Paul Quinn, MBBS (Hons), FRACS

Hi Asha

Thanks for your question. A few photos would assist greatly with making recommendations but for now just a few comments. Revision breast surgery is often amongst the most complicated procedures that Plastic Surgeons perform. If you have skin stretching/ bottoming out problems now, it would be a mistake to insert larger implants now in any location without specific manoeuvres designed to support the new implants and minimise the chance of a similar problem happening again. In most instances I would suggest a pocket change to back under the muscle and the use of existing capsular tissue (I’m sure there would be some somewhere) as lower pole re-inforcement for implant support. Try to obtain more than one opinion from Specialist Plastic Surgeons before embarking on more surgery, especially if you are adamant to increase your implant size.

Stay well  

Hi and thanks for your question. 

At only 1 week post op I wouldn't give things a second thought at this stage as the swelling is significant at this time making it really difficult to form any real conclusions. Thankfully, the tip of your nose will almost certainly appear to drop (coming down closer to your upper lip) over the next 6-8 weeks and I'm sure you'll be very happy. The tip of the nose can sometimes take up to 2 years before the final swelling resolves, however, the majority usually settles in 2-3 months. Keep in contact with your Specialist Plastic Surgeon as I'm sure he/ she will support and guide you through this time. 

Kind regards

Hi and thanks for your question. 

As you may have read on previous posts, rhinoplasty surgery is intricate and relies on many factors. Many Specialist Plastic Surgeons, including myself, would be reluctant to comment on the specifics of your planned surgery without a face to face consultation. The cost of surgery is likewise based on a number of different factors, including complexity and expected duration of surgery, the presence of previous nasal trauma/ surgery, any associated breathing difficulties, the relative balance of your facial proportions and the potential suggestion for additional procedures so as to deliver the ideal aesthetic result (eg. upper lip lengthening, chin modification etc). 

Your concerns seem very reasonable on face value but there are lots of things to discuss before providing you with a quotation for surgery. There is nothing wrong with getting multiple opinions and prices before committing to anything. The ASPSs website will provide you with a list of appropriately qualified Specialist Plastic Surgeons in your area to help you with the process. 

Best of luck. 

Hi Pammy

Thanks for your question. In short, exercises that specifically contract the pectoralis major muscle over your implant will increase the risk of implant rotation if done repetitively or with significant force. If the implants have had ample time to stabilise in position (at least 8 weeks) and the original pockets made by the surgeon are the correct size for your chosen implants then the risks of rotation or mal position are reduced. This risk is also reduced with smaller sized implants. If personal training will require you to perform these high risk exercises relatively frequently in the future then possibly consider two other options. Either stick with anatomical implants and discuss with your surgeon using a sub-fascial pocket (better for women who are beginning with a reasonable amount of breast tissue) OR consider subpectoral round implants and accept that they will look a little less natural (particularly with large implants). Your Specialist Plastic Surgeon will help guide you through this decision making process, you'll be in good hands. 

Hi Katie

Thanks for your question and photos. 

From your photos it appears you have elements of the diagnosis for tuberous or constricted breasts, albeit a relatively mild case, but this is better ascertained at your consultation. The typical concerns with augmenting a tuberous breast is the relatively tight tissues at the base of the breast and inframammary fold, which doesn't always expand or stretch up normally to accommodate the new implant volume, and the usually ptotic/ droopy nipple which can often be disproportionately large and "puffy" compared to the rest of the breast. 

I usually attempt to account for these issues by internally "scoring" or releasing the tight/ constricted tissue at the base of the breast to assist with accommodating the implant, and then often performing some form of nipple lift/ correction as required. 

From your photos, depending on the tightness at the base of the breast, it should be possible to perform a moderate breast augmentation and circumareolar mastopexy/ lift with good result. 

In particularly tight breasts, a more comprehensive lift, often with an inverted "T" scar, may be required. Post operative breast massage, surgical garments and delayed autologous fat grafting are ancillary measures that might be called upon to further improve results when required. Your Specialist Plastic Surgeon will help guide you through this process, you'll be in good hands. 

Hi Rita

Thanks for your question and photos. From your photos it appears you have a bifid tip deformity. This is actually a relatively common finding in both men and women, but is more obvious in women (particularly as they get slightly older) due to their relatively thin skin. 

It can be camouflaged with a hyaluronic acid based dermal filler, which could also be used to help lessen the appearance of your relatively mild dorsal hump. This is an office based procedure, relatively inexpensive but NOT permanent. There are risks and these will need careful consideration at the consultation with your Specialist Plastic Surgeon. 

Alternatively, a more permanent method of correction, particularly if you also desire a more narrowed/ refined nasal tip, is an open rhinoplasty. After reducing your dorsal hump, the central tissue between your alar cartilages contributing to the bifid tip appearance can be reduced and the cartilages can be sewn together. In some instances an additional on lay cartilage graft to the nasal tip may be required. 

There are plenty of very good Specialist Plastic Surgeons in Sydney who are well qualified to perform this surgery. Begin by discussing this with your family doctor. 

Kind regards

Hi Belinda

Thanks for your excellent question. Even for Specialist Plastic Surgeons it is not always an easy decision to make between a mini or full tummy tuck for a patient. In general terms, if there is a significant gap between your abdominal wall (rectus) muscles that needs repairing a full tummy tuck will be necessary. If there is a reasonable amount of spare/ loose skin above the belly button (umbilicus) a full tummy tuck will be necessary. If you can lie on your back and comfortably grab a large roll of lower abdominal skin then it is likely a full tummy tuck will be necessary, particularly if your belly button already sits quite low on your abdominal wall. 

Please ensure you are seeing a Specialist Plastic Surgeon (as recognised by the Australian Society of Plastic Surgeons - ASPS) for your procedure and he/ she will help guide you through this decision making process. Ask to see before and after photos relevant to your particular body shape and skin excess. You'll be in good hands. 

Kind regards

Paul

Hi Evie

Thanks for your question and photo. There are a couple of points worth considering here. Firstly, your existing breast anatomy may simply not allow cleavage like this to be generated (it is governed by pectoralis muscle insertion, existing breast footprint, existing nipple location, breast development etc). This can be determined at the consultation with your Specialist Plastic Surgeon. Secondly, the appearance of cleavage in a push up bra is often very different to the appearance when naked. It would be a mistake to aim for such a small gap between the breasts when naked as this dramatically increases the risk of a deformity called synmastia. Again, this will be discussed during your consultation with the PS. From your photo I would recommend a round gel implant placed under the muscle. The decision made between smooth vs textured implants, MPP vs HP and incision type are all best made at your consultation when your chest measurements and ideal implant volume can be accurately determined. I most commonly use high profile implants in my practice. 

Ensure your Plastic Surgeon is a member of The Australian Society of Plastic Surgeons (ASPS) with significant experience in this area. You'll be in good hands. 

Kind regards

Paul

Hi Kelley

Thanks for your question and photos. It's always difficult to make any definitive comments from a few photos and certainly your Specialist Plastic Surgeon is the best person to discuss this with in person. That said, from your "before" photos it appears that your breasts have a predisposition to something called pseudoptosis, where as the breasts age the nipple tends to stay relatively high and the skin at the lower pole (between nipple and inframammary fold) tends to preferentially stretch. This feature tends to predispose women to "bottoming out" following breast augmentation. In my experience this scenario is often worsened with large implants and submuscular implant placement as the constant contraction of the muscle at the upper pole tends to drive the implant downward into the skin that is already prone to stretching. 

There are a couple of options available to you at this stage (if the appearance really bothers you and is in fact as it appears in your photos) which can be discussed with your Specialist Plastic Surgeon. Internal lower pole slings, inferior pole skin reduction/ tightening, pocket change, use of adhesive textured implants, inframammary fold reconstruction if appropriate....

Hope this helps