Breast Implant Removal

Q: Breast implant removal and lift under local or general anesthesia - which one is safer?

A: If it is not necessary to remove the capsule, the implants can be removed under local anesthesia. However, if the capsule is to be removed, especially if implants are under the muscle, general anesthesia will be required

Breast Implant Revision

Q: Pain & discomfort 4 years after breast augmentation - will an implant removal or exchange help?

A: What you are complaining of is commonly seen with implants placed under the muscle. Patients are relieved when the implants are removed are placed with smaller implants placed above the muscle.

Breast Fat Transfer

Q: Breast reconstruction question? fat transfer to build up my breasts

A: Fat grafting can be done after skin-sparing mastectomy It requires fat to be reduced to microparticles, which is what I do I also combine the fat grafts with PRPorPRF Depending on the thickness of the flaps, it may take several procedures.

Breast Implant Revision

Q: Should I switch to over the muscle implants to avoid shape change due to lifting weights?

A: Submuscular implant placement results in animation deformity. Placing the implant above the muscle eliminates animation on muscle contraction. If the tissues are thin, I add an absorbable mesh and fat grafting.

Breast Implant Revision

Q: Implant shifted. What is the best option to treat this?

A: It is typical to have double bubble deformity which is commonly seen with submuscular implants where the muscle has become detached. This could be corrected by re-suturing the muscle or by placing the implants above the muscle.

Nipple Surgery

Q: Which procedure/implant would bring down my nipples?

A: The distance from the nipple to the breast fold should be 6 to 7 cms In order to reduce the distance, a wedge of skin needs to be removed from the bottom of your breast What is most important is that your surgeon knows on which pedicle the nipple was raised on, because if the pedicle is cut the nipple could die.

Breast Implants

Q: Intermittent pain/pressure 6 months after implants. Could this be my muscle?

A: The pain is most probably a result of your implant being under the muscle. This usually subsides with time. However, if it does not, you may want to consider placement above the muscle.

Breast Implant Revision

Q: To lift or not to lift? And what about scar tissue?

A: I would recommend a Vertical lift. This will correct the scar tissue and improve the shape of the breast This could be done with or without implants.

Breast Fat Transfer

Q: Can I transfer fat from my hips and upper thigh to my breasts to help them look fuller?

A: If you have sufficient fat to transfer fat grafting is certainly an option I also use external vacuum suction prior to surgery.

Breast Implants

Q: 18 months post op, are my implants sitting normally? Under the muscle

A: When implants are placed under the muscle, double bubble, and animation deformities can occur. My treatment of choice is to place the implants above the muscle.

Breast Implant Removal

Q: Size A before BA and contemplating Explant of Implants.

A: Following breast implant removal there are several options 1) No further procedures. 2) Internal breast lift with surgical mesh. 3) External breast lift. 4) Fat grafting Important factors in deciding on the procedure include. The volume of remaining breast tissue Position of nipples Amount of fat available for fat grafting.

Breast Implant Removal

Q: Can my breast implants be removed under local anesthesia?

A: If the capsule is not thickened or calcified it can be removed under local anesthesia I use a local anesthetic to numb the skin. The implant is then painlessly removed. The capsule is then infiltrated with a large volume of local anesthetic. The capsule is then cauterized thus virtually eliminating it. A drain is used to form a vacuum, thus enabling the two surfaces to stick together and close off the space that the implant was in If the capsule is thickened or abnormal in any way it is removed.

Breast Implant Revision

Q: What would be the best revision surgery for my breasts?

A: If your implants are no longer under the muscle. as Saline is heavier than gel it will cause sagging. I would recommend replacement with silicone implants, mesh support, and possible breast lift.

Breast Fat Transfer

Q: Is fat transfer into breasts safe?

A: I usually perform fat grafting at the same time as breast implant removal Depending on the size of your implants, you may need a breast lift as well.

Breast Lift with Implants

Q: Should I avoid breast lift if I have had a hypertrophic scar?

A: Keloids are more common on the back, and there are techniques that we use to reduce the risk of keloid formation.

Breast Fat Transfer

Q: Can I get a breast fat transfer while I have implants?

A: Fat grafting is an excellent way to increase breast volume and shape after breast augmentation, provided you have sufficient fat to graft.

Breast Fat Transfer

Q: Can I get a fat transfer on top of implants?

A: Fat grafting is an excellent way to increase volume after a breast augmentation, provided you have sufficient fat to graft.

Breast Fat Transfer

Q: Uneven breasts & considering breast fat transfer on one of them?

A: You can certainly add fat to the smaller breast. Liposuction can also be performed on the larger breast.

Breast Fat Transfer

Q: Can fat from saddlebags/thighs be transferred to the breasts? (photos)

A: Saddle bags are an ideal donor site for fat grafting to the breasts. The saddlebags will also be contoured at the same time.

Breast Fat Transfer

Q: What is the minimum BMI for a breast fat transfer? Or is it judged on a case by case basis?

A: BMI is not the determining factor for breast fat grafting. In your case you have sufficient extra fat in your abdomen and waist I also add PRF which is extracted from your blood to the fat graft.

Breast Fat Transfer

Q: What percentage of your patients experience lumps after breast fat transfer?

A: Lumps are more frequently seen after large-volume fat grafting. I perform serial low-volume fat grafting and see very few lumps after grafting.

Breast Fat Transfer

Q: Can a fat transfer be done to the breasts if implants are present? 230 CC, hoping to enhance volume and cleavage area?

A: Fat grafting can be very successful for enlarging breast volume after breast augmentation, provided there is sufficient fat available.

Breast Lift

Q: Could a breast lift alone help reshape my breasts?

A: A breast lift alone could certainly improve the shape of your breasts. This could be enhanced with an internal mesh bra that dissolves over time.

Breast Lift

Q: Would a breast lift involve altering the position of the nipple?

A: The purpose of a breast lift is to re-position the nipple. As your breasts are small relative to your body, you may want to consider fat grafting to the breasts.

Breast Fat Transfer

Q: Implant removal with fat transfer 1 year post-op. Is fibrous fat common and are there methods around this?

A: I have developed what is known as a cutting cannula which is very effective in fat harvesting. I also combine the fat with PRF obtained from the patient's own blood which also adds volume.

Breast Fat Transfer

Q: Is it possible to have a breast fat transfer done with fat that contains no stem cells?

A: All fat contain stem cells, The breast itself contains a large amount of fat that naturally contains stem cells.

Breast Fat Transfer

Q: Can I get fat transfer to breasts even though I have implants?

A: Fat grafts are an excellent method for correcting and enhancing the shape of the breast after breast augmentation

Breast Fat Transfer

Q: Can cupping over a fat graft increase local blood flow to the graft to help fat survival?

A: Cupping can certainly help increase the blood flow to the breast before fat grafting. I routinely use a more effective device to expand the breast before fat grafting. I also combine the fat grafts with PRF obtained from the patient's own blood.

Breast Fat Transfer

Q: Is there any benefit that could come from having PRP done before the fat transfer?

A: PRP has growth factors that stimulate new blood vessel growth. It is either injected a few days before fat grafting or at the same time as the fat grafting procedure. I now use PRF which is also obtained from the patient's own blood. PRP has been shown to have a higher concentration of growth factors as well as fibrin. I use the same technique in other areas of fat grafting.

Breast Fat Transfer

Q: How to correct breast asymmetry? Left breast is half a cup size smaller than the right.

A: You are an ideal candidate for fat grafting to the smaller breast. I add PRF to my fat grafts to encourage fat graft survival. I use the same technique for restoring fullness to the face.

Breast Fat Transfer

Q: Am I a good candidate for breast fat transfer? 30 y/o hoping to achieve a fuller, less saggy look.

A: Although fat grafting will give you some increased volume it will not really lift the breast. The breast can be lifted with an internal absorbable mesh via a circum areolar incision.

Breast Fat Transfer

Q: 34, 60kg, 165cm, how many ccs do you think I'll need to add volume to the upper pole?

A: Breast volume can be increased with fat grafting. Further volume can be added with PRF Obtained from the patient's own blood. Additionally, absorbable mesh can be placed to increase the volume of stretch marks and thinning skin can be treated with ultra micro fat grafts that are injected directly into the skin.

Breast Implants

Q: I am interested in getting implants. Will I need a lift as well or can I get away with just implants?

A: Many patients wish to enhance their breasts but are against any visible scarring. This is quite understandable.

There is however a balance between the amount of lift versus the amount of scarring. This is up to the patients to decide.

With no visible scarring, you may achieve some lifting for example with fat grafting.

For further lifting a breast implant can be inserted.

For further lifting some scarring will be necessary, this could be around the areola or a vertical scar. Additionally, surgical mesh could be added to enhance the result.

Breast Implant Revision

Q: 2nd revision wanting to change subglandular to submuscular?

A: In a situation like yours, I prefer keeping the implant above the muscle. To avoid animation deformity.

The breast flaps can be tightened through your original incision.

Breast Implant Revision

Q: Are my implants bottoming out or are they malpositioned?

A: You have what is known as the waterfall deformity.

This typically occurs with sub-muscular implants being held up high, while the breast tissue sags over the implant.

I usually correct these with conversion of the implants to above the muscle and some form of breast lift.

Breast Implant Revision

Q: What would you do? Is this fixable?

A: This problem occurs with sub-muscular implants.

I prefer correcting these by placing the implants above the muscle and under the fascia.

Breast Implant Removal

Q: Implants 2.5 years ago. Would like them removed. Would I need a lift?

A: You may be fine without a lift if your implants are small.

Internal lifting can also help improve the shape.

However, if the nipples are low after implant removal a lift will be necessary.

Breast Reconstruction Revision

Q: What options do I have besides DIEP flap to fix bad rippling after mastectomy reconstruction?

A: Although implant placement above the muscle has many advantages, rippling is one of the most common complications

Predisposing factors include:

  1. Type of implant. More common with textured, low profile, or high profile and saline implants.
  2. The overlying skin flap, thin skin flap or excess skin.

Correction includes:

  1. Replacement with Implants filled to the volume of the shell. For example, smooth round moderate profile plus X silicone gel.
  2. Thicken skin flap with fat grafting.
  3. Acellular dermal matrix.
  4. Capsular tightening --radio- frequency.
  5. Skin flap reduction with dermal flaps or contraction.

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