Procedures

the best version of yourself

BREASTS

Breasts

AUGMENTATION

Increasing the size of the breast

Breast augmentation is a procedure done to make small breasts larger, and correct volume loss associated with post breast-feeding and age-related deflation. Implants can also be used to correct birth deformities and for breast reconstruction.

How are the implants inserted?

  • The most common way is by cutting a very small incision under the breast.
  • Other incisions that can be used are; on the edge of the areolar, from your axilla and from the belly button.

Where is the implant placed?

  • An implant can be placed:
    • Under the breast tissue (sub-glandular)
    • Under the muscle (sub-pectoral)
    • or Most popular would be an interphase between the two (dual plane)

Which implant filler is most commonly used?

  • The most common type is silicone, which gives the breast a more natural feel to touch and is associated with less chance of rippling and deflation as compared to saline-filled implants

 What are the advantages of having a breast augmentation?

  • Enhances self-confidence and self-image
  • Improved cleavage
  • Enhances your figure
REDUCTION

Reducing the size of the breast

Big female breasts/ Macromastia are defined as disproportionally enlarged, sagging breasts where more than 500g (macromastia) or > 1000g (gigantomastia) is expected to be excised from each breast.

What are the benefits of having a breast reduction?

  • Improvement posture (kyphosis)
  • Improves back pain related to heavy breasts
  • Can improve the quality of sleep and breathing due to reduction of the weight from the chest area
  • improves neck pain and shoulder strap notching related to Bra straps
  • Improvement of infra-mammary skin excoriation/intertrigo.
  • Has been shown to improve self-esteem, especially of adolescents.
  • Easier to find well-fitting clothes and brassieres
  • Improves physical activity, as in some patients, enlarged breasts can cause restrictions in physical activities and sports
  • Can improve neuropathic pain caused by compression of the brachial plexus by Bra straps
LIFTING (MASTOPEXY)

We lift the breast through contouring and elevations of your breasts.

A mastopexy is commonly known as a breast lift. This is a surgical procedure performed by a plastic surgeon to change the shape of your breasts. During a breast lift, excess skin is removed, and breast tissue is reshaped to raise the breasts.

What are the advantages of having a breast lift?

  • You might choose to have a breast lift if your breasts sag or your nipples point downward.
  • A breast lift might also boost your self-image and self-confidence.
  • A breast lift won’t significantly change the size of your breasts, however, a breast lift can be done in combination with breast augmentation or breast reduction.
  • A breast lift can reduce sagging and raise the position of the nipples and the darker area surrounding the nipples (areolae). The size of the areolae can also be reduced during the procedure to keep them in proportion to the newly shaped breasts.

Why it is done:

As you get older, your breasts change — losing elasticity and firmness. There are many causes for these kinds of breast changes, including:

  • Pregnancy:
    • During pregnancy, the ligaments that support your breasts might stretch as your breasts get fuller and heavier.
    • This stretching might contribute to sagging breasts after pregnancy — whether or not you breast-feed your baby.
  • Weight fluctuations:
    • Changes in your weight can cause your breast skin to stretch and lose elasticity.
  • Gravity:
    • Over time, gravity causes ligaments in the breasts to stretch and sag.
COMBINE AUGMENTATION AND LIFTING (AUGMENTATION MASTOPEXY)

Combination surgery which includes changing the size, contour and elevating your breasts to a pre-specified shape

A breast augmentation combined with breast lift (mastopexy) can help women achieve breasts that appear fuller, rounder, perkier, and more youthful. The process is performed simultaneously to position the nipples of the patient in a more youthful, centralized location. An implant adds volume to the breast, particularly its upper pole, when a breast lift alone may not be enough to meet a woman’s aesthetic goals.

How is it performed:

  • Incisions are made, including one around the areola (the pigmented circle surrounding the nipple) and a vertical one from the low part of the areola to the base of the breast and this removes excess skin. 
  • Implants are placed through these same incisions and are typically positioned under the pectoral chest muscle.
  • As in a standard breast augmentation, implants may be silicone or saline.
BREAST AND NIPPLE RECONSTRUCTION

Nipple reduction can improve the appearance of larger nipples and the areolas to be the size that you want.

Majority of patients when undergoing a mastectomy, the nipple and areola are removed. Therefore, many patients choose to undergo nipple reconstruction surgery. 

Surgery Methods:

Several approaches can be used in the reconstruction of your nipple, depending on the condition of your new breast tissue and your surgeon’s preferences.

Skin Flap:

  • Small flaps of skin from your reconstructed breast are folded and sutured together to build a mound that becomes the nipple.
  • The skin is manipulated to give the nipple an elevated appearance compared to the breast mound.
  • Additional skin, fat, or synthetic fillers are sometimes used to make the nipple more erect.

Skin Graft:

  • If there isn’t enough tissue to create a nipple from the new breast, your surgeon may use a skin graft.
  • Grafts are usually taken from the abdomen, thigh, the crease of the buttocks, or the groin where the legs and torso meet.

Autologous graft / Nipple Sharing:

  • If the nipple on your unaffected breast is large enough, a portion of it may be grafted onto your new breast. 

Medical tattooing:

  • Tattooing is widely used to recreate a natural-looking areola and nipple.
  • Skin grafts may also be used in addition to the tattoo procedure.
  • Women who want to avoid additional surgeries may choose to have only a tattoo.
  • It’s important to note that in this situation the nipple will not be elevated.

 Breast reconstruction:

  • The goal of breast reconstruction is to reform or reshape the breast after mastectomy or lumpectomy.
  • A mastectomy is a surgical procedure that removes the entire breast, usually including the nipple and areola, to treat or prevent breast cancer.
  • A lumpectomy is the removal of a piece of the breast where there is a smaller tumour.
  • While many factors determine what kind of breast reconstruction surgery would best suit an individual, there are two main types of breast reconstruction surgery: 
    • Implants or prosthetics involve surgery using silicone or saline implants.
      Autologous or skin flap surgery is a method where tissue from another area of the body is used 
    • In some cases, a combination of both techniques may be used to reconstruct the breast more naturally.
MALE BREAST (GYNECOMASTIA) CORRECTION

Gynecomastia is when a male has bigger than normal breasts due to hormone imbalance or hormone therapy.

Who gets it?

Gynaecomastia is common and is thought to be present in at least a third of men in their lifetime.

 What does a gynecomastia surgery involve?

Gynaecomastia (Man boobs) is an enlargement of male breast tissue to a point where it becomes noticeable. Medically it’s defined as the presence of a palpable sub-area gland and duct tissue is bigger than 2 cm.

There are two options depending on the type of excess tissue you have:

  • Liposuction:
    • Liposuction is performed if you have excess breast fat.
    • Liposuction for treating gynecomastia is typically performed using local or general anaesthetic.
    • The process involves a small incision on each side of your chest, the edge of your areola or within your armpit.
    • Through these incisions, your cosmetic surgeon will insert a thin tube to loosen the excess fat and remove it using a high-power vacuum and sculpt a new more natural chest contour.
  • Male breast reduction:
    • A male breast reduction is performed if your breast gland tissue is in excess.
    • Male breast reduction surgery is usually carried out under general anaesthetic.
    • The process involves making a cut around your nipple that allows your surgeon to remove the tissue.
    • Cuts may be extended and your nipples re-positioned if you have a lot of tissue to remove.
    • The procedure will typically take 90 minutes.
    • The cosmetic surgeon will take care to place incisions so that the resulting scars are as inconspicuous as possible.

Liposuction and breast reduction surgery can be performed at the same time if you have an excess of both fatty and glandular tissue.

The befits of gynecomastia:

  • The benefits of gynecomastia surgery are that it will restore a naturally masculine appearance to your chest. 
  • With a firmer, flatter and better-shaped chest, men often feel more confident with increased self-esteem and can wear more fitted tops and reveal their chests when they want.
  • Gynaecomastia surgery is typically a short procedure with a quick recovery and virtually invisible scars.

Liposuction and breast reduction surgery can be performed at the same time if you have an excess of both fatty and glandular tissue.

FAT INJECTION

Control the shape and size of your breasts with our fat injections, by removing unwanted from unwanted fatty areas and using them to increase the size / improve the shape and make your breasts smoother.

Fat injection, also known as fat transfer or fat grafting, is a procedure that improves the body’s contours and proportions by removing fat from one or more areas and injecting the fat into another area to add volume and reshape specific areas of the body. Common areas that are treated with fat injection include the face, buttocks, and breasts and to reconstruct contour problems in any area of the body after weight loss, accidents or previous surgery.

What is the process:

  • Fat injection is an invasive surgery that aims to improve the body’s contours by adding volume and reshaping specific areas of the body.
  • Fat is removed by liposuction from one area of the body and injected into another area to add volume and reshape that area.
  • Depending on the amount required and the number of areas that require treatment, repeated treatments may be necessary.
CORRECTION OF INVERTED NIPPLE

To make your breasts look more symmetrical and to make the nipples more projected.

Nipple inversion, which can also be called nipple retraction or invaginated nipple, is a condition where the nipple is either flat or pulled in towards the breast. It is a very common condition that occurs in around 1 out of 10 men and women.

It is often due to the milk ducts in the nipple being too short. These short milk ducts pull the nipple in, therefore not allowing it to protrude out naturally. This happens gradually and is often present since puberty since this is when the majority of breast changes occur. It can be present in one or both nipples.

Procedure:

  • An inverted nipple correction aims to correct the nipple so that it projects out naturally.
  • To achieve this, your surgeon will either stretch the short milk ducts or cut them.
  • This releases the tension that is pulling the nipple in, therefore allowing it to protrude out again.

Incisions

  • A small incision is made at the base of the nipple to gain access to the milk ducts that are pulling the nipple inwards.
  • The different techniques will depend on the severity of the nipple inversion, and include the following:
    • Mild to moderate nipple inversion:
      • In patients with mild to moderate nipple inversion, the surgeon can “stretch” the short milk ducts, therefore pulling the nipple outwards.
      • The surgeon will lift the nipple and areola from the breast, stretching them and then suturing the nipples into their new position.
      • As this method only stretches the milk ducts and does not cut them, it should not affect your ability to breastfeed.
    • Severe nipple Inversion:
      • The surgeon may choose to cut, or divide, the milk ducts.
      • When the surgeon cuts the milk ducts, it releases the tension that is pulling the nipple inwards.
      • Since the milk ducts are cut, this technique will affect your ability to breastfeed (you may lose the ability to breastfeed entirely).
      • There is however, a much lower risk of nipple inversion recurrence.
      • After your surgeon stretches or cuts the milk ducts, they will use stitches to secure the nipple in its new projected position.

Advantages:

  • Having a nipple correction can help boost self-esteem in patients, particularly when they are in intimate situations.

More Procedures

Facial

Breasts

Body Contouring

Abdomen

Genital

Dermal Surgery

Hands

Patient Instruction Information

What you need to know before THE operation

INSTRUCTIONS

The pre-operative instructions are important in giving you insight on things that hamper your healing progress. Please read carefully. If you still have questions after reading this, call the rooms (011 485 4434), to have all your concerns addressed

TWO WEEKS BEFORE YOUR SURGERY

Medications:

• Do not take any aspirin-containing products (see the attached list), anti-inflammatories (e.g. ibuprofen, advil, Meloxicam), blood thinners (e.g. coumadin, warfarin, clexane), or vitamin E for 14 days before your operation. These medications thin the blood and increase the risk of bleeding. Paracetamol can be taken safely.

• Stop taking any supplements, herbal, natural, diet, or alternative drugs 14 days before your surgery (e.g. ginkgo biloba, ginseng, St. John’s wort).

• We recommend stopping birth control pills or estrogen replacement therapy 4-6 weeks before surgery, particularly for abdominoplasty (tummy tuck) or liposuction. These drugs increase the risk of blood clots in the leg.

• Only essential medications may be taken throughout the peri-operation. It’s important to inform the surgeon and the anesthesiologist are aware of any medications you take.

• Patients with heart disease, Diabetes Mellitus, Previous cerebrovascular accidents, and pacemakers should also highlight this to the surgeon and anesthesiologist.

 • Please notify our office before your surgery if you develop a cold or infection.

Smoking:

• Smoking should be stopped at least 2 weeks before your operation, and you should refrain from smoking at least 2 weeks after the operation as well. Smoking greatly increases the risk of poor wound healing and even skin loss.

NIGHT BEFORE & DAY OF SURGERY

• Arrange transport to fetch you after discharge and a person to look after you post-discharge.  

• You can take only essential medications (for example, cardiac or blood pressure pills) on the morning of surgery with a small sip of water (except those mentioned below).   

• Nothing to eat or drink after midnight the night before, and the morning of surgery. If you do eat or drink, your surgery will likely be cancelled.

• Remove all make-up and nail polish the night before surgery.

• If you are having a facelift or browlift surgery, wash your face with soap and shampoo your hair the night before surgery.

• If you are having breast surgery, make sure you have a post-operative or sports bra available and bring it into the operating room.

• Remove all jewellery and leave money and all valuables at home

• Do not shave 3 days before surgery. Shower before surgery.

• Wear comfortable, loose-fitting clothing that is easy to put on and take off (e.g. sweat pants, button or zipper shirt).

• Arrive at the hospital at least 2 hours before the scheduled operation time      

• Be prepared to take time off work. In general, at least 5-7 days (this varies quite a bit, depending on the procedure). Try to avoid strenuous work or exercise for 6 weeks post-surgery. It is recommended to have someone at your home who can assist you.

WE RECOMMEND THAT PATIENTS DISCONTINUE USE OF THE FOLLOWING AT LEAST TWO WEEKS PRIOR TO SURGERY:

Aspirin Containing Products and
Anti-Inflammatories
Herbs and Natural Products
ASA
Instantine
Ginkgo biloba
Actifed
Indomethacin
Garlic
Advil
Midol
Ginger
Aleve
Motrin
Ginseng
Alka Seltzer
Naprosyn
Feverfew
Anaprox
Nyquil
Clove
Ansaid
Nytol
Danshen
Aspirin
Oxycodone
Dong Quai
Bayer
Pamprin
European Mistletoe
Celebrex
Pepto Bismal
Fenugreek
Contact
Percodan
Focus-kelp, black tang
Coumadin (Warfarin)
Persantine
Goldenseal
Darvon
Phenylbutazone
Horse chestnut
Dristan
Propoxphene
Northern prickly ash
Duragesic
Robaxisal
Endodan
Sominex
Entrophen
Sudafed
Fiorinal
Talwin Compound
Flurbiprofen Sodium
Trandate
Heparin
Trental
Ibuprofen
Vitamin E

WHAT YOU NEED TO KNOW AFTER THE OPERATION

General Comfort

It is important for you to get up, move around the house, and take some deep breaths 4-6 times a day from day 1 after the operation. Plan to sleep on your back with your head elevated, if possible. Sleeping on your side will cause swelling on the side you are laying on. Making yourself a nest with pillows can be very helpful.

Some people experience a slight sore throat or mild cough for 2-3 days after surgery. This is a side effect of anaesthesia and should resolve in 48-72 hours.


Pain Management


The first night and day after surgery will be your most uncomfortable. The pain will then stabilize over the next 24-48 hours and then decrease day by day. Analgesia appropriate to the type of surgery will be prescribed for you. Report to the doctor if you have unbearable pain. You will heal faster if you are not tense and tired from pain.

Stool softener may be helpful for patients who develop constipation as result of opioid pain killers. You can progress to regular strength paracetamol as your pain subsides. Narcotics will interact with alcohol so do not drink at the same time you are taking them. Drains are used in 80% to 90% of our surgeries to prevent post-operative swelling and fluid buildup. You will be instructed in drain care before leaving the hospital.

The initial drainage will be bloody, changing to clear red then to clear yellow over the next 3-5 days. If blood clots in the tube, it can be cleared by applying pressure and “milking” the tube toward the bulb. Be careful not to put tension on the tube where it enters the wound. If you have less than 30mls of drainage in 24 hours before your first post-op appointment
you may call the office to make an appointment to have them removed.

Wound Care

• There is no need to change a clean, dry dressing for the first 2-3 days after surgery.
• It is preferable to have your 1st dressing change at the doctor’s office.
• You may shower after the original dressings and drains have been removed. Your doctor will give any other wound care instructions to you at the time of your surgery.
• Keep your supportive Bra on consistently for the first 6 weeks.

Complications

Please call or come into the consulting room or the Emergency Department when the clinic is closed as soon as possible if you have:

Increasing swelling, redness, or pain in the breasts.
Pus drainage from the breasts.
Excessive bleeding post-op (i.e., bandages become soaked with blood).
Shortness of breath.
Fever greater than 38 degrees orally.
Activity Limitations After Surgery


There should be no reaching above your shoulders, twisting or lifting more than 5 pounds for three weeks. No heavy activity or exercise for three weeks. Any activity that makes your face flush or makes you sweat can make you swell. No soaking your incisions (bathing or hot tubs) until your Steri-Strips® are removed, your sutures have been removed, and all scabs are healed.

After three weeks, you may resume normal activities. Do not wear underwire bras for 4 to 6 weeks after surgery, and then it is a matter of personal choice.

Scar Care


• Scar development is a process that lasts up to a year or more after surgery.
• Apply Micropore tape scars for a period of up to 6 months if possible.
• Use silicone base gel to massage the scar.
• Use clothing and sunscreen to protect the scars.
• Report any scars that you find unacceptable.
• Need to ask a question, email doctor on nkhens@mweb.co.za . We are here to help.

Contact

Get In Touch With Us

Don’t wait any longer to achieve your aesthetic goals. Reach out to us today and let us show you how we can help you.

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Suite 304
24 12th Avenue
Linksfield West

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011 485 4434
066 006 6631

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