Breast Augmentation Melbourne
Dr. Lanzer has been performing breast augmentation for over 20 years. Initially, we therefore asked him to explain to us what have been the trends in breast augmentation. For many years I was performing fat transfer to the breasts. The difficulties with fat transfer are that sometimes it can be unpredictable and the fat may not last and the procedure would have to be repeated. There are different types of breasts that seem to have been more responsive to fat. One of the problems is that sometimes people who really could do with fat do not actually have fat elsewhere on their body. The relationship of the fat in the breasts and the fat in the body is quite interesting since we know that when one performs a liposuction of the whole body, if a person puts on weight, sometimes the place where the fat comes back to is actually in the breasts and the patient has developed a larger breast. Of course, one cannot rely on this as this is not always consistent. Currently, the main medical defense insurance of Australia has decided not to cover surgeons who perform fat transfer to the breast. This may change in the future. The concerns relate to fat necrosis and possibly affecting future breast cancer. Fat transfer to breasts cannot cause breast cancer but it may make reading future mammograms more difficult. The exact area to inject fat on the breasts is also under discussion. Some surgeons prefer to inject deep under the muscle, others under the breast, and others all the way through the breast tissue. The breast is made up of combination of fibrous tissue, breast glands, and fat. We have known for many years about the extensive fat collection in the breast since we perform breast reduction through liposuction alone which actually sucks out the fat of the breast.
WHY CHOOSE SALINE IMPLANTS?
The trends in breast augmentation, particularly when one compares Australia and Melbourne compared to the United States, show a lot of differences. In Australia, silicone has become the most popular implant. The main reason for that is that when one holds the implant in one’s hand, the silicone certainly feels more natural and more like a breast than does a saline implant. However, when the saline implant is placed deep on the chest wall underneath the chest muscle, it is almost impossible to tell the difference between the two. In America, silicone implants were banned for many years because of the unknown complications related to the leak of silicone. Silicone implants have become better. The risk of leaking is less. Therefore, the popularity has increased. Having said that, every few years, a new risk or complication related to breast implant products has been reported. Therefore, there is probably nothing wrong with being extra cautious and just sticking to the saline implants. We have found that the moderate profile circular implants suit most breasts. I had a close look at the safety profile of plastic surgeon Ted Eisenberg in Philadelphia, America. He has been performing breast implants for many years and offers both silicone and saline. His strong preference is saline implants based on his safety profile and on the safety of the product. In his study, the risk of contracture where the breast implants become surrounded by a painful fibrous capsule is extremely low as is the risk of leakage and perforation.
WHAT ARE THE ADVANTAGES OF SALINE IMPLANT?
1.The first advantage of saline implants is that it contains a non-toxic product. Saline is essentially water and if there is a perforation, there is no risk to the body.
2.Saline implants are very strong. The saline implant can withstand extremely strong pressure and would have no problem with a mammogram. Patients can horse ride and jump on the breasts. This does not usually cause them to break. A needle however into the breast would perforate the bag immediately.
3.Smaller incision. Since the implant is actually filled when it is inside the body under the muscle, therefore, the incision size can be quite small as opposed to a full size implant that must be placed in the body. When using a silicone implant, there is a recommendation to use a Keller applicator tube to reduce the risk of complications associated with the implant.
4.Different products have different risks of rippling. The chosen method is to place the implant deep under the muscle so that it is not that visible on the surface in which case rippling should be less frequent.
HOW DOES ONE DETERMINE WHAT SIZE IMPLANT THEY SHOULD HAVE?
Choosing an implant size can sometimes be difficult for a patient. It is often not easy to imagine how a larger breast would look on themselves. There are digital photography methods that can help patients. However, these are not a guarantee that one will get exactly what they want either. One of the main problems is that there no absolute consistent measurement for breast implants or bras. I find it quite interesting that patients often come in saying that they are a particular size and other patients with almost the exact same breast could claim a different size of almost 2 or 3 sizes different. For instance, a person might have a size D and they call it a B whereas another person calls it an F. there is no simple way to measure the volume of breast. When I perform liposuction breast reduction we did use a test of displacing water in a bowl with the breast but this also was very inaccurate. The safest approach with patients is for them to look at photographs and to ask them what size they would like based on what size they feel they are now. There is a general rule 200 mL of volume of the saline implant would expect to expand the breast by 1 size. Other factors that need to be taken into account is the distance from the nipple to the fold under the breast. If this a larger distance, then the breast would need a bigger volume. A further factor to take into account is if the patient has had pregnancies in the past. A breast that has gone through pregnancy tends to be looser. Therefore, more volume is required to increase the breast by a certain size. Dr. Lanzer has developed a scale for the breast which is available in his Melbourne and Sydney offices. This scale is used to help predict the increased size with breast implants.
HOW ELSE CAN ONE ASSESS AN IMPLANT?
In Dr. Lanzer’s Melbourne Surgery, he also offers patients the ability to see, feel, and observe a person who has had the implant. This has been Dr. Lanzer’s practice in a lot of areas of medicine which have been new. This is so that patients can get a real understanding of what the new procedure can do. In the case of a breast implant, women are quite acceptable to be able to see what implant looks like and actually feel it. I find that this does allow the patient to predict more easily what volume they would like to see.
BREAST AUGMENTATION IN MELBOURNE
Breast augmentation in Melbourne is performed in our state-of-the-art Day Surgery Centre. The size of the implant is determined beforehand through a detailed consultation with Dr. Lanzer and also with his nurse. The implant is ordered and is all prepared. On the day of surgery, Dr. Lanzer does consult the patient again before surgery just to make sure that they are comfortable with the size that is going to be used. The procedure can be performed whilst asleep or under light sedation. Once the implant is in place, Dr. Lanzer does assess the symmetry and evenness of the implants. Before removing the open valve, Dr. Lanzer can add or remove fluid and volume if required.
IS THERE ANY SPECIAL METHOD OF BREAST AUGMENTATION BY DR. LANZER?
Dr. Lanzer has over 20 years experience in the use of tumescent local anesthetic fluid. The concept of tumescent fluid was developed by Jeffrey Klein where extremely dilute solutions of local anesthetic are infiltrated into the tissue with adrenaline. As a result, the little blood vessels close up and there is very little bleeding and reduced pain. Dr. Lanzer has started a method where he first inserts the tumescent fluid under the muscle. This prepares a nice plane for the implant and there is, as a result, very little bruising. This also tends to reduce swelling and pain after surgery. However, every patient is different and one cannot predict exactly how a person will feel.
IS THERE A DIFFERENCE BETWEEN THE 2 SIDES?
It is interesting that most patients’ breasts are different as are most of every 2 sides of the body. the classic statement is that our body consists of 2 sisters on either side and not 2 twins. As a result, one will often see one breast is slightly larger, perhaps starting at different points and possibly pointing in a different direction. The nipple may also be different. It is important that patients are aware of this before surgery as occasionally when an implant is placed inside that difference can become highlighted and more obvious.
SHOULD I HAVE A BREAST IMPLANT IN THAILAND OR WHILE ON HOLIDAY IN AISA?
I still recall the patient who came into my rooms in Melbourne straight off the airplane from having the breast implant overseas. On the plane whilst flying back, the whole suture line opened up and the breasts were actually half extruding and drooping out of the skin. This of course raised serious concerns of blood loss, infection, and future scarring that may cause further contracture. The patient did require further surgery. Surgery overseas may be successful, however the main risks that I have seen is unusual infections, bleeding where blood transfusions were given from unknown donors, and sometimes lack of finesse or over-suctioning and no ability to follow-up with the patients and correct things.
Breast implantation can be a very satisfying area of medicine. It is one of the most common procedures performed throughout the world. Dr. Lanzer uses his experience of operating over the last 25 years to give patients the most natural desired result.
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Surgical Warning: Every form of surgery has a possibility of a complication and these are given to you in detail by Dr Lanzer. It is a good idea to understand your surgical procedure well, and to obtain further advice from another Specialist Cosmetic surgeon such as a Dermatologist like Dr Lanzer.
All photographs represent one person’s experience, and results may vary for each patient. All photographs are of actual patients of Dr Lanzer. The visible change in these photographs has occurred as a result of the procedure/s undertaken.