Your Journey from Consult to Surgery

 

It is mandatory to have a GP referral to see Dr Somia. Two consultations are required by law before a date for surgery is scheduled. If you prefer one of these consultations can be held via telehealth. You will need to answer a Body Dysmorphic Disorder (BDD) screening questionnaire at the consultation.       

The 'cooling off' period between two consultations is designed to allow you plenty of time to consider your decision and feel comfortable about the procedure.   Once you confirm your decision to proceed with surgery, we will assist and prepare you for your surgery (ie paperwork and information, pre-operative testing as appropriate). 

During the consultation we will discuss your specific goals followed by a formal examination and thorough anatomical assessment of the breasts to identify the key anatomic features that need addressing. The position of the nipple areolar complex, is the areola enlarged, degree of asymmetry between breasts, the position of the inframammary fold, the outline and footprint of the breast, amount of excess breast tissue and amount of excess skin. Certain key measurements are made to facilitate planning.

I will proceed to ask you questions regarding your health to ensure it is safe to proceed with surgery. I will then photograph your breasts. These photographs serve as medical records and help in planning the surgery and comparing the results after the surgery. At the end of the consultation I will present a customised surgical plan appropriate and effective to address your concerns and achieve your aesthetic goals. Adequate procedural and financial information will be provided to enable you to make an informed choice whether to proceed with surgery or not. 

 

Cost of Surgery

 

If you choose to have Reduction Mammaplasty/Breast Reduction surgery as a private patient you will have 'out of pocket expenses'. After the consultation, your plastic surgeon will give you the necessary financial information and provide you with a formal financial quote that will show the cost breakdown and the out of pocket expenses associated with your surgery. 6 months of after care is included.

 

Procedure Details 

 

The surgery is performed in a facility licensed for cosmetic surgery and takes approximately  3-4 hours depending on the size of the breast, the complexity and if any additional procedures such as liposuction are necessary to contour the breast. Surgery is done under a General Anaesthesia to ensure you are comfortable and the Specialist Anaesthetist will ensure your safety and comfort during the operation.

Before the skin incision is made, I inject long acting local anaesthetic at key points to block the nerve for long lasting pain relief.

Anatomic specific correction of the enlarged breast is then undertaken. 1) The areola is reduced in size 2) The nipple areolar complex is repositioned along with its blood and nerve supply to the new location 3) the excess breast tissue is excised, 4) the excess skin is excised to achieve the desired shape and position. Multiple stitches at multiple levels in the breast tissue are used to hold the new shape. The skin incisions are meticulously closed with fine dissolving sutures in multiple layers to ensure good healing, wound strength and a favourable scar. Sterile dressings and a soft bra will be applied.

You will stay overnight for monitoring and pain relief. You will be discharged home with pain medications, antibiotics and care instructions. No drains will be used.

 

Post op care of the suture line

 

The first post op visit is 5-7 days following the operation. The dressings will be removed and the wound is examined for infection. Expect to see some residual bruising and swelling in the breasts. The suture line will be cleaned with sterile saline solution and the suture line secured with micropore tape. You will be instructed to change the micropore tape once a week.

You may shower, but must take care to "pat dry" or blow dry the tape to ensure excess moisture does not collect in the breast fold. Excess moisture will impact healing and scarring.

 

Scar Management

 

Scar management is an essential part of the after care that I provide my patients. Designing the location of the scar, meticulous tissue handling during surgery, sterile techniques, layered suturing for better healing and choice of sutures are important factors that influence the quality of the scar.

In addition, I have found that silicone scar therapy and sun protection in the first 3 months is equally important. You will be instructed to apply micropore or silicone scar tape over the suture line for 3 months and avoid direct sun exposure. There is no harm in continuing the silicone scar management beyond 3 months. 

 

Recovery and time off work after breast surgery

 

I have found that every patient recovers differently influenced by their general health, diet, age, genetic makeup and presence of other medical conditions. 

Initial recovery approximately 1-2 weeks.   A return to normal activities can usually be expected after 4 weeks.   The results are visible soon after the operation but allow 3 months for the healing process to be complete.  A soft bra helps to support the breast and should be worn for the first 12 weeks. You can start wearing an underwire bra after 12 weeks. 

You can return to work when you feel well and confident.    Most patients take 1- 2 weeks off work if they work indoors.   Patients working outdoors or in a physical capacity where the ear is at risk may need to take up to 6 weeks off work whilst they recover.   Talk to us about your specific occupation and surgery.   

Most patients resume driving after the first week provided they are comfortable getting in and out of the car and wearing a seat belt.   You should check your vehicle insurance policy for their requirements in this situation.  

 

Risks of Breast Reduction Mammaplasty Surgery

 

Surgery is considered  safe and the risks are low when the 5 Pillars of Surgical safety are adhered to. The 5 pillars of surgical safety are 1) Surgery performed by a Specialist Surgeon 2) anaesthesia performed by a specialist anaesthetist 3) surgery performed in a facility licensed for cosmetic surgery 4) Surgeon is able to provide after care and 5) Surgeon is able to admit patient to the hospital in the event of an emergency.

Generally speaking all invasive surgery carries risks similar to air travel risks. When travelling by air the expectation is a safe journey and arrival, it is understood and accepted that things could go wrong. The choice of the airline based on safety record, competency of the Pilot and and flight path are important elements in determining risk. Similarly, for your breast surgery, the experience and expertise of your Surgeon, the skill of your anaesthetist and the standard of the hospital will determine the risk. Risks, both general and specific, will be discussed during your consultations and written information will be provided to help you make an informed choice.    

 

GENERAL RISKS include pneumonia, deep venous thrombosis and pulmonary embolism, stroke, heart attack, allergies, awareness, death, bleeding, infection, sensation change, haematoma and seroma, skin contour irregularities, damage to deeper structures, Firmness, delayed healing and tissue death, exposed sutures, dog ears or additional skin folds, dressing issues, asymmetry, scars and unsatisfactory results. 

 

Risks specific to reduction mammaplasty surgery

 

Partial or total loss of nipple sensation, Loss of nipple, areolar or breast skin due to necrosis, Keloid scars requiring treatment, Excess residual skin requiring surgical treatment, inadequate reduction requiring re reduction, fat necrosis resulting in asymmetry, infection, blood clot ( hematoma) or seroma requiring hospital admission, treatments or both.

 

Before and after photographs

 

Our practice privacy policy prevents sharing patient before and afters online. However, during your consultation you will be shown indicative before and after photos.     

 

 

 

DISCLAIMERS:   All surgical procedures are performed by Dr Naveen Somia PhD, FRACS. ( APHRA Reg:  MED 0001189889).  For full information on Dr Somia's qualifications and risk/recovery information on procedures please visit the procedure page on this website.  All surgical procedures require a GP referral. All surgery carries risks. Outcomes experienced by one person do not necessarily reflect the outcomes of others given factors such as genetics, diet and exercise. Information provided is general only and does not constitute formal medical advice. Please seek a 2^nd opinion from a qualified Specialist Plastic Surgeon.