings and bandaging that require replacing on a daily basis for the first two weeks. A bandage that wraps around the head, under the chin and over the ears, should be worn for 24 hours for the first six weeks after surgery, and then at night or at home for another 6 weeks. Stitches inserted by the Cosmetic Surgeon are usually removed within 1 – 2 weeks, depending on your healing and recovery.

Initial pain and discomfort is addressed with pain relief prescribed by the Cosmetic Surgeon and Anaesthetist. Initial bruising should resolve within one to two weeks after surgery. Swelling takes longer to resolve; up to 6 to 12 weeks.

You need to sleep on your back for approximately 6 weeks, supported by pillows at your sides to prevent you from turning on your side.

Improvements in your appearance can be noticeable as early as a week to two weeks, but optimal results are not seen until further down the track in your recovery as swelling resolves and the tissues heal.

3. Will the scars from the Facelift surgery be visible?

Again, this is depending on the skill and technique of the Cosmetic Surgeon (and one reason it pays to do your research and seek several opinions prior to choosing a Surgeon to perform your surgery). In the right hands, your incisions are carefully placed and hidden to avoid detection.

4. Does facelift surgery include lifting the eyes?

Facelift surgery addresses the loose and sagging skin and tissue of the face. Surgery to the eyes, known as Blepharoplasty, can be performed on either or both the upper and lower eyelids. This is often performed in conjunction with a Facelift to achieve the overall refreshed appearance sought by the patient. Facelift surgery may also be combined with neck lift surgery, specifically addressing the sagging skin and tissue on the neck area. A Browlift may also be recommended in conjunction with Facelift surgery to achieve a lift of the forehead and eye area.

These different procedures will be discussed with you at length by the Cosmetic Surgeon in light of what you want to achieve, your present appearance, and what procedure/s is/are most suitable to achieve your goals.

5. How long does Facelift surgery take?

Facelift surgery can take anywhere between 2 and 4 hours depending on what your particular surgery entails. It is usually performed under general anaesthetic.

6. I’ve heard of thread lift surgery for the face; is this a better and less invasive option to Facelift surgery?

In short this is not a better or less Invasive procedure.

Thread lift surgery involves the insertion of threads into the facial tissue which are then pulled tightly in an attempt to lift the skin and tissue. The threads have barbs placed along their length in order to provide grip on the tissues.

Unfortunately, whilst thread lifts are heavily promoted and marketed, patients who have pursued the procedure are inevitably unhappy with the results. This is partly due to thread lifts being performed on many patients who are not suitable candidates for the procedure. The procedure is also performed by medical practitioners who are not adequately qualified in performing surgery and lack a thorough understanding of the facial tissues, underlying muscles, nerve supply and blood supply.

Many of these patients then seek Facelift surgery to achieve the results they were originally seeking. Unfortunately, this poses significant difficulty for the Cosmetic Surgeon performing a Facelift as the threads are extremely difficult and time consuming to remove, adding time and complication to the Facelift procedure.

7. Will I require further procedures after the Facelift surgery?

No facelift surgery can offer an absolutely perfect result, and usually the Cosmetic Surgeon will discuss with you prior to surgery what further procedures may be required following surgery to enhance or maintain the results. For example, Dermal Fillers may be recommended after surgery to add volume to areas of the face such as the cheeks or lips to enhance a youthful appearance. Another recommendation may be the use of a Cosmetic Facial peel to resurface and rejuvenate the skin. Only ever pursue further facial treatments on the advise and recommendation of your Cosmetic Surgeon.

Looking after your skin and face will contribute to long lasting results. Discussing with your Cosmetic Surgeon your ongoing skincare regime and other treatments is important to achieving and maintaining the best results.

The over-riding message if you are considering Facelift surgery is to do your research, seek several surgical opinions. Choose a fully qualified  and experienced Cosmetic Surgeon with previous results that appeal to you and with whom you can build confidence and trust.

For a Face Lift or Neck Lift consultation contact Dr. Bobby Kumar at the Bare Aesthetics Cosmetic Surgery Clinics in Sydney or Adelaide on (02) 9571 4850 or 0430 491 009 or send us a request at www.bareaesthetics.com.au/contact-us.php

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.

The Top Cosmetic Surgery procedures for Men

Typically cosmetic surgery is normally associated with women having procedures such as Breast Augmentation, breast reductions and liposuction. If we discuss men having cosmetic surgery we normally think about well known male actors and celebrities such as Sylvester Stallone, Michael Jackson and Mickey Rourke. These men are not great examples of natural and aesthetic cosmetic surgery results. However; men do have great Cosmetic surgery results it is just that we hear about the extreme and ridiculous results performed on the infamous celebrities.

Statistics released in March 2011 by the American Society of Plastic Surgeons (ASPS) demonstrate that many more men are now becoming more conscious about their appearances and maintaining their appearances that they are now considering some form of Cosmetic surgery. The statistics revealed that the overall increase in cosmetic procedures in men increased by 2% in 2010 when compared to the previous year. Some procedures in particular like Facelift surgery rose by 14% and Liposuction increased by 7% in 2010.

The ASPS statistics for 2010 show that men underwent an increased number of Surgical and minimally invasive procedures; the increase in surgical procedures grew faster than the traditional minimally invasive treatments.

The increase in men having cosmetic surgery may be related to a number of factors; such as an increase in the general fashion and cosmetic industry and therefore an increase in the participation of men in requiring cosmeceuticals and that their requirements do not seem to be unusual or the domain of women. Also with the changes in workplace perceptions and socially men may feel the need to have a rejuvenated and youthful appearance as well as being fit and healthy. Men and women have shifted the age for when they are choosing to have children. As such men may feel that they are now ready, mature and financially capable enough to make the decision to have Cosmetic plastic Surgery.

Interestingly once the minimally invasive procedures such as Botox® or dermal fillers were popular with men. It is apparent that as men age, so do the tissues and the addition of gravity means that the tissues sag. Consequently a much more comprehensive surgical procedure is required and is necessary to lift and rejuvenate the body to show any significant improvement.

Top Ten Cosmetic Procedures for Men (as an increase in percentage)

The list comprises the fastest growing cosmetic procedures between 2009 and 2010.

1. Facelift – 14% increase

2. Otoplasty (Ear Surgery) – 11% increase

3. Dermal Fillers – 10% increase

4. Botox® – 9% increase

5. Liposuction – 7% increase

6. Male breast reduction (Gynaecomastia) – 6% increase

7. Eyelid surgery (Blepharoplasty) – 4% increase

8. Dermabrasion – 4% increase

9. Laser hair removal -4% increase

10. Laser vein treatment – 4% increase

Top Ten Cosmetic Procedures for Men in 2010 (By Volume)

The top 5 Cosmetic Surgical Procedures (Invasive)

1) Rhinoplasty (Nose surgery) - 64,000
2) Eyelid Surgery (Blepharoplasty) – 31,000
3) Liposuction/Liposculpture – 24,000
4) Male Breast Reduction (Gynaecomastia surgery) – 18,000
5) Hair Transplantation – 13,000

The Top Five Cosmetic Minimally-Invasive Procedures

1) Botox ® – 337,000
2) Laser Hair Removal – 165,000
3) Microdermabrasion – 158,000
4) Chemical Peel – 90,000
5) Dermal Fillers – 78,000

The majority of cosmetic surgery clinics show that whilst there are high profile men having cosmetic surgery, clearly many more men are “average” males who are looking to improve their looks and therefore to look as good as they feel. Many of these men are normally seen as tough male role models such as firemen, plumbers and bricklayers.

There are the men who are still quite physically active, perhaps approaching retirement who still wish to have a rejuvenated appearance to go along with their active lifestyle. It is not unusual in my practice to perform a combined Facelift, neck lift as well as an eyelid lift for mature men seeking to reverse the effects of the sun, genetic aging and gravity and to create a rejuvenated face and neck.

After having performed the cosmetic surgery procedure, it is not uncommon to observe a new invigorated male patient. The procedure itself appears to have provided a greater sense of self confidence; male breast reduction is such an example. Many males with large breasts commonly known as “man boobs” are often reluctant to go to the beach or engage in any social activity where they need to remove their shirt.

Following male breast reduction surgery most patients are motivated to join gyms to improve their general health, wellbeing and fitness levels. They have an increased desire to lose weight and build muscle to match their improved chest/breast area.

Many of these men have very supporting partners often of similar age, which is contrary to the popular perception that these are men with much younger partners. In my practice many of these women will not have had any cosmetic procedures or surgery, and so this has not been a natural or expected transition for their male partner to consider cosmetic surgery. It is a choice that these men make to help them maintain a rejuvenated, natural and aesthetically pleasing appearance for themselves and sometimes for their partners as well.

If you are looking for an experienced and skilled Cosmetic Surgeon who performs male cosmetic surgery procedures and non-invasive procedures such as Botox® and dermal fillers then contact Dr. Bobby Kumar today on (02) 9571 4850 or 0430 491 009 for an appointment at the Bareaesthetics Cosmetic Surgery clinics (Sydney,Port Macquarie or Adelaide).

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 .

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.