Breast Surgery FAQs

Mastectomy and family history of breast cancer

TOPIC: Breast Reconstruction

Q: PATIENT

Hi, I’m 62 next month and have a family history of breast cancer. I’m wanting to know if I see a surgeon and ask for a mastectomy will my request be granted and isn’t it up to me if I want one. I have been thinking of this or a long time. I have lost my mother, one sister now have another sister fighting breast cancer. My younger sister is going to have a mastectomy. I want one also. I don’t want to be told I can’t have one. Thank you.

A: MR DEAN WHITE

Hello,

It sounds like your wishes are not unreasonable. You should discuss this with an oncological breast surgeon so that the particular risks of you developing breast cancer are made clear. If you feel like you want to proceed a plastic surgeon can discuss what reconstructive options are available to you.

Best wishes, Dean

[This question and answer first appeared in the forum at breast.com.au ]

August 2013

Breast Feeding After Breast Reduction Surgery

TOPIC: Breast Reduction

Q: PATIENT

Hi, I’m 20, 170cm, 60kg and only just fitting into a 10F.

My breasts grew very quickly when I hit puberty and I am now left with large sagging breasts and big areolas.

I am interested in a breast lift/ reduction but I’m concerned as to how this will effect breastfeeding for the future?

A: MR DEAN WHITE

With more modern techniques it may still be possible to breast feed after a breast reduction. Previously not much if any of the breast glandular tissue stayed attached to the nipple but this is now more preserved. The baseline ability to breast feed (without previous surgery) is also not really known as studies can vary widely. Having said that it is not possible to predict the effect of surgery – you would need to accept that your ability to breast feed may be reduced as a result of the surgery.

[This question and answer first appeared in the forum at breast.com.au ]

August 2013

Breast Reduction – Medicare rebate

TOPIC: Breast Reduction

Q: PATIENT

For the last 2 years I have had severe shoulder pains, neck pains and headaches. I have grooves in my shoulders from bra straps and some sort of growth and skin irritations under my breasts. I am 5ft tall and wear a 12 f cup. I have breastfed all 3 of my children so they are saggy, flat and very unattractive. I had enough and decided to speak to my GP. The problem is I am a single working mum paying mortgage and education and doing it quite tough. I don’t have health insurance and don’t know how I will afford it. I know Medicare covers some of the costs. Is there any other assistance I can get because I really can’t stand the pain I’m in and how depressed I’ve become because of it. I need help.

A: MR DEAN WHITE

Your symptoms are very typical of ladies with larger breasts. It certainly sounds like a breast reduction would be appropriate. Breast reduction attracts a Medicare item number which means that it is technically available through the public system. Unfortunately in practice very few public hospitals are doing this type of surgery because of limited resources and the need to treat increasing trauma and cancer cases. This leaves private care as the alternative. While you do get a very small rebate from Medicare it really does not offset many of the costs including hospital and theatre expenses. Private insurance pays for this component (less your excess) and a portion of surgical and anaesthetic fees.

I hope this is of some benefit to you.

[This question and answer first appeared in the forum at breast.com.au ]

August 2013

Breast Augmentation – recovery, breast feeding, further surgery

TOPIC: Breast Augmentation

Q: PATIENT

Hi there! im a 19 year old girl. I have B cup breasts and have always wanted larger. However I am hesitant and have many concerns. This is my first investigation into breast enlargement and I am wondering if a few questions could be answered. I am vaguely aware of the price and am more interested in the details of risk and damage possibility.

  1. Do you have to have surgery every 5 years (or so) after the initial surgery?
  2. How long is recovery time?
  3. Does it make finding breast cancer more difficult?
  4. Does it affect breast feeding?
  5. If I were to take a photo of my breasts could you give me indications as to which size/shape of implant would be most suitable? If you could answer at least one of these questions it would be a giant help!! Thank you!

A: MR DEAN WHITE

It is very sensible to ask these sort of questions – you need to be well informed and comfortable with the decision you come to.

  1. There is no need for regular or maintenance surgery. If there isn’t anything wrong nothing needs to be done. Having said that implants, like any other prosthesis, can have problems. Also your body will change with time, pregnancy, breast feeding etc. so the appearance of your breasts will change. You cannot rely on not needing more surgery in the future.
  2. Recovery depends on the position of the implant. In general placing them beneath the muscle is a little more uncomfortable than under the breast tissue. In general a week or so will see most women back to light activity.
  3. No – there is no evidence that it makes breast cancer surveillance harder. You would need to let people know if/when you have mammograms because different views may be required.
  4. Breast feeding in general should not be affected.
  5. You’re much better to have a consultation as there are several aspects to measure and also a more extensive discussion regarding what appearance you are trying to achieve.

[This question and answer first appeared in the forum at breast.com.au ]

July 2013

Breast Lift/Reduction Cost

TOPIC: Breast Lift

Q: PATIENT

I am 18 turning 19 and I have E sized breasts and they are extra saggy and also my nipples are too large. I would love to get a breast lift. What would you suggest would be best and an estimated cost?

In essence a breast reduction incorporates a breast lift and reduces the areola – (coloured skin around the actual nipple).

A: MR DEAN WHITE

To work out your best options you need to see a plastic surgeon. Pricing is dependent on whether you have private insurance as this can mitigate a lot of the expense (this surgery usually attracts Medicare and private insurance rebates).

I hope this helps, Dean

[This question and answer first appeared in the forum at breast.com.au ]

July 2013

Breast Lift Technique

TOPIC: Breast Lift 

Q: PATIENT

can I get a lift without an implant and without moving the nipple?

A: MR DEAN WHITE

Hello, No a lift can be achieved with an implant (smaller lift needed), a mastopexy (moving the nipple) or a combination of the two – the technique is dependent on your body and wishes.

[This question and answer first appeared in the forum at breast.com.au ]

July 2013

Breast feeding post-surgery

TOPIC: Breast Augmentation

Q: PATIENT

Short question, can you breast feed after implants?

A: MR DEAN WHITE

Breast feeding has not been shown to be affected by breast implants, so the short answer is yes.

[This question and answer first appeared in the forum at breast.com.au]

April 2013

Breast Reduction – Wise or traditional anchor method?

TOPIC: Breast Reduction

Q: PATIENT

Hi…I am 47 and size 12F and within my healthy weight range. I have breastfed two children in the past and have droopy heavy boobies. I am on a disability pension as I have MS, so I am on the public waiting list. I have been told I can choose from the wise method or the traditional anchor method. I have googled and youtubed both, but would like to know which is best, and would like to hear of any one who has had the wise method and what they think.

A: MR DEAN WHITE

They are actually the same thing. Wise is a technique with an “Anchor” scar and an inferior pedicle. The Anchor scar can also be used, however, with different breast pedicles.

The other option is a minimal scar technique where the scar is shaped like a “lollipop”.

[This question and answer first appeared in the forum at breast.com.au ]

28 March 2013

Breast Reduction and Weight Loss

TOPIC: Breast Reduction 

Q: PATIENT

Hi, I have be contemplating getting a breast reduction, for a number of reasons, I am also in the process of losing weight. I am a size 12DD/slightly bigger in cup size but not big enough for a DDD bra at this current point in time and losing weight to fit a size 8-10. My question is; if I was to get a reduction (I am looking at getting a reduction to a B maybe C cup size) before losing the weight I plan to, would it greatly affect my breast?

A: MR DEAN WHITE

In general I recommend waiting for your surgery until you are at a stable weight.

If you lose weight afterwards the breast shape can change or empty meaning that the final cosmetic result may be less than ideal.

It is also generally safer with regards to the surgery if you are at a healthy weight.

[This question and answer first appeared in the forum at breast.com.au ]

March 2013

Breast Augmentation and starting a family

TOPIC: Breast Augmentation 

Q: PATIENT

A friend (who has augmentation 7 years ago) has told me that I will need to wait a year after surgery before trying for a baby. I couldn’t imagine why this would be. My surgeon didn’t mention anything about that but he did say that breast feeding wouldn’t be a problem. Is there any truth to this?

A: MR DEAN WHITE

As a general rule breast feeding should not be affected by breast implant surgery.

I’m not sure why the advice was given about waiting for 12 months. You do need to consider that pregnancy/breast feeding will alter the end result so revision surgery may be required.

[This question and answer first appeared in the forum at breast.com.au ]

March 2013

Additional Breast Reduction Surgery – 30 years later

TOPIC: Breast Reduction 

Q: PATIENT

I am 64 yrs i had a breast reduction about 30yrs ago but they have now grown back with one side considerably larger. I suffer terrible back pain and neck pain.

I have a pace maker so am wondering if i can still have this procedure.

Thanks

A: MR DEAN WHITE

Providing you are fit enough for surgery there is no reason you can’t have further reduction surgery. There are some aspects that are a bit different with regard to complications which would need to be discussed with you (Nipple sensation and nipple survival in particular).

[This question and answer first appeared in the forum at breast.com.au ]

27 March 2013

Recovery and time off work after breast reduction surgery

TOPIC: Breast Reduction 

Q: PATIENT

I’m looking at having a reduction this year, and from what I have researched, the approx. time suggested for recovery after surgery is two weeks. I understand that that differrent cases will differ, but as I work for myself and cannot simply ‘ask’ for more time off, I want to make sure I allow enough time off work to get the best results. I am a mobile dog groomer, so my work is very physical…lifting dogs, lots of bending over…my back suffers the most, but would this sort of movement be restricted longer than normal with this type of job after surgery?

Thanks in advance

A: MR DEAN WHITE

I generally recommend 2 weeks off work for most people but 3 if their job is more physical. This is a guide as you only really know what your recovery will be once you have the surgery!

Most women find that the post-operative pain and recovery is much better than they were expecting.

[This question and answer first appeared in the forum at breast.com.au ]

13 March 2013

Advice regarding significant breast asymmetry

TOPIC: Breast Asymmetry – Reduction or Augmentation

Q: PATIENT

I’m 29 and live in t-shirts due to the fact that I can’t wear anything tight as you can see a HUGE difference in my breasts exp now that I have had children. When I was 3 weeks old I got a germ in a hospital which resulted in me needing to have my breast lanced and they did surgery. I have a very small scar but my mum was told as I was so little they had no idea how or even if it would effect my growth with I was older. I now have a dd cup and an a cup. I cant afford surgery but I need some help this is affecting me with my self confidence. Is there any way I can get assistance with medicare??

A: MR DEAN WHITE

With significant breast asymmetry you can get surgery through the public system – a reduction or an augmentation depending on what is required. There are significant waits through the public system for this (several years).

Your other option is going through the private system where private insurance/Medicare will cover a component of the costs. This has the advantage of getting a surgeon of your choice and getting the operation at a time that suits you.

[This question and answer first appeared in the forum at breast.com.au  ]

6 March 2013

PIP Breast Implants – TGA update

Current Advice to Australian Women regarding PIP Breast Implants

PIP (Poly Implant Prothèse) implants were manufactured in France and were available in Australia from September 1999 to April 2010. They were distributed by Medical Visions Australia, and it is believed the total number used in Australia was around 13000 implants.

In April 2010 they were withdrawn from the international market as it was discovered that they were no longer being made up to medical standards. The silicone used was industrial grade and not tested as being suitable for use in people i.e. medical grade. Originally, the implants had used approved silicone. Sometime in the years before 2010, the company which apparently was in financial difficulty had begun to use the non-approved silicone.

Concerns were raised by the French regulating authority that they may have a higher risk of rupturing and that the safety of the silicone could not be guaranteed. This was not seen as a reflection on implants made to medical grade standards.

The TGA (Therapeutic Goods Administration – Australia’s National Regulator) has looked at the information available and determined that the risk is no higher than with other breast implants. It would be fair to say that this is based on stringent standards for defining the rate of ruptured cases so it is possible it may be under reporting the actual number of ruptured implants.

The advice from the Australian Government at a population level is that removal of PIP implants is not routinely required in the absence of rupture. For the approved implants on the market in Australia, which all meet the stringent medical grade criteria the baseline rate of rupture is estimated to be 10-15% at 10 Years. If an implant ruptures, symptoms vary between women – it may not be noticeable at all, it may cause a noticeable change in the shape or feel of the breast, and it may cause tenderness.

It is recommended that if an implant is ruptured, it should be removed and replaced. While there seems to be no evidence of systemic disease or increased risk of breast cancer with implant rupture, the silicone within the breast can cause problems for example tenderness or lumps.

If you have any concerns with regard to your implants you should discuss this with a specialist plastic surgeon. Often clinical assessment can determine if there is a problem. If further investigation is required an MRI scan may be useful.

If you have PIP implants with a rupture they should be removed.

If you have PIP implants that are not ruptured, your options are to leave them, have them removed, or have them removed and replaced with approved implants. The pros and cons can be discussed with a specialist plastic surgeon with a breast surgery interest.

This article written by Mr Dean White, MBBS, Grad Dip Epid Biostat, FRACS also appeared in www.breast.com.au
March 2013

Resuming exercise after breast augmentation surgery

TOPIC: Breast Augmentation

Q: PATIENT

I am booked in to have breast implants (under the muscle) also with a small breast lift and fat injection. I have lost 10 kilos in the past few years and am finally feeling really happy and healthy with my weight, exercising atleast 5 times a week. I’m worried that after surgery I won’t be able to exercise whilst recovering and will gain weight again. Is there a rough timeline of when I can start exercising again and to what intensity?

A: MR DEAN WHITE

“You should speak to your surgeon about this as they should be able to give you a more tailored answer to your specific case.

In my practice I recommend easing back in to exercise gradually and incrementally increasing it. In general most women can start low grade exercise within about 2-3 weeks.”

[This question and answer first appeared in the forum at breast.com.au ]

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