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Contact the offices of Dr. Craig Layt today to schedule a consultation. We offer a range of cosmetic surgery procedures and non-surgical skin treatments.
The duration of the operation is between one and two hours. You will be observed in recovery for a period of time while the effects of the general anesthetic subside before you are discharged. During the post operative period you will have an appointment with the clinic 1-2 days after the procedure to remove drains if they are used. Another appointment is scheduled at 5-7 days for a wound check and a review with Dr. Layt and his registered nurse. You will then see Dr. Layt at approximately 6 weeks and 1 year after surgery. For further information or to book a consultation about this procedure or other procedures available at this clinic please visit www.DrLayt.com or telephone 07 5597 4100.
Hi I’m Dr. Craig Layt, plastic and reconstructive surgeon. Welcome to our clinic. This presentation’s designed to give you some information that you need to make some decisions about your breast augmentation. Here the clinic we try to do things in a relaxed and friendly manner. I look forward to meeting you some time.
Dr. Craig Layt is a fully qualified plastic surgeon who specializes in cosmetic plastic surgeon. Dr. Layt studied medicine at the University of Queensland and later trained as a general surgeon. He then furthered his surgical training by completing a fellowship of the Royal Australasian College of Surgeons in Plastic and Reconstructive surgery. He followed this with further training, specializing in cosmetic procedures.
Dr. Layt is a member of numerous national and international bodies for both plastic and cosmetic surgery. Nonsurgical and anti-aging procedures are also available as an extension of the services offered. The surgical and nonsurgical anti-aging procedures complement each other and work on the same principles of patient education and individual treatments for individual people. Our motto is restore, rejuvenate, respect. The restoration and rejuvenation of the face and body along with respect for our patients, their families, our practice, and ourselves. Dr. Layt’s clinics are situated on the beautiful Gold Coast, Queensland, and in Balana, the Northern Rivers region of New South Wales.
At the initial consultation a fitting will take place where various implant sizes are placed into a garment in order to assist Dr. Layt and the clinical staff to help you decide on the final size of the implant. So what I’ll get you to do now is to simply put your top on and this will show you how you’ll fill out in your clothing, so it’ll give you a really good idea on what that size is gonna look like.
Alright. Okay. Yeah makes quite a difference. It does doesn’t it? Do you like that size? Yeah it looks great. Excellent. So we’ve now decided on the volume that we want. What we really need to work at now is what style of implant we want, whether we want it to be wider and flatter or narrower and pushes out more. Now that depends upon the sort of natural proportions of your breast and so what we’d need to do is we’d need to just measure that for you, so we’ll do that now.
One week prior to the operation you and Dr. Layt will have a second appointment to finalize all of the decisions made during the first consolation and answer any questions you may have so you can proceed to the operation day relaxed and confident in your decision.
Incision under the arm or the one around the nipple we do essentially the same operation. Sometimes it’s preferable to use a certain incision in a certain person, sometimes it’s actually necessary to do that, it really just depends on you. What we’re really trying to do is individualize this operation to get the best result for you. And in the end it comes down to, apart from we’re going to use a shaped implant it comes down to your personal preference. Each of them has advantages and disadvantages. Through the armpit what we do is we use an endoscope, which is a bit like the laparoscopic sort of surgery, things like keyhole surgery to take out gallbladders, that sort of thing. With a TV screen and a camera and long instruments we’re able to go up through the armpit and do exactly the same operation that we would do through the other cuts. So it’s an excellent way to do things and one just ends up with a little scar that looks a little bit like a crease up in the armpit. Yeah perfect.
The only other decision we would need to make would relate to size. What you’re going to find is it’s the one decision you’ll agonize over a little bit but what tends to happen is you get to a natural range where you believe you’re right. And as long as you’re in that range everything will be fine. If you get sort of below that range I’ll say, hey I think you probably need to go a little bit bigger. And if you go above that range I’ll say, well it depends on what job you want to do in the future as to whether you should actually choose that implant.
One of the things, there’s no accurate way of saying we will put in a 327 mil implant and you will be this size, but we get pretty good at working with you to get to the position that you want to be in from the point of view of your size.
Are there any risks I should know about? Well any operation has a potential to have some complications and of course it’s important that you know about those. Part of them we’ve already talked about as part of our decision making process. Clearly wherever we make an incision you’re going to have a scar. We’ve spoken about capsulacontracture and the chance for that to happen and the things that we will do to decrease the risks of that. Probably the most serious potential complication you could get would be to get an infection around the breast implant. Now that’s a very rare thing indeed. Studies have shown that there are a lot of times that’s actually related to bugs coming out of your own blood stream and lodging on the implant. The problem with that is that having a foreign material there makes it very difficult to treat. And the end result in that situation may very well be that we would need to take your implant out, let things settle down, and maybe 3 months or so later we put a new implant in. That’s the most serious thing that could happen.
Other things that can happen. You can lose some feeling to your nipple. And that’s due to stretching of the nerves. It’s not that you cut the nerves or anything like that. Nerves don’t like being stretched, and we’re putting an implant in there to make your breast bigger and stretch things up, so that is an uncommon complication, it’s in the sort of low single digits. You could get a collection of blood or fluid around the implant. Now often we use drains which come out through a little hole poked out just in the armpit there in order to take out any fluid or blood in the implant. Sometimes a little vessel might decide that it’s going to start bleeding again despite being sealed off during the operation. If that happened your breast might swell up and get sore and you’d know that there’s something wrong. In that situation it can be dealt with it’s just a matter of going back to the theatre, cleaning things out washing things out, stopping that bleeding and popping your implant back in. So in the short term you’ll be a bit more battered and bruised but in the long run everything should be fine.
We’ve spoken about being able to feel the edge of the implant. The thinner you are the more likely that is. And we even spoke about the potential for some rippling and that sort of thing. Particularly if you’re very thin the way we would try to avoid that. If you’re a little asymmetric from side to side then that can persist afterwards but we will be trying to do some things to try to correct that little bit of asymmetry during the surgery. Obviously you’re not a blank canvas so we’ve got to work with what we’ve got. Apart from that they’re the main risks that you really should know and there’s all of the information we’ll be giving you that will include all of that as well as everything we’ve discussed today as well. After we’ve decided on side and things we’ll give you all the information that you need to have a look at things and you go away and have a think about things. If you wish to proceed there’s no problem about that, my door’s always open and I’m happy to talk to you further about things and make sure that we can get the best result we can for you. What we’ll do is we’ll get Rebecca to play around with some sizes with you and then I can poke my head in and we can make some decisions. Alright sounds good.
You might say to me well why would I choose one over another? To some degree it’s a matter of one whether you can put up with moving the smooth implant around. Two it’s also a matter of just the look you’re after. If I was to put two implants the same size, one textured one smooth same shape everything in your breast and get you to stand there and take a photograph we wouldn’t be able to tell the difference. If however we were to get you to do something a little kinky and jump up and down on a trampoline with your top off then we would see a difference. This textured implant would tend to bounce around a little bit, jiggle around, whereas the smooth implant would tend to bounce up and down just a whole lot more.
In some cases we need to use a textured implant. That’s kind of when for example when we make a decision that rather than using a round implant we’re going to use a shaped one. We can use a shaped implant in any patient. We’ll get a nice result in any patient with that. The negatives of using that shaped implant are that we need to go through a cut underneath the breast. We can put implants in through other incisions that may be more positive from your perspective. The reason we need to do that is we need to get it sitting the right way because it has a shape to it and it’s also that little bit stiffer. So that’s one of the other negatives of these implants is they’re that little bit firmer.
And why would you choose one over the other? That’s a really good question. The reason you might choose a shaped implant over a round implant would be that in certain patients who don’t have a good breast shape and we need to try to force the breast to do something, these implants can be of some use to us. The other patients I find the shaped implant very good in are patients who are really thin because the softer round implants tend to want to do things like ripple a little bit. So if you don’t have any coverage over it with your own tissues you may see those ripples. So in those patients I’d tend to use that firmer shaped implant.
Yeah that makes sense. The other patients these can be of some use in are patients who have a little bit of sag. Just borderline for needing a lift and you can often get away with using this, and in that way it’ll kick up the edge of the nipple a little bit by filling out the bottom part. So if you think about that when we’re trying to force the breast to do something these are the ones that…but if you have someone who basically has a lovely breast shape, just needs to be a bit bigger, then the round implants are often the way we would tend to go. Oh okay.
This is a saline implant. It was invented because of issues with these silicone implants that you probably would have heard of from many years ago. You might not of because it was a fair while ago. These implants were the old silicone implants, they’re very thin walled, and if I was to cut that open it would just run everywhere. The modern implant has a much thicker wall to it and inside if I was to cut that open it’s a bit like Turkish delight, something like this. So you can see that it bulges but goes back in.
We could use a saline implant, but there’s some big negatives about that. They feel like a bag of salty water rather than like an implant and they do tend to go down in that with all the bending and folding all these little valves can become incompetent so occasionally they go down which isn’t dangerous but it means that basically your breast deflates. So I don’t use many of those for that reason unless patients insist.
So if we look at what we’ve done we’ve gone through whether we go in front or behind the muscle. We’ve looked at whether we’d use a round or a shaped implant. We’ve looked at whether we use a textured or a smooth implant, a silicone or a saline implant. There’s really only two things left for us to talk about. The first is which incision we would use, whether we would go around the nipple or around the edge of the areole, through a cut underneath or up through the armpit.
So Jamie you’re thinking about a breast augmentation. Yes I am. Okay how old are you now? 27. Great. And you’re otherwise fit, well, healthy? Yes I am. Okay any history of breast cancer? No none at all. And you would never have had a mammogram or anything like that? No. Any children? No. Okay and you ever had any problems with your breast? Lumps, bumps, any other issues like that? No no. Okay.
So you know much about breast augmentation? Not too much no. Okay well I’ll take you through everything and we can make sure you understand what we’re talking about. In the end what we’re trying to do is design an operation that will get you the best result we can in your particular situation. So that means we’ve got a few decisions that we can make and some of them will make a difference and some of them really aren’t that important so I’ll try and take you through all of those.
Essentially there’s six decisions we need to make. They are: where we make an incision, whether we go in front or behind the muscle, whether we use a textured or a smooth implant, whether we use a round or a shaped implant, a silicone or saline implant, and finally size, and that’s often the thing that you really want to get to. Yeah. We’ll get to that last. Okay so each of those decisions that we make have some pros and cons about them, and what we really need to do is go through those pros and cons so we can understand why we’re trying to make the decisions we’re trying to make.
Let’s look for example at going in front or behind the muscle. Most of the time I would be encouraging you to go behind the muscle rather than in front. There’s a few reasons for that. The most important of those is it gives you a lower rate of capsulacontracta, or hardening around the implant. I’ll talk to you a little bit more about that in a minute. But there are some other advantages. It tends to give you a smoother look at the top of the implant, you don’t tend to get that Tory Spelling edge to the implant. The other thing is you don’t use mammogram view, whereas if you go in front of the muscle you actually lose about 25% of the mammogram view. So there are obviously some pretty big positives.
There are some negatives. It hurts more going behind the muscle, but that’s only for the first few days. The other negative going behind the muscle is that if you were to put your hands on your hips and push in hard you can sometimes find your implants will move a little bit. That’s usually not an issue for people, and they don’t stay up there, they just pop back in.
So I mentioned to you about capsulacontracta. Now that’s a very important thing because it’s the one thing that we really try to avoid. You would have heard of hardening of an implant. Yeah. Okay that’s capsulacontracta’s the technical term for that. So this implant here is 30 years old. I took that out of somebody because it was rock hard. So you can see that that’s not a rock hard implant. So what makes it feel hard? Well what makes it feel hard is this. If I was to make a 10 cm cut on your leg today in a year’s time it might be 8 or 9 cm in length, it shortens. So if I put an implant inside and there’s a little scar about it which would be a natural thing to happen, as that scar tightens then the natural thing for it to do is to become a spear and squeeze on it, so it’ll feel hard. What we’ve found is that putting it under the muscle decreases that risk from about 15-30% down to about 1-3%. That’s a huge difference.
The other things that we can do is we can either use a textured or a smooth implant and just use a different technique with each. With the smooth implant we great big pocket that this implant sits in. From about day 1 or 2 after the operation we show you how to move that implant around inside that pocket. So that keeps the pocket open so even if it shrinks a little bit it’s still not going to tighten onto the implant. The advantage of that is it gives you that nice floppy kind of a breast that jumps up and down and it’s a very good way to do things.
The other alternative for us, similarly it’s a very good way to do things, is to use this style of implant which has a textured surface. So that surface has all hills and valleys in it and if we were to magnify that up it would look like a random pattern, set of mountains kind of thing. We put that in, we put it where we want it to be, and the scar grows into it. So that means it’s got a big surface area and it breaks up the direction of the collagen. So that means that as that scar tends to tighten it’s just gonna smooth off over the implant and it won’t tighten quite as much because of the higgldy piggldy pattern of the collagen fibers.
So they’re two different ways of doing things. Now there’s been a lot of studies done on this and what they’ve found is that in front of the muscle the textured implant is significantly better from the point of view of hardening. Behind the muscle there’s been no significant difference at this moment found between the two. So if they do find there’s a difference at some stage it’s going to be fairly small. Okay. So that decision in the end we can make that together based on what we’re really trying to achieve.
