Hello there, it's James Southwell-Keely from Woollahra Health and Beauty, we're the big blue building on Edgecliff Road just down the hill from [inaudible 00:00:19] Junction, train station, bus stop, et cetera. Love to see you. Today, we're talking about breast augmentation surgery, it's a hot topic, it always is. It is, in fact, the most common plastic surgery, cosmetic plastic surgery procedure performed in Australia and around the world.

Now it's actually a very hot topic at the moment, more so than usual because of the recent discovery of atypical large cell lymphoma, which is a type of tumor that can be found in the capsule, the scar tissue that forms around the impact but we'll touch up on that later in this discussion. Now, we're talking about the breast in this series. We're going to do a series of talks about different aspects of cosmetic breast recon surgery as well as reconstructive breast surgery.
As a small addendum here, plastic surgery covers both cosmetic and reconstructive elements to the surgical pathway. We'll be leaning more towards the cosmetic in this series of talks but we'll definitely be touching upon the reconstructive aspects of breast surgery as well. Why do patients have breast surgery? It's a really interesting question. Obviously, there's the necessary breast surgery we have for obstructed ducts, cancers, lumps and bumps, et cetera, but there's the cosmetic as well.

The reasons that patients have cosmetic surgery are many and varied. We'll kick through those right away but first of all, what different types of surgery do I perform and what different types of cosmetic breast surgery exists out there? We have straight out augmentation which increases the size, the volume, and improves the shape of breast. Then there's reduction surgery where you have large breasts and wish to be smaller. Following on from that is a breast lift operation where it's more about the shape, improving the shape and lifting the nipple areola complexes back more towards the position they once occupied in your youth.

There's a mixture of an augmentation and a breast lift where you need a combination of increased volume as well as an elevation of the nipple areola complex. There are, of course, combinations of all of the above for breast asymmetries, maybe one side of your chest wall is over-developed relative to the other or maybe you have an underlying asymmetry in your chest wall so the rib cage is receded on one side and overly projecting on the other, for instance. Definitely, asymmetry is a big reason to do, undertake reconstructive and/or cosmetic breast surgery.

Finally and equally importantly, is reconstructive breast, so surgery for patients who've had mastectomies and wish to restore their normal physiology so that they fit back into their clothes the way they once did and feel whole again and good about themselves. That's really, really important and an incredibly satisfying part of my work, I must admit.

Let's talk then about the different motivations that patients will undertake augmentation breast surgery, so that's to increase the volume and improve the shape of one's breast. These are listed in no apparent order and come from person observation and discussion with patients but also looking on the internet and just seeing what different patients are asking. There's an incredible consistency in these questions that are asked.

The first is, and probably most importantly, self-esteem. Patients feel that they are some way deficient and the augmentation surgery makes them feel more whole, more comfortable in their own skin. There are lots of different reasons for that motivation but it's a very successful operation in terms of addressing that issue.

Next is asymmetry, we've touched upon that in the introduction that sometimes one breast will develop into a D cup size and the other breast will develop into a B cup size. This makes purchasing clothing very difficult, patients are very self-conscious about this down at the beach or in the gym change room and it can really hamper one's social development and people feel very stigmatized in this situation.

Following on from that, there are different congenital problems where patients are born with an under-developed breast or tubular breast or constricted breast. They're all similar conditions and all the same condition, different names but there are variations on that asymmetry, with increasing levels of asymmetry or difference in size and shape between right and left breast. Attending to these and making them look as close as possible to one another can be very challenging surgery but, once again, incredibly satisfying, where for me, surgeon, and for the patient.

Next is a reduction in size of one's breast. This is another reason patients come to surgeons requesting breast [inaudible 00:05:07] surgery. There's a phone in the background, it's probably a patient now inquiring about some of these procedures we're talking about now. Here we go, a reduction in size, how does this happen? It could happen with significant weight loss, just as you've lost weight from your waist and your hips so too you lose weight from the breast. 50-70% of your breast volume is made up of fat and tissue and it's metabolically active. As you lose weight from this part of your body so too do you lose weight from the breast.

With this loss of weight you lose volume, like a deflated tire or a balloon that's losing its air and they become saggy. Accompanying that reduction in volume, you have a redundancy or an excess of skin and the nipple areola complex or the nipple [inaudible 00:05:52] of that starts drooping down towards the ground. To restore the shape and volume of one's breast, breast augmentation in and of itself is sometimes enough, and sometimes we need to combine that with a lift operation.

We've touched upon mastectomy and restoring a patient's feeling of wholeness after cancer surgery, that's a very important reason for using breast implants. It's not an augmentation, per se. Whilst we use similar techniques, the procedure is actually quite different. The risk profile is quite different and the follow-up is quite different. In essence, we're using the same technologies to effect the same result and that's ultimately patient satisfaction and a feeling of restoration of oneself.

Patients come asking about ... It touches upon their self-confidence and self-esteem issues but they feel that they are inadequate before the eyes of their partner. An indirect effect of the benefit from the breast augmentation surgery is the improvement of one's sex life.

Now, this is a little bit esoteric and obviously has never been proven but it's certainly something that pops up time and time again on the internet forums and patients discuss this with me in my room so it can't be neglected as an obvious motivation for such surgery. On the whole, I think it's more about feeling confident in your own skin and if there's something you've lost or have been born without making you whole again, and so you can live a happy and fulfilled life.

Now, let's go back to what I mentioned right at the introduction and that's this atypical large cell lymphoma. It was on the television last night, Tracy Greenshaw presented on this on A Current Affair. It's been in the newspapers statewide and nationwide recently and it's certainly been in scientific publications quite frequently over the last five to 10 years. It seems to be building a head of steam, we seem to be learning more and more about this condition as the years go by and further research is undertaken. In fact, a lot of that research is coming out of Australia and specifically out of Sydney. We're very proud of that, to be at the forefront of the inquiry and investigation of this rare yet emerging condition.

What we learn today is as follows, it tends to occur in textured implants. Now, the reason that we use textured implants at all is probably historic and it was, the texturization implant was introduced to decrease the rate at which scar tissue formed around implants. We call this capsular contracture, it can cause painful, distorted breasts. Everyone's seen those glossy mag photos of those terribly distorted breasts on celebrities and the sensational headlines associated with that. That often is a reflection, wholly and solely, of a capsular contracture.

The reason for the texturization was well thought out and was good, and that emerged through the eighties. What we've found since then, through the nineties, the early 2000s, and now into the next decade, that there is a degree of irritation that's caused to the body's tissues through this texturization. That coupled possibly with bacterial seeding at the time that the implant was inserted can together couple to produce this atypical large cell lymphoma.

There's been a drift back towards the smooth implants. The smooth implants were the first type of implant produced over 50 years ago. The reason we went away from them in the first place was that they caused a high degree of scar formation and this capsule formation, this capsular contracture. Placing the smooth implant beneath the muscle, the pectoralis major muscle on the chest wall, in fact reduces that rate of capsular contracture down to the level achieved using the textured implants so, in fact, it's probably the best bet in this current climate.

There have been no cases reported worldwide of atypical large cell lymphoma using smooth implants today and so I've certainly heavily drifted towards the use of smooth implants for all my patients. There are some patients that still benefit from the textured surface and when I use the textured implants I use the Mentor implants. Once again, to date they have the lowest rate of atypical large cell formation, lymphoma formation. It's something that involves a detailed discussion with patients and then a thorough follow-up before you undertake such a procedure or recommend such an implant, and it really needs to be decided on a case-by-case basis.

By way of a brief prop, there is a smooth implant and here is a textured implant. The smooth implants are universally round, the textured implants will be tear dropped implants which when we see in profile demonstrate an upper polar, it's thinner, versus a lower polar, it's thicker, placed anatomically beneath the skin and into the breast. It was once argued that it created a more natural appearance, that's arguable. You certainly can't see my hands through the textured implant as well as you can through the smooth implant because the light's essentially passing straight through the silastic shell, and hence you can see my fingers beneath that.

In summary, then, smooth implants are never anatomical or teardrop shaped but if you use a soft gel and place it beneath the muscle you can produce a very similar effect. That's probably a discussion topic in and of its own right. We can talk about the history of breast implant surgery and the different controversies and problems that we've had over the years. Personally, I'm very confident to use the smooth, soft, silicone gel implants placed in the submuscular pocket.
That's it for now. This has been our first talk from Woollahra Health and Beauty, myself, Dr. James Southwell-Keely discussing the breast and breast augmentation surgery. This is the first part of the multi-part series about the breast. Remember, we're at Woollahra Health and Beauty, that's a big blue building on Edgecliff Road and I look forward to seeing you soon. Goodbye for now.

Video transcription:

Hello James Southwell-Keely here, just going through a checklist that patients often ask me and I run through in my mind at that point of discussion during my consultation with them what do we need to do to get this operation right. What are the key points for this cosmetic operation that will detail successful result. This is something that we're not quite happy with and really the latter is never acceptable so to get the best results you need to ultimately produce a beautiful harmonious natural look that is hard to detect that the casual passer-by won't stand say wow that that patients had cosmetic surgery but that patient had a lift or a nip or a tuck you really want to be able to blend back into society back into your community and look as though nothing happened. But your little secret my little secret is that we've done a little something to refresh things to rejuvenate things and that will be long lasting and willing jury that helps there are things that I think about during our consultation these are things that we'll discuss during our consultation and I look forward to seeing his soon bye now.

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A proper mummy makeover usually starts on your face with some anti-wrinkle injections & fillers, then working down to the breast to deal with the downward movement or sagging of the breasts from constant breast feeding, and then onto the tummy tuck to remove all the loose skin and excessive fat around the abdomen, and possibly finished off with some lipo, as during pregnancy the female body stores all excess fat just in case.

Not all yummy Mummy makeovers require the full treatment. On average a mummy makeover deals with drooping breasts, enlarged areola, a wider waist, fatty areas in the abdomen, stretch marks, and a sagging tummy. Surgeries can take up to 4- 8 hours under general anaesthetic with a few nights in hospital, followed by a very relaxed recovery period of 2-3 weeks.
To establish what is right for you, it’s always highly recommended and best to go and see a few specialist plastic surgeons, FRACS qualified surgeons, whom work in renowned hospitals. The best yummy mummy Plastic surgery results are usually achieved the first time. You don’t want to take the risk of an under qualified or inexperienced doctor and you always want to be in a healthy state of mind to make the right decisions for you and your new mummy makeover body.

Find out more about the procedures here: Breast Augmentation | Breast Lift | Liposuction | Abdominoplasty (tummy tuck)

Before seeing your surgeon ask yourself the following question, what type of nose do I have? To help prompt you, think about the following list:

1. Big nose:
Is your nose too big for your face? Young women often inherit their mother’s good looks, but their father’s big nose. Making a patient’s nose proportionate to their face softens one’s whole look.

2. Pointy nose:
Does your nose taper to a pointy tip? This can look mean or witch-like and always benefits from a gentle rounding off.

3. Bulbous nose:
Normal nose but big tip? Unlike the pointy tip, some people’s nose tip is like a big, round ball. Simply refining the tip can bring balance back to the nose, and indeed the face.

4. Flat nose:
Building up a flat, wide nose can make all the difference. Many “ethnic” rhinoplasty patients benefit from augmenting (building up) the nose rather than reducing it in size. This is far more sympathetic to the overall appearance of the face.

5. Crooked nose:
Straightening a crooked nose involves re-breaking the bones, and straightening the septum. Some patients end up with a crooked nose after an accident, while other patients are born with one.

6. Hump nose:
This is one of the most common complaints that brings a patient to their surgeon. The hump contributes to the size of the nose, making it look big, and of course its shape. Hump reduction rhinoplasty patients are invariably happy with their surgery.

7. Revision nose:
Patients who require revision surgery after a previous rhinoplasty require an extra detailed assessment and attention, because it is never as easy second time around.

But first things first, consult a FRACS qualified surgeon, who specialises performing nose jobs. He or she can walk you through the process. Take your time to understand what is being explained to you, ask as many questions as you need to, see your surgeon at least twice before the day of surgery and don’t be afraid to seek a second opinion.

Hello there Dr James Southwell-Keely here again just a follow up question on breast implants. Choosing Silicon versus Saline. The Silicone implants were taken off the market for several decades in the United States which has given them a slightly bad name overall. However, in Australia in Europe and in the UK their usage was never ceased and in fact we have excellent safety data to suggest that they are a very safe product to use.

Once more they are back on the market in America and they are struggling to catch up with the experience that the rest of the world has had using them during this entire time. Hope to see you soon.

Take care. Bye now!
Dr JSK

Dr JSK Video interview with Bondi Beauty TV's Renae Leith-Manos on what do you need to consider when choosing a plastic surgeon

Below is a transcription of the video

Renae: I’m here with Dr. James Southwell-Kelly from Darling Point who is a plastic surgeon who has come to lift the veil on all things plastic surgery and explain what everything is. Now welcome.
James: Thank you. Thank you so much.
Renae: So please explain to us, how do you choose the right plastic surgeon? I mean we all have seen the stories on, you know, 60 minutes of these cowboys who are posing globally as plastic surgeons and they’re not. So please tell us what are the [inaudible 00:35] make sure we choose the right person, when you’re not available.
James: Very good. Alright. Well, qualifications and word of mouth, I think, are the safest means to choose your plastic surgeon.
Renae: Hang on, hang on. Word of mouth in the eastern suburbs, I don’t know a woman in the eastern suburbs who will ever admit to having any injectable. So there’s no way [inaudible 00:55] around here, James.
James: There’s sometimes a special friend, maybe there’s a secret handshake, something like that.
Renae: Shall I start a website?
James: Possibly.
Renae: The Secret Handshake.
James: That’s right.
Renae: Who we recommend.
James: There you go.
Renae: But what qualifications do we look for to make sure that it’s the right person? Is a nurse okay, for example, to inject my face?
James: Look, technically, a nurse under supervision of a doctor is okay.
Renae: Okay.
James: As to the letter of the law.
Renae: Because that would be a bit cheaper, right?
James: It is a bit cheaper, a hundred percent. Yeah. My personal opinion is that you want the person doing your injection or applying the therapy that can deal with any problem that may arise.
Renae: Absolutely.
James: Yeah.
Renae: So, how many years of study have you got? You were telling us earlier.
James: Yeah, that’s right. My gosh. [inaudible 01:39] to be thinking about it.
Renae: 16 years or something?
James: About that, about that.
Renae: Globally, Paris, London, Leon.
James: Yes. All of those international centers because they do things slightly differently over there. Ultimately, the pool of medical knowledge is the same but the nuances are different.
Renae: Well, on that global scale, why are people going to China and South America and why are things so much cheaper there? Is that just an economic thing or is it a…?
James: It is an economic thing. It’s a really good question. So there’s a question of labour cost which is always cheaper over there, so the cost of running an operating suite, the cost of nursing staff, the cost of the trucks delivering the anaesthetic drugs, the oxygen's, everything. All the infrastructure, everything, is cheaper, and so you can fly over there and have your surgery and go home, maybe having had a little holiday as well, for probably 80% of the cost that [inaudible 02:38] have it here.
Renae: How do you feel about that as a practitioner working in Australia?
James: Look, ultimately, it’s up to you, the individual, to decide where you go but this is what I would counsel anyone who was thinking about that. After your surgery, you feel a bit low. You’re in pain. You want that support. That’s when you need the most love. And why be away from home? Why be away from family and friends?
Renae: A hundred percent.
James: So that’s one reason I’d say do it locally. The other reason is, if you have a problem and now you’re back in Sydney - two weeks ago, you had your breast augmentation in Thailand or wherever - …
Renae: Brazil.
James: …what do you do? Who do you go to?
Renae: You’ve got to start from scratch then.
James: You can start from scratch.
Renae: Come to someone like you or you have to work at what they’ve done.
James: Or you go to the emergency department at a public hospital and, you know, when it unravels, it’s a disaster. It’s a disaster for everyone.
Renae: Have you seen some of those?
James: A hundred percent. We’d see…I work at St. Vincent’s Hospital in Darlinghurst and I’d see…well, the unit, plastic surgery department, they would see maybe one case every two to three months.
Renae: Wow.
James: And all manner of different things – silicone implants in noses, infected breast implants, implants extruding from the skin, all sorts of horrors.
Renae: So all of those people trying to look more beautiful and be happy within themselves and coming off second best.
James: Coming off second best and, as you alluded to earlier, it’s always harder to deal with the problem than it is to get it right in the first instance.
Renae: So you pay the 20% more?
James: You pay...
Renae: To be sure.
James: It’s always advertised that it’s much much less than that but by the time you’ve had a [inaudible 04:03] travel insurance and all the other little add-ons that are never advertised in the advertised price, it ends up being not that much cheaper but the risks are so much higher.
Renae: That’s for sure. Now I want you to look into the future and tell us how you see plastic surgery, injectable, the whole thing, being a part of life, because who would have thought ten years ago that having botox would be kind of, you know…I don’t know what the stats are. Is it 1 in 2? Probably. Or 1 in 2 women over a certain age? It’s so common.
James: It’s a great stat and I’m going to run with that.
Renae: But what do you see? I mean, are we all going to be lining up for a face-job at 60 in ten years?
James: Well, look, as the surgical techniques progress and as surgical technology and the medical knowledge increases, procedures become less and less invasive and the down time becomes less and less. You’re back to work, back to your normal social activities sooner. So…
Renae: Signs get less, I mean that you’ve had [inaudible 05:04].
James: Signs get less. Absolutely. And so it will become a more readily available and a more socially acceptable commodity, essentially.
Renae: Well, it’s starting to already, isn’t it?
James: It’s starting to already. Absolutely.
Renae: And can you ever see, you know, someone, probably in America, with all due respect, creating a peel that keeps us young? Do you think that’s possible? I mean, there are people working at that. [inaudible 05:26]
James: There are definitely people working on it. I think we’re probably many generations off that.
Renae: Damn.
James: I’m sure.
Renae: So our childrens’ children’s children, maybe.
James: Yeah. Maybe. Maybe getting close.
Renae: Might stay young forever.
James: Might stay young forever. Okay, so, would you want to stay young forever?
Renae: It’s a good question.
James: There’s a hypothetical...
Renae: And that’s a question that’s been addressed historically since time began and I think, you know, it’s okay to get older.
James: It’s okay to get older and…
Renae: But I want to look as good as I can, as fresh as I can while I’m doing that.
James: Absolutely. Be the best you can be.
Renae: A hundred percent.
James: Through every stage of your life.
Renae: Yes. I agree.

Dr JSK Video interview with Bondi Beauty TV's Renae Leith-Manos on "A plastic surgeons tips to naturally improve looks" view this video and more from Bondi Beauty Bondi Beauty

Below is a transcription of the video

Renae: I’m here with Dr. James Southwell-Keely from Darling Point who is a plastic surgeon who has come to lift the veil on all things plastic surgery and explain what everything is. Now, welcome.
James: Thank you. Thank you so much.
Renae: And what I want you to tell us is maybe five, if we can come up with them, but a few ways to enhance your appearance. You were talking about keeping your teeth clean, maybe your hairstyle. What are some things that we can do in everyday life to, you know, keep ourselves as fresh and young as possible?
James: So you’ve already said a couple of...
Renae: Sorry.
James: ...very obvious ones there but very good ones. So, bad teeth don’t look great.
Renae: Right.
James: [inaudible 00:43] getting your teeth fixed are very expensive but certainly whitening them will freshen up [inaudible 00:47].
Renae: I had mine done by zoom.
James: Really?
Renae: Yeah.
James: Amazing.
Renae: Really good.
James: Look how good that is.
Renae: I know. It was great. Really good experience. So I recommend it.
James: Yeah. There you go.
Renae: Hair.
James: Hair.
Renae: Yeah.
James: Hair is another...
Renae: So what should we do with our hair?
James: Well, look after your hair.
Renae: Yeah.
James: So...
Renae: How for men, if they’re losing it…because…
James: It is. It is, but you can change your hairstyle.
Renae: Okay.
James: Or shave it.
Renae: Yeah. Okay. Go for that Bruce Willis look.
James: Bruce Willis look. He’s kind of timeless.
Renae: Yeah, he gets away with it.
James: A lot of people get away with it.
Renae: Yeah. Okay.
James: I like that. Very good.
Renae: There was an article in The Telegraph a couple of weeks ago where it mentioned a lot of people who don’t age, celebrities who don’t age, like Judie Dench, like Christie Brinkley, like Elle Macpherson, and it was saying that sure, you know, they’ve had some [inaudible 01:29] their hairstyle they’ve generally kept the same from, say, their twenties, which does something to the eye or something so that you still relate to them as being younger. What do you think?
James: I think that’s probably a really good suggestion but I’d also suggest that it might have taken Elle Macpherson’s hairstylist an hour…
Renae: [inaudible 01:49].
James: …back in the day, and now it might take a few more hours. So as we age, every part of us ages and having your [inaudible 01:57] look as good as it can takes time.
Renae: And another tip that you can give us?
James: Makeup. So, you’ve got to adjust your makeup. As you get older, you’ve got to highlight the highlight-able features of your skin and your face and you want to detract from those that are aging.
Renae: We talk a lot about changing your foundation for women. [inaudible 02:16] same products. A lot of women keep the same products from their twenties to their forties and that’s not a good idea.
James: No. No. Change your products with changing ages and stages of life.
Renae: Absolutely.
James: Yeah.
Renae: And what about glasses? Men particularly seem to get, you know, case in point, you look great in glasses but a lot of men get really anxious about having to wear glasses because I’m single when you go on a date and they go, oh you know I wear glasses. It’s like, so what? But what do you think? Should we all be getting contact lenses or…? I had laser. There you go.
James: Look, I’ve considered laser and I’m waiting for ten-, twenty-, thirty-plus year data to say that it’s safe.
Renae: Oh gosh.
James: And I’m sure it is. It’s like a 1 in 10, 1 in 100, maybe more, 1 in a 100,000, chance of a problem. I [inaudible 02:58] with my eyes. So I [inaudible 03:02] my work every day.
Renae: Yes.
James: But look, glasses are great.
Renae: Yeah, I agree.
James: It’s just a fashion thing, you know?
Renae: Yes.
James: I didn’t need them until I was sort of mid-twenties and I was a little bit upset when I had to get them but now that I have them, it’s just a part of life.
Renae: And as a doctor, it’s kind of cool.
James: It’s kind of…yeah.
Renae: Makes you look smarter.
James: Yeah.
Renae: Not that you’re not but…
James: Everything helps.
Renae: And sunscreen. Do we still need sunscreen as we get older?
James: Always.
Renae: Are you wearing it today?
James: I’m always wearing it.
Renae: Really?
James: Yeah. [inaudible 03:29]
Renae: And what do you wear? What’s your favourite sunscreen? Can we ask you that?
James: It’s nothing fancy.
Renae: That’s what we want to hear.
James: Good. Skin Cancer Council.
Renae: Excellent. That’s a really good product.
James: 50+.
Renae: It’s endorsed by them. We know it works.
James: Has to.
Renae: Fantastic. Well, thank you for coming to talk to us today.
James: Absolute pleasure.
Renae: The world of plastic surgery is so interesting. We might invite you back again.
James: It would be my pleasure.
Renae: When there’s some breakthroughs and, you know, we’d love to hear what’s happening, and we loved your input on all the celebrities out there. Thank you.
James: Any time.
Renae: Okay.
James: Any time.
Renae: See you soon.
James: Bye.

Hi there it's Dr JSK here. I thought we'd talk about turning 50. At some point or another we'll all be there and what can we expect? Or what can we see when we look in the mirror around this time?

Now the first to say is that we all age differently so one person looking at the mirror at 50 will look very different to another person, that's the first thing. Next thing is the skin, at a superficial level the skin becomes a little thinner, become a little crapier or more wrinkled and we might see in particularly paler skinned individuals a blotchiness coming into the complexion, patchy pigmentation that sort of thing.

Now at a deeper level if we look at the face, plastic surgeons divide the face into thirds. There is the upper third, between the hairline and the upper eyelids. The middle third, between the lower eyelids and the mouth and then the lower third which runs from the mouth down to the chin and of course below this is the neck. But that’s all for now, so to discuss the facial thirds in aging from 50 and upwards further, you will have to tune in next time. Bye now!

Hi there it’s Dr JSK here. Going to talk to you this afternoon about SMAS facelifts. Now the SMAS is the most common type of facelift. The SMAS is a layer in the face. Our bodies are organised in layers and one of these layers is the SMAS. Now that is S-M-A-S that stands for Superficial Musculo Aponeurotic System, it’s a complicated medical term but really what it means it’s a tough fibrous layer that when elevated gives the patient excellent longevity for their facelift and a nice natural result without unnatural tightness on the skin surface. It can be done in various different ways it can be tightened by itself, a small sliver can be removed and closed back up or it can elevated, redraped and secured to itself again. There are some of the finer points of SMAS facelift surgery. I hope to see you soon.