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October 2017

National BRA Day!

It’s National BRA (Breast Reconstruction Awareness) Day.  18th October 2017.

The Australian Society of Plastic Surgeons say they “launched BRA Day Australia in 2013 to raise awareness about breast reconstruction so all women, no matter where they live, have the same access to information.

“BRA Day is not about trying to talk people into having a reconstruction; but simply to ensure all women and their doctors to have a conversation about breast reconstruction so women undergoing a mastectomy are aware of their options.”

Dr Damien Grinsell specialises in breast reconstruction, and works alongside a highly talented team of Breast Surgeons. Book a consultation with Dr Grinsell to have your questions answered.

For more information, click on the link below.

Breast Reconstruction Awareness Day

Choice of round vs teardrop Breast Implants

What sort of look are you after?

The decision of implant shape is made by me based on 2 major premises. Firstly the type of look the patient is trying to achieve and secondly how big they want to go.  In general terms most women are suitable for round implants in cosmetic breast augmentation and these form the staple implant type that I use.  A round breast implant gives a fuller upper pole or what I refer to as ‘WOW’ factor.

A teardrop implant gives a more natural look with less upper pole fullness.

Teardrop or anatomically shaped implants give a more natural look per given volume ie if you compare a round and teardrop 300 cc implant then the teardrop will give a more natural look. Thus I will use these in the circumstances where the patient has picked a bigger volume but still would like a natural look.  They also tend to be a better choice in patients with very little breast tissue as the cohesive silicone gel is firmer and is less likely to wrinkle.

A similar natural look can be gained in the same type of thin small patient using different techniques. The left picture shows a 330 cc teardrop under the muscle. The right is a smaller 250 cc round under the muscle.

This opinion piece was brought to you by Dr Damien Grinsell.

For more information or to answer any questions please feel free to call 03 85602999 or email enquiries@horizonplasticsurgery.com

How to achieve a natural Breast Augmentation

Is it possible to have a natural result from breast implants?

Fortunately the answer is yes. There are a number of ways a fully qualified plastic surgeon can achieve this look.  The biggest determinant is the size of implant the patient chooses.  Regardless of technique if the implant is too big for the body frame it will look fake. Generally speaking an implant placed under the pectoral muscle will give a more natural result compared to on top of the muscle.  Similarly for any given single volume of an implant a teardrop or anatomical shaped implant will give a more natural look than a round.

The best piece of advice in order to achieve a natural look is to pick a modest size implant.

In summary a teardrop implant under the muscle with a modest sized implant will give the most natural result possible.

300 cc teardrop implant placed under the muscle.

This opinion piece was brought to you by Dr Damien Grinsell.

For more information or to answer any questions please feel free to call 03 85602999 or email enquiries@horizonplasticsurgery.com

How I choose the type of Breast Implant

Breast Implant types

History is littered with poor quality silicone implants from big corporations trying to make a quick buck. How can you be sure you are getting a quality implant??

Breast Implants can be grouped into the following main categories

  1. Saline
  2. Silicone smooth round
  3. Silicone Textured round
  4. Silicone Textured Anatomical (Teardrop)
  5. Polyurethane
  6. Motiva (microtexturing)

The initial and foremost characteristic that I look for in a breast implant that is going to last 20-30 years is safety. This means a company with a long track record with a low leak and capsular contracture rate.

History is littered with poor quality silicone implants from big corporations trying to make a quick buck 

First to the implants I don’t use. Saline gives a far inferior look and feel compared with silicone implants and has a much greater chance of visible wrinkling.  For this reason I use silicone implants in 99% of cases.  Polyurethane implants are more difficult to use and do not have a proven safety record so are only used rarely in my practice.  Motiva are the newest type of implant using microtexturing technology which whilst it may have potential advantages, is unproven at this point in time.

This leaves options 2,3 and 4. I use all of these from the 2 longest and leading implant companies – Mentor and Allergan.

This opinion piece was brought to you by Dr Damien Grinsell.

For more information or to answer any questions please feel free to call 03 85602999 or email enquiries@horizonplasticsurgery.com

Choosing between saline and silicone breast implants

Saline vs Silicone Breast Implants

The short story is that silicone implants are better in almost all respects. They have a more natural feel and look compared with saline, and are far less likely to cause visible wrinkling and folding.  If the implants are in for long enough and a rupture occurs then the implant will not deflate and leave you lopsided like it will with a saline.  For this reason it silicone is my preferred choice.

 The cosmetic benefits of silicone breast implants tip the scales in its favour with this plastic surgeon.

Why would anyone choose saline you may ask? Well despite all the advantages of silicone there are a couple of important advantages of saline.  Firstly it is a natural substance within the body so if there is a leak then it is just reabsorbed by the body with no consequence.  The second major thing to consider is that there is proven statistically lower rates of capsular contracture in saline implants. Any reoperation surgery after a leak is also easier with saline.

This opinion piece was brought to you by Dr Damien Grinsell.

For more information or to answer any questions please feel free to call 03 85602999 or email enquiries@horizonplasticsurgery.com

Hand Postoperative Instructions

DRESSINGS

Hand Procedures

The usual dressing will be a gel gauze on the wound covered with gauze and a bandage. This may be supplemented with a half plaster splint for certain procedures. You should keep this clean and dry for the first week.

SUTURES

Most of the sutures are dissolvable and under the skin and can’t be seen. They don’t need removal.  There may be some sutures which need to be removed which is usually at day 14.

PAIN RELIEF

Major operations by their nature will have some degree of pain involved. Your surgeon will let you know the specifics of your procedure.  The pain is generally not as bad as expected.  Pain relief is very important and we take it seriously.  Often you will need 1 or 2 doses of stronger medication through the drip for the first night and after this the rest of your pain relief can be taken in tablet form.  This will be discussed with you by the anaesthetist before the operation.

MOBILITY

You will be encouraged to mobilise on the first post-operative day and your mobility will progressively increase over the next few days.  This is critical as the most important thing you can do to prevent DVT (deep vein thrombosis) is to walk. It also speeds your recovery and decreases the chances of other complications.  Your inpatient stay will depend on the procedure but many operations can be performed as day cases or overnight stays. Light activity such as a fast walk that raises a sweat is comfortable at 4 weeks. Sporting activities and heavy lifting should be avoided for about 6 weeks.

TIME OFF WORK

For minor procedures done in our rooms you literally only need the time off for the procedure itself which is usually about 30 minutes. Similarly most day case operations only require one day off work.

For major procedures the usual timeframe is 1-2 weeks however this depends on the actual procedure and the nature of your employment. Please ask your surgeon for a more accurate guide

DRIVING

You will be permitted to drive 1-3 weeks after your procedure depending on the type of surgery.

SENSATION

It is not uncommon for the skin around the scar and the area that has been operated on to be numb after the operation. This is normal and does not mean that a major nerve has been cut.  It occurs because when an incision is made or skin has been removed then there is damage to microscopic nerves which can’t be seen.  If you feel tingling, burning, or shooting pains this is not cause for alarm and in fact is an indication that the small sensory nerves are regenerating.  This feeling will disappear with time and the sensation will return but it can take a long time.

SCAR MANAGEMENT

Horizon Plastic Surgery advises scar management to start 2-3 weeks after your surgery or when the wounds are healed.   You can either tape the wounds with micropore which will provide support to the wound and then moisturise and massage each time the tape is removed.  This tape can stay on for 2-3 days each time.  If you are finding that your skin is becoming irritated then please discontinue use and contact our nursing staff who will advise you of a course of action.  For high risk patients you may be prescribed a silicone gel tape called sicacare which can aid in reducing scar formation and can be bought buy from the chemist.  Scar management should be continued until 3 months post surgery.

TED STOCKINGS

You will usually be required to wear TED stockings for compression to prevent DVT (blood clotting in the legs) post-operatively.  If required these will be fitted at the hospital on your admission day.  They are generally only worn whilst you are in hospital.

MEDICATION

You will be discharged with both pain relief and antibiotic medications.  Please take as directed. Most medications you ceased prior to surgery can be recommenced 1 week after your surgery but this will be individualised to each patient so please ask your surgeon.

Carpal Tunnel Surgery

This is the most common hand operation that is performed. Carpal tunnel syndrome is a condition where the nerve (median nerve) that runs through the palm of the hand goes through a tunnel which is called the carpal (meaning wrist) tunnel.  If the nerve gets compressed on its way through the tunnel then it causes symptoms and this is called carpal tunnel syndrome.  Symptoms include –

1 Numbness in the thumb, index finger, middle finger and half the ring finger

2 Pain in the hand

3 Pain in the forearm

4 Weakness of the hand

It typically gets worse at night when the swelling increases in the tunnel and can be exacerbated by certain positions of the hand eg. Talking on the phone or driving.

The diagnosis is a clinical one however most patients will also require a nerve test to confirm the diagnosis before proceeding to surgery. This is called a nerve conduction study and electromyogram or more simply known as NCS/EMG.  It is very helpful if your GP can arrange this prior to your appointment as surgery can then be booked straight away.

The most usual operation performed is an open carpal tunnel release. This is an incision in the palm which is about 4 cm long and the tunnel is released.  It is a very successful operation with a greater than 95% success rate and is done as a day case.  In severe case it can take a long time for the nerve to recover and the symptoms to improve.

In specific instances an endoscopic approach may be considered.