Following my blog last week on breast reduction surgery I have had some comments asking about breast lifting. Breast lifting (also known as mastopexy) is a procedure to correct the changes of nipple position and breast shape that occur with time and recreate a youthful appearing breast. Theses changes can occur with aging, weight loss, pregnancy and following breast feeding. Generally the nipple descends and the breast mound droops (breast ptosis) as the breast skin loses elasticity. A good way to think of this is the breast skin acting like a bra supporting the breast gland. Just like an old bra that has lost its elastic nature the breast skin also fails allowing the gland and nipple to head south.

There are two main options to correct breast droop, either tighten the skin or expand the breast gland volume using an implant. This second option known is as augmentation-mastopexy and I will discuss in a separate blog as it is worthy of discussion alone. Mastopexy is a term that describes the goal of breast and nipple lifting which improves the breast shape but maintains the current breast size. There are however a number of surgical procedures to attain this goal, the choice of surgical procedure should be individually tailored to the patient’s breast shape, skin characteristics and desires. The most important issue is how drooped the breasts are, generally the more droopy the breast the more surgery is required and results in more scarring. Scarring can be limited from around the nipple alone, to around the nipple and a short scar on the lower portion of the breast, to a scar that includes the nipple, lower breast and in the fold itself. Only after consultation with a Plastic Surgeon will you know what the best option is for you. Minimal scarring is desirable but the overall goal of a youthful breast should not be compromised to keep the scar short. A longer scar on a youthful breast is better aesthetically than a shorter scar on a droopy breast.

It is worth remembering that once the breast has been lifted and returned to its youthful appearance then the changes can again occur slowly with time. Plastic surgery can turn the clock back but once the procedure is performed the clock will start ticking again. Having said this, a good quality and well chosen mastopexy should gain many years of satisfaction for the patient.

If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: chris@breast-body.co.nz

Breast reduction surgery is one of the most common procedures I perform and becoming more popular over a wide range of patient ages. Historically referrals from family doctors was poor as the potential surgical gains from the symptoms of large breasts were poorly understood. Patients with large breasts (also known as mammary hypertrophy or mammary hyperplasia) suffer from a constellation of symptoms and concerns. Physically patients can experience neck and/or back pain, breast pain, rashes under the breasts, bra shoulder strap grooves, and may need to wear their bra to bed for support. Exercise is often difficult or impossible due to the breast mass being poorly supported or due to tight fitting swimming or gym gear. Patients also suffer socially due to the attention their chest gets when wearing fitted clothing, consequently they tend to wear loose clothing several sizes larger than their lower body and slump their shoulders forward to hide their breast size. Emotionally the prolonged psychological weight of having large breasts can be as bad as the physical symptoms. The key things are knowing that if you have large breasts your symptoms are typical, you are not alone and surgery is a very good option to consider. What you should expect to gain from breast reduction surgery are breasts that are smaller (shorter, narrower and less full), lighter, perkier and generally more youthful. You will also gain a new self-confidence and be able to wear normal bras, shirts, dresses, swimming and gym gear. Exercise will be achievable and your neck, back and breast pain should improve as will your posture. You will appear proportionate to your friends and family as well as appearing slighter in frame as your heavy upper body has been treated.

Patients who present for breast reduction surgery generally come in two age brackets, those that are 18-30 years before having a family and those 35+ years following a family. A small age difference I know but there are a couple of issues that patients need to be aware of. Like all plastic surgery procedures the post-operative result of breast reduction can be affected by a number of life factors from the day of surgery onwards. Pregnancy and breast feeding can affect the breast size, shape and gland density. So, in theory the result of breast reduction can be affected by pregnancy and breast feeding. However, I believe the overall the gains of having a breast reduction before having a family are immense and exceed any potential pregnancy changes. The second group of patients are post family and typically have been thinking about having a breast reduction for many years, almost universally my patients in this group comment following surgery that they wish they gone and had their breasts reduced years ago.

Surgery can be performed as a day procedure, or with a single night in hospital, as the post operative pain is usually quite mild. Recovery is faster than most patients expect and a commonly I need to tell patients to slow down their activities in the early days after surgery. I would expect that most patients are back to work or study and driving by 1 week after surgery.  The sense of physical and emotional improvement is immense making breast reduction one of the most satisfying plastic surgery procedures for patients and plastic surgeons alike.

If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: chris@breast-body.co.nz

Anaplastic large cell lymphoma (ALCL) has been identified as occurring in a small number of patients with breast implants. ALCL is a rare type of non-Hodgkin’s lymphoma and is not a cancer of breast tissue. The US FDA is investigating this possible association and “believes that there is a low but increased risk of developing ALCL adjacent to the breast implant”. Approximately 60 cases have been identified throughout the world, which represents a fraction of the 5-10 million women who have received breast implants. It is estimated that the risk of ALCL for breast augmentation patients is between 1 in 250,000 and 1 in 1 million. Breast implants have been proven not to increase the risk of breast cancer; breast cancer can affect up to 1 in 7 women in developed countries. There is no association between ALCL and any particular breast implant brand, shell or whether the implant has saline or silicone fill.

Of the known cases of ALCL in patients with breast implants there are some warning signs that patients should be aware of. If a breast lump is detected or if one of the breasts becomes larger or tighter than the other then it is recommended that breast augmentation patients are reviewed by a Plastic Surgeon. An MRI scan may be ordered to assess the implant integrity and adjacent breast tissue for any abnormal lumps. If a seroma (a fluid collection around the implant) is suspected then an ultrasound scan can be used for documentation or used to aspirate any seroma fluid which can then be sent to the laboratory to test for the presence of ALCL cells. If  ALCL is suspected or confirmed with these investigations then implant removal with capsulectomy is recommended. The breast capsule is then sent to the laboratory for further testing.

There is, however, a slightly silver lining to this warning – ALCL developing around breast implants is a clinically indolent disease with a favorable prognosis that is quite distinct and different from systemic anaplastic lymphoma kinase–negative ALCL. Although some women underwent irradiation and/or chemotherapy after breast implant removal and capsulectomy for ALCL, more recent reports suggest that outcome and survival may be equivalent with only implant and implant capsule removal.

Prospective breast augmentation patients need to be aware of ALCL and discuss this with their Plastic Surgeon, patients need to be reassured that the risk is of developing ALCL is extremely low and that ALCL behaves in an indolent manner.

If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: chris@breast-body.co.nz

Surgery to cause weight loss has become increasingly popular recently, such as gastric banding or bypass surgery, as have TV reality shows which prove that similar weight loss can be achieved by dedicated diet control combined with exercise. Weight loss surgery is known as bariatric surgery and in the US alone in excess of 250,000 patients are having these procedures every year to help manage their obesity and related health issues, such as diabetes and hypertension. The number of bariatric procedures performed in NZ are similarly increasing every year. Initially in NZ these procedures were performed purely in private and paid for by patients without health insurance funding, now a limited number of selected patients are offered bariatric surgery throughout the public health system and there can be a part payment provided by health insurers for private surgery.

I am grateful to have had the opportunity to operate with some of the pioneers of body contouring surgery in Los Angeles when I worked at the University of Southern California in 2005/2006. The techniques we used then created a core of great surgical options but are better understood now have also been modified to tailor and finesse individual patient needs.

Weight loss, either through surgery or diet and exercise, improves general health in a number of ways, increases life expectancy and most importantly quality of life. The flip side of the coin is that patients who undergo major weight loss are often left with excess loose skin that creates undesirable folds and contours. This appearance is psychologically and physically a let down after all the effort patients have put into improving their health. Body contouring surgery can help to create the body shape they set out to achieve.

Excess skin occurs commonly around the abdomen, buttocks, thighs, breasts and arms, it can also occur around the back, face and neck. Depending on the degree of weight loss, skin quality, patient health and desires a number of body contouring surgical options are available. Procedures often performed by Plastic Surgeons following massive weight loss include abdominoplasties (tummy tucks), lower body lifts, belt lipectomies, thigh lifts, arm lifts, breast reductions, breast lifts with or without breast implants, face lifts and neck lifts. Some of these procedures can be performed under the same anaesthetic but often procedures need to be staged with a rest period of 3 months or more between stages. There is no rule as to which procedures are performed first, the key is matching the patient’s goals with their health and anatomy to maximize outcomes. Prior to body contouring surgery patients need to have achieved their weight goal and been stable for at least 6 months, be physically fit, be under the care of a dietitian, and be psychologically sound and motivated. This last point is usually not an issue as patients are typically very motivated and realize they are only half way along their journey when they present for body contouring. I have found with my body contouring patients they are hugely appreciative and pleased with their outcomes, truly life changing and inspirational.

If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: chris@breast-body.co.nz

There have been a number of media releases regarding breast implants manufactured by in France by PIP (Poly Implant Prosthese). These implants are known as “PIP” or “M” implants. The issue has arisen after the French company halted production in 2010. The company had attempted to reduce costs and produce cheaper implants by using lower grade non-medical silicone. This resulted in deficient quality implants that are prone to failure.

My understanding of the current situation (and this may change as more information becomes available) is that PIP and M implants potentially have weak silicone shells. This could result in implant rupture and silicone leakage. This is the prime reason that implant removal has been recommended. The media has questioned whether there is a breast cancer association with this brand of breast implants. At best, this is the media reporting a single French patient’s breast cancer diagnosis, at worst it is scaremongering and needs a media retraction. It is worth remembering that the rate of breast cancer in patients without breast implants is the same as patients with breast implants, this has been scientifically proven in medical studies. It is therefore unlikely that women with PIP or M breast implants have a higher risk than normal for breast cancer. I would however recommend a consultation and mammography or MRI to provide reassurance about the integrity of the implants and also to ensure the breast gland is normal. As part of breast cancer screening in New Zealand women over 45 should have annual mammograms.

To my knowledge PIP implants have not been used in New Zealand or the United States. Some have been used in Australia, but the majority were used in Europe, the UK and South America. There has been no detail of usage in Asia, of concern particularly with surgical tourism. If you have any doubt it is important to contact the Surgeon or Clinic who performed your surgery, they will be able to inform you of your implant details. If you do have PIP or M implants then I would advise you to consult a Plastic Surgeon for advice and discuss whether implant removal is best for you. This decision may require imaging to check the implant integrity using an MRI scan. If the implant is damaged then implant removal and capsulectomy is advisable. If desired, it is possible for a new replacement implant to be inserted during the surgery so that breast shape and size is maintained.

As per my previous blog it is important to enquire about the breast implants your Plastic Surgeon uses, as there are varying prices, quality of implants and warranties. Beware of any cheap breast augmentation deals at home or overseas as part of a travel package, this is usually associated with cost cutting by the clinic and your potential breast implant could be cheap but of second rate quality.

If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: chris@breast-body.co.nz

I often have the discussion of how to improve the appearance of a patient’s abdominal area. The usual issue is poor shape from excess skin creating an undesirable shape with folds instead of a flat front and contoured flanks. The main causes are weight loss and pregnancy changes. It is a very frustrating problem as patients as a rule have undertaken an active lifestyle, lose weight, and strengthen their abdominal “six-pack” muscles. No matter how many sessions with a personal trainers, abdominal crunches or TV infomercial ab-exercisers purchased, the excess skin and folds do not improve. The reason is that when abdominal skin is stretched from pregnancy or weight gain the elastic supporting fibres are irreversibly damaged. Although the skin will take up partially the leftover excess will hang creating folds. The other factor that needs explaining is that the underlying abdominal muscles are often stretched also. The abdominal muscles act like a corset holding the tummy flat and holding the flanks in creating the desirable female hourglass figure. Once stretched these feminising feats are lost.

The degree of excess skin and muscular weakness will determine whether a full or mini tummy tuck (abdominoplasty) is the correct surgery. A mini tummy tuck addresses excess skin and weakened muscles located below the belly button (umbilicus). A full tummy tuck addresses the entire abdomen. Both surgeries remove the excess skin and tighten the muscular corset, just in different degrees. Understandably the full tummy tuck does more, but necessitates a longer incision and scar, relocates the belly button and has a longer recovery. However, if you need a full tummy tuck you will not get the desired result from a mini tummy tuck. Your Plastic Surgeon will help you make the correct decision based on your individual characteristics.

Tummy tucks can be combined with liposuction or breast reduction, lift or enlargement. In combination, tummy tucks and breast surgery are the classic “mummy makeover”. In my experience abdominoplasty patients are fit and motivated characters who achieve their goals of a feminine contour.

If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: chris@breast-body.co.nz

The theme of the meeting was using these agents intelligently, applying them to specific structures, with a view to a balanced and individual approach. On the first day of the meeting I attended the Masterclass, a select small group aimed at facial anatomy and live demonstrations of injections. The content was fantastic but what really stood out was the difference in anatomical knowledge between the surgeons and non-surgeons. The surgeons were extremely comfortable and competent with their anatomy whereas the non-surgeons were really seeing this for the first time. Herein lies a problem, most botox and fillers are being injected by non-surgeons, effectively GPs who have completed a weekend course or two and are then deemed competent by the drug company marketing the product. Not surprising then that the products are often used in a less than ideal manner. Patients who are attended by such practitioners are only offered botox or fillers, these patients do not get the benefit of being assessed by a Plastic Surgeon who has both non-surgical and surgical techniques available – these patients will get a complete individualized management plan that may be purely non-surgical, surgical or may include both.

Facial rejuvenation should be the goal of botox and fillers, not creating a different facial appearance. A good idea is to look at a photo of yourself 5-15 years ago and hold it next to your face as you look in the mirror. What do you see and desire? Regaining the youthful characteristics takes an artist’s eye and a surgeon’s knowledge and steady hand. Botox and fillers certainly have a place in cosmetic surgery but must be applied by an intelligent practitioner who understands how faces are constructed and how they move dynamically. A little botox here and there, some filler there and here will work wonders if applied in a balanced manner.

As the face ages the skin changes, the face loses bulk and is affected by gravity. Traditionally facelifts and the like pulled back the aged and drooped skin but did nothing to address the loss of volume in the face. Now the combination of surgery, fillers and botox has really provided Plastic Surgeons with the complete package for facial rejuvenation. In your goal of facial rejuvenation, carefully choose a practitioner who has the full armamentarium of surgical and non-surgical techniques to assess and address your individual characteristics.

As indicated in the blog last week there are a number of breast implant options available to you in regard to cosmetic breast augmentation.  Implants have used for breast augmentation since the 1960’s and have since gone through generational research and development changes leading us to the implants available today.   The implants developed in the 1960’s and 1970’s were prone to complications mainly due to their liquid silicone fill. These problems lead to silicone implants being withdrawn from the Unied States market from 1992-2006 after government pressure. The problematic implants were subsequently replaced with improved implants that addressed the earlier faults. In New Zealand we did not have this issue of silicone implants being removed from the market and as such New Zealand Plastic Surgeons have significant experience with silicone implants.  It was interesting working in Los Angeles and attending conferences in the United States in that United States Plastic Surgeons still prefer to use saline implants simply because their experience and training has predominately been with saline implants.  However, there is now a trend towards more silicone filled implants being used in the United States.

The most exciting change in implants have been the use of silicone cohesive gel as a filler.  It has a very natural feel and similar density to natural breast tissue but because it is cohesive the leakage issue has been all but eliminated.  All silicone implants have a silicone shell and there is a choice between a smooth and textured shell.  The tesxtured shell was developed in an effort to minimise capsular contracture  development. The theory with texturing implant surfaces is that they disorganise the capsule formation creating a thinner and more pliable capsule . There are varying degrees of texturing available from different implant manufacturers. Another surface option used to produce low rates of capsular contracture is to coat implants with polyurethane foam. Implant companies that currently supply the New Zealand market include Silimed, Allergan, Mentor, Eurosilicone and Nagor. All have interesting points of interest and Plastic Surgeons have their own particular likes and dislikes.  It pays to be well informed about the implants being used, not only in regard to the implant shell or whether the fill is silicone or saline, but also of the implant size in regard to volume, diameter and projection and whether the implant is round or anatomically shaped. Anatomical implants tend to be used in augmentation situations where there is no or very little breast tissue pre-operatively.  In these situations, breast shape is determined by the anatomically shaped implant. If a round implant was used in these situations it would create a rounded undesirable appearance.  In situations where the patient has a moderate amount of breast tissue or has lost breast volume after post breast feeding, pregnancy or weight loss then a round implant may be a better option.

I hope this information has been useful to you for when you consult your Plastic Surgeon to discuss your breast augmentation surgery.  If you have any further queries or comments regarding breast augmentation feel free to contact me at chris@breast-body.co.nz

Breast Augmentation is one of the most popular cosmetic surgery procedures performed in New Zealand and around the world.  We have all seen images of TV celebrities and celebrity wannabes who have had surgery to enhance their breasts to unusual and sometimes ridiculous and gargantuan proportions.  Thankfully this media coverage has resulted in useful social commentary such that patients now typically request natural and proportionate breast augmentation appearances.  The emphasis is on a look that is proportionate, natural and ultimately believable.  Obviously fake breasts are definitely on their way out.  Where I was working in Los Angeles in 2005-2006 there was a definite trend for women requesting smaller implants and also for women previously augmented with disproportionately large implants requesting revisional surgery to decrease their size to more natural dimensions. If large implants are used to create an overly enhanced unnatural look they can cause premature ageing and drooping of breasts, which may in the future necessitate revisional surgery such as implant exchange or combined with a breast list procedure. The size of implant chosen depends on a number of factors, such as patient desires and individual physical characteristics that must all be taken into consideration to gain an optimal outcome.

Choosing a Plastic and Reconstructive Surgeon well versed in cosmetic breast surgery will provide you with an informed choice about the type of implant, the position of the implant and the incision used.  Your Plastic Surgeon will inform you whether your desired breast size increase is realistic, if you are an appropriate candidate for breast augmentation using implants alone or if a breast lift combined with implants is the best option.  There are also a number of breast implants on the market provided by different companies.  They are not all equal in quality and their price does vary.  It is important to enquire about who the implant manufacturer is and whether the manufacturer provides a warranty for the product.

As New Zealanders we tend to be more realistic than our American or even Australian friends in regard to body proportion.  The majority of patients who attend for breast augmentation in my practice have either an undeveloped bust or have lost breast volume following pregnancy, breast feeding or weight loss.  This group of patients want to create a bodily balance by increasing their bust size to a proportionate level, with the goal of feeling and appearing more feminine.  Ultimately, cosmetic surgery is about enhancing your appearance and in so doing creating a more natural looking beauty.

If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: chris@breast-body.co.nz

“The Fountain of Youth” – Dr Chris Porter’s inside view of cosmetic surgery where he aims to help you to make the best possible informed choice and achieve your cosmetic surgery goals.

Welcome to the first of my weekly blogs which I hope will educate you and provide you with useful information when considering cosmetic surgery.  The title “The Fountain of Youth” was chosen because we know the fountain is a legendary spring that reputedly restores the youth of anyone who drinks its waters.  With the explosion of the digital era there are now a number of cosmetic surgery websites that are presented as if they are a fountain of youth and a number of medical practitioners who claim to be Plastic Surgeons.  I thought that the first blog entry would be best served to explain who really is a bona fide Plastic Surgeon and why this is important to you if you are considering a cosmetic surgical procedure.

“Who is a Plastic Surgeon and Why is this Important?”

 With the increasing popularity of cosmetic surgery over the past decade it has become increasingly difficult and sometimes confusing for patients to identify a properly trained Plastic Surgeon.  Cosmetic procedures both surgical and non surgical broadly encompass the face, neck, breast, body and limbs.  As the diversity of cosmetic procedures has increased so has the diversity of practitioners offering them.  Cosmetic surgery initially was the domain of Plastic Surgeons but as cosmetic surgery has become more popular, so have the number of practitioners claiming to be Cosmetic Surgeons or Plastic Surgeons. Have they performed the training required to label themselves as Plastic or Cosmetic Surgeons?  In New Zealand bona fide Plastic Surgeons hold a standard medical degree and then have undertaken four years of supervised training under the Royal
 Australasian College of Surgeons and have passed vigorous testing both in exams and technical ability before being allowed to call themselves a Plastic and Reconstructive Surgeon.  Plastic and Reconstructive surgery is the only surgical training scheme to formally include cosmetic surgery in its training.  Accordingly, all trained Plastic & Reconstructive Surgeons are well versed in cosmetic surgical and non surgical procedures that have proven outcomes and desirable results.

There are a number of pseudo-Plastic/Cosmetic Surgeons/Practitoners  who have jumped on the plastic and cosmetic surgery band wagon who offer limited cosmetic surgical and non surgical procedures.  These practitioners may be Surgeons from other specialities, non surgical skin specialists, general GP’s without any specific surgical training or even medical spa nurses without on-site medical supervision. The only way to be certain that your Plastic or Cosmetic Surgeon is formerly qualified as a Plastic and Reconstructive Surgeon is to check for the FRACS  (Plastic and Reconstructive) on their certificate of qualification or you can go to the New Zealand Association of Plastic Surgeons website www.NZAPS.co.nz
 and search for your specific surgeon.  By choosing a Plastic and Reconstructive Surgeon for your cosmetic needs you will receive a professional educated discussion offering you an informed choice of the best procedure from a wide range of potential options.  Unfortunately, the internet is full of cosmetic surgery websites that are glossy and glamorous and without the correct information about the practitioner performing your procedure, you may get a less than desirable outcome. In the cosmetic surgery market place the potential patient needs to be aware and well informed, I hope this initial blog has been helpful to guide you towards choosing your Cosmetic Surgeon and ultimately achieve your cosmetic surgery goals. 

If you have any specific requests regarding cosmetic surgery topics that you would like discussed in this blog, please feel free to email me: chris@breast-body.co.nz