Trish Hammond: Lovely, so I’m here today with Dr. Rohit Kumar. Dr Rohit Kumar is a cosmetic plastic surgeon who’s from the Sydney Cosmetic Sanctuary, which is based in Leichhardt in Sydney. Welcome.
Dr Rohit Kumar: Thanks, Trish, how are you?
Trish Hammond: I’m great, and yourself?
Dr Rohit Kumar: Yeah, not too bad, thanks. How can I help today?
Trish Hammond: I thought we’d just have a bit of a chat about Post Breast Augmentation. Well, actually, there’s a lot of inquiry after people have had a breast augmentation, like they might not look like they are or they’re not happy with them, or they’re having a bit of anxiety. I thought I might just have a bit of a chat with you today about the post breast augmentation procedure and what people can expect.
Dr Rohit Kumar: Sure.
Trish Hammond: A standard augmentation will take about, what, roughly an hour to two, would that be right?
Dr Rohit Kumar: Yeah, a standard sort of augmentation where you actually don’t have to adjust the actual breast very much. Relatively symmetrical breasts, and you’re putting an implant in, whether over or under the muscle, or as dual plane technique. Which is certainly my preference. It should take between 60 to 90 minutes.
Trish Hammond: All right, so we’ve had our surgery, we go back in to recovery, can you take it from there, tell us what we can expect.
Dr Rohit Kumar: All right, so usually what would happen, certainly … I’ll explain what sort of happens with my patients and would think that that’s very similar to what most patients would go through. What would happen is after the surgery, pretty much straight after the surgery, you will be placed into some garments. Now, you may have some tape on your breasts straight after surgery, and the garments may be placed before you go home, or you may wake up from your anaesthetic with the garment in place. Very very rarely, some surgeons prefer to put the garment on a few days after the actual operation, but in any situation, within a few days of surgery, you will definitely be in your breast garment. Now this garment is something that is measured before surgery, so that the size is a relatively good fit for you, because it’s a little bit hard to work out exactly what that fit is going to be once the implants are in.
What we like, and what patients should feel, is that the garment should be holding your new breasts snugly and quite firmly, about the equivalent of maybe wearing a t-shirt that’s two or three sizes too small for you. That level of firmness, certainly nothing more than that, and it definitely should not be uncomfortable. You’ll wear this garment then, virtually 24/7 for the next six weeks in my practice. A little bit longer, a little bit shorter, depending on your surgeon’s personal preference. For six weeks you would be wearing this garment, and you might buy two so that you can take one off, and then when you’re washing it, you have a second one on. Some practices will certainly provide you with this as well, as part of your fees. You can wear a sports bra as well, as long as it fits properly and there’s no wiring. Any sort of support, does not need you to have any wiring in it over this period of time. After six weeks, once everything’s settled, then you can go back to getting into a bra of your choice.
Trish Hammond: You do that for … Basically it has to be, what you put on is a compression garment to keep everything tight and in place, and help to form the new breasts?
Dr Rohit Kumar: That’s right, so what the garment does there’s a variety of things the garment does. One, it actually gives you a little bit of piece of mind, holds everything where it is, and patients feel very comfortable knowing that they’ve got some sort of extra support. That’s a really important thing. The other things that the garments do is, while they’re providing support, they’re holding everything where they are, and they’re also helping remove oedema and swelling, which again, helps the healing process, and helps things heal more quickly. Having a garment on not only helps from a position placement in holding the implants where they are to a degree, it helps with the oedema, certainly helps with wound healing overall, and makes everything feel comfortable so the pain post surgery is negligible as well.
Trish Hammond: Okay, so going to wake up, we’ll have the compression garment on. I know it’s different for everyone, but you’re going to feel like you’ve been run over by a bus, or really tight, or …
Dr Rohit Kumar: Look, most … That’s actually really, it’s a very good question, because it is very different for different patients. Now, techniques can also make a little bit of difference here. Certainly, breast implants, if they’ve been placed just above the muscle, tend to possibly hurt a little bit less. Once you go under the muscle, you’re actually cutting the muscle a little bit. You’re going through the muscle. Those tend to be a little bit more sore, but not significantly more sore. You are tearing muscle as opposed to not having done that or in the sort of above muscle technique. Yes, it’s a little bit more sore, but the way I sort of describe it and [inaudible 00:05:06] explain it to my patients, is imagine you’ve done a hundred push ups. It’s that level of soreness around that area that you’re going to feel.
It’s not excruciatingly painful, it’s not sort of, “Ow, this is really sore when I move my arms.” It’s more just like you’ve done a lot of … You’ve done a crazy day’s worth of exercise and so when you move and flex, or do things around it, there’s a little bit of ongoing … You can feel it, there’s a bit of pain there. For the vast majority of patients, you should be able to have Panadol, Panadeine, maybe some Nurofen, and that should hold any pain that you’ve got in check. Certainly by 24 to 48 hours, that should be almost gone. If not gone completely. Most of my patients are up and around, and shopping or doing whatever they like the day after surgery.
Trish Hammond: Okay. All right, then we have our compression garment on for six weeks, but during that time, I’ve heard patients say things like they’ve experienced sharp pains, and all that. That’s going to happen, isn’t it?
Dr Rohit Kumar: Yes, so there’s a lot of niggles, if you like, in that first six to eight weeks that may just happen once, may happen occasionally, and you can rest assured that that’s sort of in keeping. Most of these tend to happen when the implant is put underneath the muscle, and not so much when it’s pushed over the muscle. Now think about it this way. Say if you were up against a wall and you were doing a stretch, and you were stretching your calves. After a minute or two minutes, or whatever, you’ve done the stretch, it’s things are getting all stretched out. You feel it, you then stand up straight again, and the stretchiness has gone, and your pain settles down. If you have put an implant underneath your pec muscle, then that is under, stretched by that new implant.
Trish Hammond: Yep. Sorry, can you say that again, just … Under the muscle.
Dr Rohit Kumar: Right, so when you put in a breast implant, underneath the muscle, that pec muscle is now having to deal with stretch, and that is unusual to where it used to be and how it used to lie. Now unlike doing a stretch on your calves against a wall where you can stop and you can straighten out, you can’t do that with the pec muscle itself. The implant is there all the time. It has to get used to the pressure and everything pushing it, and it’s stretching out, and some patients may feel a little bit of like, a spasm-ing of the muscle, or a bit of a niggling, or sometimes in an occasional little sharp stab of pain. That’s just the muscle coming into terms with the implant underneath it and getting used to it. Over a period of time, it will stretch to accommodate, and things will get back to normal.
Trish Hammond: Okay, so after you’ve had your surgery, like I know you’ve got a [weak 00:08:06] compression gown on all the time, but when can you actually shower. How soon after can you shower?
Dr Rohit Kumar: It depends on the dressing type that you have had applied to you. All dressings that I apply for example are all waterproof, and I have, I absolutely find with my patients showering that day or the day after without any problems whatsoever. You should be able to have a shower, get those areas wet. Obviously I wouldn’t recommend going into the swimming pool and staying there for a period of time, and if you have that in the early stages. Having a shower and keeping everything clean, you should be able to do that immediately.
Trish Hammond: All right, and what about time off work? It’s such a contentious issue. Some people, they need a couple of days, some people a week, two weeks. Is there a standard how long someone should have off work?
Dr Rohit Kumar: Again, I think it … You have to individualize it and tailor it to the patient, because almost always, it depends on the type of work that you do. If you’re going to be someone that’s going to be in an office, and been doing … You’ve sort of been doing work on book working, or computers, et cetera, most patients will be able to get back to this within a week of their surgery. If your work involves you doing more sort of manual labour, or lifting things, or moving things around, you may need a week to 10 days before you can get back to doing that a little bit more comfortably.
The important rule here, certainly for me, is that heavy lifting and lifting things more than five kilograms should wait for at least six weeks before you actually go ahead and do that. While the implant is there, and while the pec muscle, and because I do the vast majority of my implants are underneath the muscle in a dual plane technique, I don’t … While they’re sort of settling in and being healed into their position, you don’t want the muscle over the top to be squeezing too much and then potentially putting them out of place.
You take it gently, your body will be your best guide, your body will give you a very good idea of if you’re doing too much because it’ll get sore or you’ll be exhausted, or it’ll be stiff. If you take it easy for the first six weeks, no heaving lifting of more than five kilos in that time period, you’re going to be fine. Certainly, going back to work provided you’re not doing that type of things, you’ll go stir crazy, I think, within a week and staying at home. I think most people want to get to work by about two or three days.
Trish Hammond: Sure, so with the hospital stays, I know that some people are overnight, some people are just a day. Do you just stock standard, keep people in for a day, and then they can go home that night?
Dr Rohit Kumar: I think the vast majority of breast augmentation is a day on the procedure now. Unless, for some specific reason, you’ve had a revision or redo, and you’ve had to put some drains in, and it was a technically a little bit more difficult, or there was something that was a little bit more untoward. I think for a standard breast augmentation, you should always plan to be in and out on the same day.
Trish Hammond: All right, and what about a breast lift that might be a little bit longer?
Dr Rohit Kumar: Same thing. Same thing but all my breast lift patients stay in for the same day, and go home with a breast lift or a breast lift with a breast augmentation. Yeah, they should certainly be a day on the procedure.
Trish Hammond: Oh, wow.
Dr Rohit Kumar: If there’s, yeah … Those likely take a little bit longer, but surprising when you do a breast lift with breast augmentation, for example, there is very little difference in pain, if anything, and if anything the breast lift component, most patients don’t even comment on that. The only comment is the stretch that the pec muscles have done from the implant. A breast lift, a breast augmentation and lift, or breast augmentation, these are all day procedures.
Trish Hammond: What about reduction? Oh, you’ve cut out again. Oops, not sure what’s happened. We seem to have lost you. Oops. I can’t hear you at all, now. Not sure what’s happened.
Trish Hammond: What about when it comes to breast reduction? Is that also the same?
Dr Rohit Kumar: Well, with breast reduction, it’s a little bit different in that most patients who have a breast reduction tend to stay overnight. They all still wear a garment. They all still wear a garment for six weeks, and they all manage their actual wounds for six week, because there’s bigger cuts and more wounds that we have to deal with a breast reduction patient, but usually the patient stays overnight. There’s a drain in on either side of the breast, and very often those drains will come out that very next day, within 24 hours, and then the garment essentially is all they have to wear. The interesting thing with a breast reduction is that most patients will mention that they’ve had very little to no pain, which is really quite interesting. I certainly see patients who have a tummy tuck and a breast reduction at the same time and they will talk about the tummy being a little bit more sore, but almost not even noticing that they’ve had any operations done on the breast.
Trish Hammond: Wow. For me, it was the total opposite. The breast reduction for me was bloody awful, the worst surgery ever. It’s just amazing.
Dr Rohit Kumar: When you do the breast, you really should be operating on fat and skin and you really shouldn’t be going deeper than that. You’re not going into the muscle, you’re not going into the other areas and given that that is what is actually happening, it tends to not be something too sore for the vast majority of patients.
Trish Hammond: We’ve come home now. What about … Sorry, are you still there? Yeah, great. What about-
Dr Rohit Kumar: Yeah, I’m here.
Trish Hammond: What about after surgery? I know everybody’s different, and you need to ask your surgeons this anyway, but when can your surgeon expect to see you, speak to you or follow up with you for the first time?
Dr Rohit Kumar: Again, you’re right, it does depend on the actual surgeon, but in most situations, after surgery, you’ll be seen at approximately one week after surgery, between one and two weeks. Most dressings, particularly if you’ve used something like a prineo dressing, will stay intact anywhere between four and six weeks, so you’ll be seen at two weeks, then at six weeks, then usually three months and six months afterwards for the vast majority of follow-ups, but obviously, if there’s been a problem, if there’s been an infection, if the wound is not healing as well, or if you’re just wanting to see a surgeon more often, then your surgeon should arrange that with you.
Trish Hammond: The next question I want to ask you is, I’m asked all the time, what about with regards to driving? After your surgery, how soon can you start driving?
Dr Rohit Kumar: Look, I think it’s, again, it will be depending on how well you’re healing. For the vast majority of patients, within a week to ten days, you should be able to drive. Sometimes, even earlier. You do need to take into account that the muscles particularly in a reduction or, sorry, in a augment patient, your muscles might be more sore, so you might have a little bit less control of the wheel when you’re turning it, and you may, depending on the procedures you’ve had, you may need to put a small pillow in front of your seat belt so that it doesn’t actually rub on the breasts themselves, but for the vast majority of patients, within a week, you should be back to driving.
Trish Hammond: This is a really … Not a curious one, but this is different for everyone too. I know it’s different with above the muscle and below the muscle, but what about exercise and let’s talk about the different levels of exercise here as well, because I don’t mean just walking, but about for those-
Dr Rohit Kumar: It’s a very common question, actually, and my answer is very straightforward. If you’re an athlete and you went out and you’re playing sports and you tore a muscle, you’d be out of action for six weeks, right, for the vast majority of athletes, and the same applies. You haven’t torn a muscle. You’ve had a surgeon cut them, but the injury is essentially the same, so walking, getting around, doing aerobic exercise, start that a day or two after surgery. That’s not a problem, just in terms of gentle walking or brisk walking and you build up to it. Exercise that actually physical involve the muscles, so involving the pec muscle, so that may mean things like swimming or physically grasping and pulling things or lifting weights, they should wait six weeks, just like any other athlete that might have torn those muscles, and after that, you should slowly build up after that point.
Trish Hammond: Last week, I spoke to a young lady who had a breast augmentation about three years ago, and what’s actually happened now, she’s presented with a bit of a double bubble and her breasts have kind of gone a little bit pointed out towards the side. She was really happy with them at first, and then something happened that they kind of just popped out of their place. Is this common?
Dr Rohit Kumar: It shouldn’t be. It shouldn’t be common. I think there’s a lot of factors and having not seen her, it’s very difficult to comment, but the reality is that a double bubble can be caused by a variety of things, whether the implant’s too big for pocket that’s created, whether the pocket’s too big, whether the positioning above or below the muscles was not appropriate for the size of implant. What’s happened to the breast crease? Have you done anything? Say you’re a body builder and you’ve been using your pecs a lot more than you normally would.
There’s a lot of factors that come into play when you look at the development of a double bubble, so without seeing the individual circumstances, what we can say is that usually a double bubble forms when the implant is too big for the pocket that’s been created, and so you’re actually getting a distortion of shape, or it’s cousin, if you like, the waterfall effect is that if the implant is placed in a position and then the breast falls over the top of that over time, which can also have a double bubble sort of shape over the time as well. Often, it’s an issue in terms of marrying the size of implant with the pocket and the location of the pocket. If you get those three things right and that they’re appropriate for the appropriate patient, then your double bubble risk should be a lot lower than if you’ve got one of those things out of kilter.
Trish Hammond: If someone does get a double bubble, as far as the surgeon [inaudible 00:06:42], is it just bad luck? You got to get it done, get it fixed. What I’m trying to say here is who’s fault was it?
Dr Rohit Kumar: It’s hard to say. It is very, very hard to say. Look, it’s often as I said, sometimes it’s a decision based on the implant. Sometimes, it is surgically related and the type of surgery you’ve done. I certainly see a lot of patients who’ve been operated overseas who are seeing me for double bubbles, and to me, that is obviously and indication of not only surgical misadventure, but it’s also probably that you weren’t guided appropriately to choose the implant that best suited you, and you’ve got for an implant that’s way too big for what would have suited your frame, so often, it’s up to the surgeon to actually help you choose an implant that suits your frame, rather than just go, “Yup, fine, we’ll put the big one in,” because the big ones, and certainly once you go above 400, 420CC, the potential of developing something else tends to get a little bit higher.
If your frame can support it, if your breast dimension support it, then that’s not a problem, but if you’re a young, petite person, and you’re asking for a 500CC implant, then it really is important for the surgeon to discuss with you your higher chance of possibly developing a double bubble, but also maybe guide you away from that, because it’s probably not the most proportional implant. Also, it makes sense to see the type of operating and dissecting you would need to do to cope with that larger implant and if you don’t have the skills to do that, then yes, I think a double bubble is going to be on the cards.
Trish Hammond: What about for the … You see it happen with all the time on all the closed Facebook groups that we have and people say, “Oh my god, look, one’s higher than the other,” and irregular and all that. Can you explain to us a little bit about dropping and fluffing and what that actually means, because people go into a bit of a meltdown when they don’t need to.
Dr Rohit Kumar: You’re right, I’ve heard a few of these terms along the way. I just use the term breast dropping and the reality is that when you actually did the implant right at the very beginning, you set the implants high because you know that they’re going to fall with gravity. You know that you want to position them to where they’re going to go once gravity kicks in, once the pocket stretches and once the muscle stretches out and accommodates the implants, so if you put them exactly where you would expect them to be when you wake up and for the rest of your life, they’ll just go lower than that point and they’ll change, so what you need to do is when you create the pocket, you put them a little bit higher, you set them up so that you know that over the next few weeks to months, they’re going to settle down to their proper location.
Now, if you look at most people’s images on their websites, the before and after image, realistically, they should be commenting because the images are almost always at least six months apart, so when you look at the breast pre-surgery, during surgery …
Dr Rohit Kumar: When you look at the breast pre-surgery, then during, and then certainly after and after not just a month after, but then six months after, they’re very, very different. Initially after surgery, everything’s stretched, they’ve almost got a bit of a sheen to them, they’re sitting a little bit higher, and as everything starts to accommodate the new implants, all of that will gradually settle in, and so your breasts don’t actually achieve the true shape and form and position for up to six months after surgery.
Trish Hammond: That was my next question. Six months after surgery, that’s pretty much going to be your natural shape and then gravity, they may drop a little bit over the time, and that sort of thing, but that’s going to be your basic shape, six months into surgery.
Dr Rohit Kumar: That’s right. That’s exactly right. A good six months before you have an idea of exactly what you’re going to look like. Anytime someone looks at their breasts and goes, “Oh, they don’t look right,” or “My left is sitting higher than the right,” or something like that, you can’t actually really make a call, and there’s no rule that says that they both have to fall at the exact some rate, so one may settle down earlier than the other, and it’s just a matter of time and then you see what they’re like at about six months.
Trish Hammond: Another thing I wanted to ask you is, and I know this different for everyone yet again, as well, but what about scarring? I know it’s not very common for people to have the implant incision under the arm anymore in Australia. Is that right?
Dr Rohit Kumar: That’s right, for a variety of reason. I tell my patients, “You don’t fix the engine in your car by coming in from the roof. You actually come in from the garage.” That’s the analogy for breast augmentation: to create the pocket that’s going to be appropriate, you come in from the breast crease, because that gives you the best view, and it’s all the less contaminated. While you can hide a breast crease incision wearing a bra or bikini, if you’ve got it in your armpit, which is also at a very dirty, contaminated area to go and put your implant through, not only is it difficult to create the pocket, it’s a scar that doesn’t tend to form as well as it does in the breast crease, and you’ve got it in an area that’s going to be significantly more visible. If you wear strapless dress or something out, you’ll see the armpit scars. You won’t see the breast crease scars.
Trish Hammond: Now, for those women that have had a breast augmentation, having a bit of a panic thing: “Oh my god, they’re not okay,” the best course of advice is to of course contact your surgeon and make that your first port of call.
Dr Rohit Kumar: First port of call: contact your surgeon, see what they say, see what it’s like, give it time, let them all settle in and if you’re still not happy, if you’re not happy with the answers, if you’re not happy at six months as to what they are, then, by all means, get a second opinion.
Trish Hammond: Say, for example, if someone isn’t happy and they’ve gone down, when you say “get a second opinion”, does that mean you may have to get someone else to do a revision for you?
Dr Rohit Kumar: Quite possibly
Trish Hammond: You wouldn’t look at that before six months?
Dr Rohit Kumar: No, I think most surgeons wouldn’t touch a breast that was [inaudible 00:13:02] healing phase, which is in the first six months, unless there was something really dramatically wrong with it. You would wait six months if there are a few little things that just hopefully will settle with the tincture of time.
Trish Hammond: I won’t keep you much long, because I know you’re really, really busy and I thank you so much for your time here, but one last question: what do you like to use or what do you suggest your people use for prevention of scars?
Dr Rohit Kumar: Look, there’s no hard and fast rule about these. There are silicon creams and silicon tapes out there. There are studies that say X works and Y works, but they’re all about the same, so what I tell my patients is to use something familiar and something that they’re comfortable with, preferably, something with vitamin E, because that certainly has shown to have some improvements, and it’s not necessarily what you use, but the action of massaging that makes the difference.
Trish Hammond: That’s what I thought.
Dr Rohit Kumar: Six weeks onwards, start massaging it really hard, not a gentle massage, really try and keep breaking down the scar that’s forming and use what you feel comfortable with and you feel that has had either good result with your or a friend or you believe in and that can be a silicon based cream like Strataderm or it can be just straight forward Vaseline with vitamin E.
Trish Hammond: Oh really? I wouldn’t use Vaseline on my body.
Dr Rohit Kumar: Well then, ……….
Trish Hammond: I wouldn’t use that either.
Dr Rohit Kumar: It works well.
Trish Hammond: I don’t like anything that’s got petroleum in it, which is the Vaseline …
Trish Hammond: Anything else that you can add that you think. We’ve pretty much covered everything, haven’t we?
Dr Rohit Kumar: We’ve covered most things, actually.
Trish Hammond: Thank you so much for your time today.
Dr Rohit Kumar: Pleasure, Trish, no worries at all.
Trish Hammond: Ladies, if you’re up for a breast augmentation, and you like what Dr Rohit Kumar had to say, you can have a talk to your surgeon about it or if you’d like to go and see him, he’s, as I said before, at Sydney Cosmetic Sanctuary based in Leichhardt, New South Wales. If you want to find a bit more, want to have a bit of a chat, just feel free to drop us an email at firstname.lastname@example.org. Thank you so much, Dr Rohit Kumar.
Dr Rohit Kumar: Again, pleasure, no worries at all.
Trish Hammond: I’ll let you get back to your afternoon operations.
Dr Rohit Kumar: Cheers.
Trish Hammond: Thanks a lot.
Dr Rohit Kumar: Buh-bye.
Trish Hammond: Bye.