Verified Plastic Surgeon
 Dean Trotter

Dean Trotter

Verified
  • Dr. Dean Trotter
  • Richmond, Victoria, Australia
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Should I have different cc implants?

Hi, similar to a recent enquiry but pre-surgery. I have asymmetrical breasts and assumed in surgery I would have some of this evened up with different cc implants used. However after a consult with a surgeon I was told this isn't the case & the same size cc would be used (between 300-350cc in both) even though the different sizes were measured & acknowledged. Why is this? Is this just surgeon preference or can different sizes be used? I'm worried the difference in volume will be extra obvious and that will bother me as much as having smaller breasts. The smaller (right) breast also seems to droop more. You can really tell the difference in volume if I bend over. Thank you

MissE 17/06/2016 WA

  • Answer
    Thanks for your question,
    Unfortunately I can't see both your breasts in the photos so I can only answer in general terms.
    Usually, unless there is significant breast asymmetry (half a cup or more), most surgeons won't insert different sized implants.  This is for a number of reasons:  
    Firstly, different implants have different dimensions.  If only a small difference in volume, i.e. 25cc, then the difference might only be a few millimetres, however if a big difference, it could be a difference of centimetres.  This difference is in all dimensions, i.e. both base width and projection.  Therefore, inserting different implants can actually create asymmetry rather than correct it.  
    Secondly, once an implant is inserted, the proportion of asymmetry is less because the added volume will correct some of the asymmetry.  For example, if the volume of the breasts are 150 and 175cc pre-operatively, then the volume asymmetry is 25cc (17% difference) .  If a 300cc implant is inserted, then the post operative volume would be 450 and 475cc, but the asymmetry is still only 25cc (6% difference).    
    Therefore, careful planning when choosing your implants is required.  A 3D scan (Vectra for example) is very helpful in this regard.
    There are certain circumstances where different implants are very useful, for example with tuberous breasts or in reconstructive breast surgery, however if simply a volume rather than shape asymmetry, different implants may not be necessary and can even be problematic.
    All the best with your surgery.
    Kind regards,
    Dean

Multiple Surgeries Following Weight Loss

After dropping 50+kg, I am needing a few surgeries. Tummy Tuck Thigh Lift Arm Lift Breast Lift with some fill Some lipo possible also. I have had 1 appointment with a surgeon who agrees with what I want done. Time is my issue. I am wanting to speak with a surgeon who will perform all of the surgeries over a few days, or use 2 surgeons during the same theatre time (I have a friend who is having this done in WA, but I don't really want to travel). Full private health, and some (fingers crossed) will be Medicare applicable due to the weight loss issues. I have a period of time where my business pretty much stops for 4 weeks, so to be able to do it all then is ideal.

Honey Summer 10/05/2016 NSW

  • Answer
    Thanks very much for your question and well done on your weight loss.
    It seems like the issue for you is not so much what operations you want, but what is the safest way to do them.  That being said, if you've lost more than 50kg there may well be other operations that might be a good option for you and could change your plans.
    Body contouring procedures following massive weight loss are time consuming and there are limits to what the body can safely undergo.  Problems the may occur due to long operations, particularly hypothermia, bleeding, infection and deep vein thrombosis.
    Generally following massive weight loss achieving best results will require multiple surgeries.  Some combinations of surgeries work well together and others can increase the chance of complication, or mean that each procedure is compromised in order to try to reduce the risk of complications.  For example, a tummy tuck or body lift can increase tension on the upper thigh, potentially increasing the risk of healing problems if a thigh lift is performed at the same time.  Having 2 plastic surgeons performing your surgery won't change this risk so it is not really a question a time, more of what what the body is able to heal.
    Many patients elect to stage their surgery.  A common initial procedure is a body lift or tummy tuck plus a brachioplasty and/or breast reduction/mastopexy.  A secondary procedure may be thigh lift plus any revisional procedures that are necessary.   
    Staging the surgery several months apart allows everything to heal and scars and results to settle - making it more clear what revisions (if any) are necessary.  Whilst is technically possible to have the surgery staged over a few days, I believe that you are better to have two bigger operations separated by several months to allow the soft tissues to settle and full recovery after each procedure.
    My suggestion would be that you need to decide what parts of your body bother you the most.  Hopefully you can then plan a strategy to address as many of these issues in as few surgeries as possible, with the least risk of complications.
    Kind regards,
    Dean

Left with the snoopy effect

I had a breast augmentation a year ago. After losing 30kgs I was left with saggy breasts. I went to the surgeon and was told I needed a life in one side not the other. He went over the muscle and put 425cc in both. He only did a doughnut lift. The next day when I had my dressings changed I noticed that in the breast I had the lift that there was slight hang over the implant. The nurse told me that as they drop it will sort itself out give it 6 months to a year. But as they dropped into place the hang got worse. I also suffered with tubular breasts. It has now been a year and my natural breast hangs so bad that it touches the top of my stomach. I emailed his assistant and the response I got was I need to book in and pay the $160 to see him. I'm at a complete loss with what to do as this has already cost me $16 grand and I refuse to pay for something that he told me he could fix.

Hayleighr 21/03/2016 SA

  • Answer
    Hi Hayleigh,
    I'm sorry that you've had a disappointing outcome and I can definitely understand that you are unhappy and frustrated.
    Unfortunately I think you need to have a revisional procedure.  Most likely this is a mastopexy with an anchor (inverted T or "Wise" pattern) style scar.  Hopefully there is no need to adjust your implant and it is likely that ultimately you will obtain a good result with further surgery.
    This is a difficult situation when you have already spent a lot of money and have an outcome that you are unhappy with.  My advice is that you contact your surgeon again - perhaps try to have the same conversation with them that you are having with other surgeons over the internet via PSF.  
    Kind regards,
    Dean

Lift or just breast enlargement?

After breastfeeding for 4 yrs in total I've lost a lot of breast tissue and am looking at having Breast augmentation surgery. I'd like the enhanced look without looking overly "fake". I'd like to go up to a full E cup. Thank you in advance for any responses!

Forever88 21/03/2016 NSW

  • Answer
    Thanks very much for your questions and photos.
    I think you don't need a lift and are likely to be able to get a good outcome from a breast augmentation.  
    If you're looking to be an E cup post surgery I think there is a risk that you will look a little "fake" because a large implant will be necessary to give you that volume.  This might not be an issue for you and the best way I think to decide this is to have a consultation with a plastic surgeon who can show you some photos of other patients and also a 3D photographic simulation (such as a VECTRA scan).
    Kind regards,
    Dean

I am 1 year post Op and I'm now suffering from severe Nerve Pain?

I am 1 year post op, I went from a b cup to now implants the size of 525cc. I'm having problems with them and need reversion sugery, I have a constant numbness ride down the side of my back and body on the right side. I have a lot of random throbbing pain every so often on and off and recently I have been getting a very sharp burning pain in random places in my boobs, I think this may be nerve pain? I went to The Cosmetic Institutie and they have done such a bad job!! My scars are horrible looking and very painful every after 1 year and very noticeable. I'm quite concerned with the random pain I'm getting even tasks like lifting is painful for me. What are the long term effects these pains could have in my life and future?

ashkate 21/03/2016 NSW

  • Answer
    Hi there,
    I'm sorry to hear that you are having problems following your breast augmentation.
    It does sound like you have nerve pain.  You have quite large implants, especially since you started out with a B cup.  This means that often the chest wall and breast nerves are stretched to allow placement of the large implant.  Usually though, the pain and numbness from these nerves will settle down with time.  I realise it is already a year and you are probably wondering if it will ever get better but yes, generally it will.  Some nerve related pain can take more than 1 year to improve.  It is uncommon to have permanent numbness following a breast augmentation so I would expect things to improve.  
    If the pain is ongoing it is definitely worth seeing your surgeon and your local doctor.  Occasionally referral to a chronic pain specialist or neurologist is helpful with this sort of problem.
    Regarding the scars, there maybe things that could be done to improve them.  I suggest that you also contact your surgeon regarding this problem to see if they can help, otherwise contact a plastic surgeon for an opinion.  The Australian Society of Plastic Surgeons can help in this regard.
    All the best and I hope your pain and scars start to settle soon,
    Dean



can an implant be done without a lift?

Hi. I have severely sagging breasts. I was wondering if implants without a lift would be possible? My breasts look large front on but side on there is nothing there. I am hoping to achieve a more 'boob' type shape but a lift is well outside what I can afford. Would any implant 'lift' or fill the area underneath my breasts as it's quite empty, all my volume is on top of my breasts. Would implants just make the shape worse?

jenC 21/03/2016 NSW

  • Answer
    Hi Jenc,
    Thanks very much for your question and photos.
    Yes, you need a lift.  Without it you are very unlikely to be happy with the results of any sort of breast surgery.  I think you are correct that an implant is likely to make the shape worse.  Fortunately, you appear to have good breast volume, therefore I think a lift alone will give you an excellent result and you do not need an implant.  
    I suggest you have an in person consultation with a plastic surgeon.  Most likely you will find the cost of a lift or even a breast reduction is less than you think.  Depending on your individual circumstances (i.e. medicare or private health insurance rebates may apply) you may find a these procedure are less expensive than a breast augmentation.
    Kind regards,
    Dean

Are my breasts too far gone and what procedures do I need to achieve my desired outcome?

I'm 38 and have breast fed all 3 of my children the youngest being 10. I haven't had previous surgeries. I live near the Gold Coast and am willing to travel for the right surgeon.. In taking these photos I've noticed the size difference in my breasts has increased being that my left is looking smaller than the right. Perhaps it's due to gaining weight and now getting the weight off. Trying hard anyway, lol. My dream result is to have size D-DD, side boob and a round (not stuck on) natural, full U shape if that makes sense? I definitely don't expect perfect just improved... And a lot bigger, lol. Is this possible with what I have? I would love to hear your suggestions.

Kimi G 02/02/2016 NSW

  • Answer
    Hi Kimi,Thanks very much for your questions and photos.
    No, I don't think your breast are "too far gone".  I think you can obtain the results you are looking for but most likely you will need to compromise to some degree with one of your goals, most likely your desire to be natural.  Your other wishes are all similar and are possible with significantly increasing the breast volume and improving the shape.
    I think for best results you need a breast lift and an augmentation.  As you point out you have noticeable asymmetry - lifting and slightly reducing the right breast more than the left will address this.
    A round or shaped implant are options for your augmentation and either can provide the volume and projection you are seeking.
    You could elect to have an augmentation mastopexy to try to and achieve all your goals in one procedure or decide to stage the procedures.  In general an augmentation mastopexy saves time and money but has a higher risk of complications and revisional surgery.  This is because the procedure is trying to achieve in one operation (i.e. increase volume, decrease skin envelope and reshape the breast tissue) what is often achieved in two separate procedures (such as an augmentation followed by a mastopexy some time later).   If you have an augmentation only you may find you are happy with the results and can delay the mastopexy indefinitely.  I think this unlikely however and most likely to get your dream results a mastopexy will be needed.
    I hope this answer helps you.  For best advice I suggest you consult a plastic surgeon in person who can give you specific advice and go over in detail the pros and cons of each approach.
    All the best,
    Dean

Why do my scars look like this 6 months post op?

I am wondering why my scars look so red and large at 6 months PO? I'm still putting Strataderm on them everyday & have followed all my surgeons instructions for PO care since day 1. Is there something else you can suggest I put on them or what I can do to make them better?I can see the thin scar under some parts of the redness. Can I get Fraxel laser like some people have suggested? Any advice would be greatly appreciated. I went 330cc round unders. I was a 12a/b before my BA. Thank you

Bailey 01/02/2016 NSW

  • Answer
    Hi Bailey,
    Thanks for your questions and photos.  
    You scars are still quite active which is why they are red or raised.  Most likely, you have a hypertrophic scar.  This is where excessive collagen is formed and the scar becomes thick and raised.  Fortunately it tends to settle down with time in most cases.  Some treatments may help speed up this process.  
    Scars such as this generally respond well to corticosteroid injection into the scar.  Pulsed dye laser, silicon tapes/gels, dry needling, pressure dressings, massage and surgery are other options which can be successful.
    I suggest you contact your surgeon for specific advice and treatment.  In the meantime continue to massage with strataderm or apply a silicon tape.
    Kind regards,
    Dean

I'm not sure what procedure I require?

I had a breast lift over 10 years ago and I am left with a mess. The scaring is incredibly noticeable. One nipple is bigger than the other. The areola area is uneven on both side. One side sits higher then the other. I also require breast implants due to weight loss and age. To have this "mess" fixed do I require reconstructive surgery?

Sophie Coco 24/01/2016 QLD

  • Answer
    Hi Sophie, 
    Thanks for your question.  I'm sorry that you feel that your breasts are a "mess" but it is likely there are solutions to your concerns.
    It sounds like you would like surgery to correct asymmetry and implants to restore volume.  Technically this is not reconstructive surgery - this term is usually applies to procedures to rebuild structures following their removal.  For instance reconstruction of a breast with tissue or an implant following a mastectomy.  What you are describing would generally be considered cosmetic surgery.  That doesn't mean it is any less important, simply a way of classifying surgeries.
    The distinction between cosmetic and reconstructive surgery is definitely artificial so your question is very reasonable.  In fact, many procedures considered "cosmetic" utilise "reconstructive" techniques and vice versa.  This is well understood by the Australasian College of Surgeons - in order to become a Plastic and Reconstructive Surgeon in Australia (FRACS qualification) you must demonstrate proficiency in both reconstructive and cosmetic techniques.
    From what you describe, you may be a candidate for an augmentation mastopexy.  This procedure will allow revision of your scars, a breast lift, symmetrisation of the nipple and areola complex, and addition of implants to increase volume and fullness.
    I suggest you arrange an in person consultation with an experienced FRACS qualified Plastic Surgeon who can explain your options and the costs involved.
    Kind regards,
    Dean
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