Dr. Shahriar Raj Zaman, a specialist plastic surgeon has spent considerable time working in Darwin and continues to visit regularly. Dr. Zaman shares a complex lower limb reconstruction, highlighting the challenges of performing surgery in a regional area like Darwin.

Q1. Can you give us some background on your patient?

This case involved a 41-year-old male from a community outside Darwin. The patient sustained a foot injury after stepping on a sharp object, which led to a severe infection. Initially, a forefoot amputation was necessary to control the infection. Further tests then revealed the patient had undiagnosed Type II diabetes, which contributed to the severity of the infection.

Before surgery, I had several discussions with the patient about the extent of the injury and the complex lower limb reconstruction required to save the remainder of his foot. In cases like this the reality of a below knee amputation is real. The patient was highly motivated to preserve his foot, as using a prosthesis & a wheelchair in his community posed significant challenges.

Q2. What type of reconstructive surgery did the patient require?

The patient required a free flap reconstruction. A procedure typically used in complex cases where simpler methods aren’t sufficient due to the exposure of vital structures like bones and tendons. We began by thoroughly cleaning the infected wound and removing dead tissue to assess the size of the defect. Next, we performed a free tissue transfer. We used skin and fat from the patient’s other thigh to cover the exposed tendons and metatarsal bones. Finally, we completed microsurgery to reconnect the blood vessels to the remaining foot.

Q3. What were the unique challenges of performing this surgery in a regional area like Darwin?

Performing a complex lower limb reconstruction surgery in Darwin presented several challenges:

Patient Demographics & Cultural Awareness: In regional areas, it’s vital to tailor treatments to a patient’s understanding and cultural background. Patients need to fully comprehend and carefully follow post-operative care instructions for optimal outcomes. If there is doubt, alternative procedures may need to be considered. It is also important to form treatment and care in the context of a patient’s cultural needs where community roles and acceptance play a big part in successful outcomes after surgery.

Limited Specialised Nursing Staff: Free flap surgeries require vigilant post-operative monitoring, especially in the first 72 hours. In regional hospitals like those in Darwin, where these surgeries are not as common, nurses may need additional training to identify potential complications early.

Access to Specialised Services: Without sufficient plastic surgery services in Darwin, patients may be displaced from their home to pursue reconstructive surgery interstate, or they may face more drastic options, like amputation in this case, to remain close to home.

Q4. What was the outcome of the surgery on your patient?

The free flap reconstruction was successful. After a seven-day hospital stay and close follow-up, the patient’s reconstruction fully integrated, and he is now able to walk with modified footwear. Although the patient no longer has toes on his right foot, the procedure preserved his ability to function and walk without requiring a prosthetic leg.

Q5. What do you enjoy most about working in Darwin?

Darwin is a fantastic place to work! Aside from its stunning waterfront views, beautiful sunsets, and vibrant multicultural food scene, there’s a real sense of community among healthcare professionals. Many visiting medical officers, like myself, are drawn to the opportunity to make a meaningful contribution to the people of Darwin. I would highly recommend any healthcare professional considering it to take the leap – working in Darwin is both rewarding and fun!

For further information, please see: Whitton T, Zaman SR, Farrell G. The ASPS Darwin workforce project: past, present and future. Australasian Journal of Plastic Surgery. 2024;7(2).

The Australian Society of Plastic Surgeons Partners with NT Health to Bring Specialist Plastic Surgeons to the Top End. Read more about the program here.

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Providing plastic surgery services in rural and regional areas of Australia and New Zealand has its own challenges. The Australasian Journal of Plastic Surgery (AJOPS) welcomes papers exploring these issues.

The practice of rural and regional plastic surgery in Australia and New Zealand has many challenges, including:

• limited access to specialised surgical services
• attracting and retaining skilled surgeons willing to work in these areas
• the logistical difficulties of providing comprehensive healthcare in geographically-isolated region

If you are working on research looking at issues affecting the provision of plastic surgery in rural and regional areas, consider submitting a paper to AJOPS. You may be looking at ways to enhance the quality and accessibility in these areas, analysis of particular types of injuries more prevalent in rural and regional areas, or workforce issues.

Visit the AJOPS For Authors page for more information about the types of papers we accept.

Please find below links to some relevant articles previously published in AJOPS:

• Bryant K, Dean NR, Innovation in rural workforce strategies by a national surgical society: the ASPS experience. Australas J Plast Surg. 2021;4(1):3-5.
• Sreedharan S, Menezes H, Cleland H, Goldie SJ. Petrol-related burn injuries presenting to the Victorian Adult Burns Service. Australas J Plast Surg. 2019;2(2):45-49.

Find our more about AJOPS here.

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Who is the ideal candidate for a deep plane facelift?

Good candidates for a deep plane facelift include healthy men and women who are dealing with moderate to advanced facial ageing, but who still have relatively resilient bone structure and skin. Common concerns include:

• Drooping of the midface and lower face
• Jowls and loss of jawline definition
• Deep creases extending from the nose to the mouth
• Excess neck tissues

The best candidates for deep plane rejuvenation also possess the following characteristics:

• Non-smoker
• Realistic cosmetic goals
• General good health without conditions that impair healing

Due to the extent of change a deep plane facelift can produce, candidates are usually in their 40s or older with more advanced signs of facial ageing. In today’s social media-driven environment, people may be led to believe they need extensive surgery when it would not, in fact, be beneficial.

What can I expect for recovery time?

Generally, the initial recovery period after a deep plane facelift lasts one to two weeks. During this time, you can expect to experience some degree of swelling, bruising and discomfort, which gradually improve. You will be advised to rest, avoid strenuous activities and sleep with your head elevated during this time.

After the first two weeks, you may resume light daily activities. Because the deep plane technique focuses on deeper structures of the face and maintains more of the natural blood supply to the skin, overall healing time may be more rapid than with other types of facelift. Most patients can return to work about 10 to 14 days after surgery.

Will I have scars after a deep plane facelift?

Scars are an inevitable part of any facelift procedure. However, the incisions used during a deep plane facelift are not as extensive as some other facelift techniques, therefore there is less post-procedure scarring.

Additionally, because the deep plane facelift does not separate the SMAS and the skin, there is less tension on the incision lines once they are closed. This encourages the scars to heal into soft, flat lines.

What is the expected lifespan of a deep plane facelift?

A deep plane facelift aims to provide more substantial and long-lasting results than other facelift techniques. By addressing the underlying structures that truly support facial contours, the deep plane technique creates a strong foundation to sustain the results. Provided you maintain your weight and health, and take good care of your skin, you may enjoy the outcome for years.

That said, gravity and ageing will continue exerting their effects. Your skin and other facial structures will continue to age, and you may notice loose skin, lines or volume loss developing over time.

More questions?

This blog post is written by Dr Ellis Choy, and published here with his permission. Dr Ellis Choy is a Specialist Plastic Surgeon based in Sydney, you can also find out more about his practice and specialty areas at our Find a Surgeon directory.

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Q1. Tissue engineering is an unfamiliar concept to many people. Can you please explain what it is and how it is done?

Tissue engineering is a discipline of biomedical engineering that endeavours to restore, maintain, improve or replace biological tissues. The key elements of any engineered tissue are cells, growth promoters and regulators, scaffold or matrix and a blood supply; summarised as the so-called “diamond concept”. It is driven by the same principles as plastic surgery but operates on a smaller scale. Bringing plastic surgery and bioengineers together will be very important in the near future, so that the successes achieved by bioengineers in the laboratory can be scaled up to solve complex reconstructive problems such as large bone defects, nerve injuries and large volume soft tissue defects.

Q2. I understand tissue engineering is a rapidly evolving area of research/surgery. Can you provide some history as to how this niche area developed and how it has changed over time?

Because the definition is a bit broad, a wide range of therapeutic approaches and devices have been referred to as tissue engineering. Some of this is marketing and some is misinformation but if we look at how tissue engineering evolved and look specifically for the diamond concept, it is easy to navigate.

Scientists have been trying to grow cells ex vivo since 1897. This culminated in Alexis Carrel more or less inventing cell culture, leading to him winning the Nobel Prize for medicine in 1912. Given the convergence of tissue engineering and plastic surgery mentioned earlier, it is fitting that he also features heavily in the history of microsurgery!

But culturing cells still isn’t tissue engineering per se. Materials science made some significant advances during the two World Wars, which informed progress in the development of implants but again, this can’t be considered tissue engineering. Stem cell research starting to become a legitimate science in the 1960s but it wasn’t until the 1970s that the key elements of tissue engineering were all brought together by Judah Folkman. He studied histogenesis in stem cells and worked out that proliferating cells needed a supportive matrix; morphogens such as growth factors and hormones, and vascularity. This is referred to as a bioreactor. Any development in the field since has sought to optimise one or several elements of this four-sided diamond concept.

Q3. Can you provide an update as to what successes, barriers/failures you have had, and what current clinical trials are underway?

My job has been to translate the successes of pre-clinical tissue engineering research into humans. This begins by getting directly involved in pre-clinical work, including animal studies, and making a concerted effort to understand the science. As a clinician, understanding the relevant aspects of cell biology was not difficult but I had to work hard to understand engineering principles. Exploring opportunities to use the human body as a bioreactor has been a very interesting exercise that involved blending together knowledge of axial vascular anatomy, rests of tissue with regenerative potential and donor site morbidity. Our greatest success was tissue engineering 36cm of missing tibia. The midface remains a challenge, being such a hostile and functionally demanding environment and we have learned an awful lot about the limitations of using the body as a bioreactor.

Clinical trials involving tissue engineering that are currently underway include the use of bioresorbable implants for large bone defects in load-bearing bone of the lower limb, membranous bone of the skull and mandible, camouflage correction of pectus excavatum deformity of the chest, volume replacement after removal of symptomatic breast implants and a 3D printed device for suture-less repair of nerve injuries. The last trial I mentioned is not so much tissue engineering but it is headed in that general direction. 

Q4. How can it benefit patients, surgeons, and hospitals?

I think that the key benefit that tissue engineering offers is a robust solution to complex reconstructive challenges with fewer of the problems that we see in patients who survive their primary pathology. Patients are making it through their trauma or cancer treatment better than ever now, which means that they live longer with the consequences of tissue that is missing. If missing functional units could be replaced without the need for revision, without the risk of implant failure and without donor site morbidity, surviving might just be that little bit more worthwhile for patients and the health care system. I don’t see this doing reconstructive surgeons out of a job but it is important that we get intimately involved in turning great science into great clinical outcomes and cost savings in health care.

Q4. I gather there is huge potential for tissue engineering to be applied to the human body. What do you think the future holds for tissue engineering in surgery?

I see a time when it won’t be so necessary to use the body as a bioreactor. As I mentioned, I still see a role for plastic surgeons. For any given defect, the missing tissue can be replicated ex vivo; bringing small volume cellular elements from a patient into the laboratory, engineering the required tissue – or even an entire organ – to exact dimensions informed by clinical imaging, creation of a vascular network that is of sufficient size to be surgically manipulated, and then working out a way of returning it to the body from whence it came. I see potential in organoids, which are self-assembling groups of cells forming miniature functional organs, but more about that another time!

Learn more about Dr Michael Wagels’s research here.

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Q1. As a plastic surgery trainee, what sparked your interest in research and especially in the area of petrol burns?

I became interested in research while at medical school.  I took some time out of clinical training to “intercalate” in a clinical anatomy degree.  For two years I left the medical faculty and joined the science faculty.  I conducted my own successful research project, collaborating with plastic surgeons from the local Canniesburn Hospital in Glasgow, which led to research presentations in London and Barcelona.  As a young student, this was a very exciting experience and hooked me into research.

At an early stage at University, I also decided I wanted to be a surgeon, and a plastic surgeon especially.  The first operation I ever scrubbed for was a burns patient.  He was a young man with mental health problems who had used petrol to set himself on fire.  The resulting burns were life-changing. 

In Australia, I was lucky to spend time as a surgical registrar in the Victorian Adult Burns Service (VABS) at the Alfred Hospital, Melbourne.  I noticed a worrying trend of patients being admitted with significant injuries, all of which seem related to petrol use.  One holiday weekend, I was on-call and I remember being confused about which patient was which, because we seemed to have multiple, almost identical, referrals for young males from regional Victoria, who had sustained burns from petrol on fires.  It sparked an interest and made me look further into the epidemiology of petrol burns.  

Q2. What is the profile of a typical patient who presents with petrol burns?

Our research into petrol burns initially focused on Victoria.  We found that the majority of petrol burns admissions were young, male, and coming in from outside metropolitan areas.  We then extended our study population to the whole of Australia and New Zealand.  This was the first international study of its kind and it confirmed that the patterns of behaviour were similar across the whole continent.

Q3. How do the outcomes differ between patients with petrol burns and non-petrol burns?

Our studies compared outcomes for patients with petrol related burns with non-petrol burns. We found that patients who sustained petrol burns; had larger burns, were more like to have airway burns from inhaling hot smoke, and overall, a higher chance of dying from their injuries.

Q4. How does/can your research influence health policy and guidelines in the prevention of petrol-burns in Australia?

We calculated the financial cost to care for all of these patients across Australia and New Zealand.  The cost was estimated based on total body surface area affected by burn.  The mean cost was $190,733 AUD per patient or $540.3 million AUD overall, for the ten year period of our study. This does not include the cost of transfer to hospital from regional locations, post discharge care in the community, or the loss of income for the individuals and countries as a result of long-term rehabilitation.  These figures highlight what a huge problem petrol burns are in Australasia – a real healthcare crisis that needs urgent intervention!

We have engaged with the Country Fire Authority (CFA) and Fire Rescue Victoria (FRV) to develop public education programs.  We also want to work with these agencies to influence government policy on regulations regarding safe handling and storage of petrol, for example, by implementing recent changes from the USA on the design of petrol can nozzles. 

Learn more about Stephen Goldie’s research here, or to find his contact details follow the link to our find a surgeon page.

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Q1. Tell us about the condition of Dupuytren’s contracture. What is it and how does it affect function?

Dupuytren’s disease or Dupuytren’s ‘contracture’ is a common condition that affects the hand and fingers, specifically affecting the connective tissue beneath the skin of the palm. It is characterised by the thickening and tightening of this tissue, forming nodules or cords that can cause the fingers to shift into a bent position.

As the disease progresses, affected fingers may become permanently bent, which can lead to functional problems, such as difficulty in performing tasks like grasping objects or shaking hands. The severity of Dupuytren’s contracture varies, with some experiencing mild disease and others having more severe deformities.

We don’t know what causes Dupuytren’s contracture but there is likely to be a genetic component as it tends to run in families. More common among men over 50, and in people of Northern European descent, leading to its nickname ‘Viking’s disease’.

Q2. Professor Rozen, you have published widely about collagenase injection for Dupuytren’s contracture. How does this work and how does it differ from other methods of treatment? How effective and safe is it?

Collagenase is an enzyme that works by breaking down the collagen fibres that form the thickened cords in the palm, allowing the fingers to straighten.

Instead of cutting out the contracted tissue, collagenase is injected directly into the affected area. The enzyme then weakens and breaks down the collagen, making it easier to manipulate and straighten the fingers.

The effectiveness of collagenase treatment varies depends on the severity of the contracture and some individual factors. Our research studies have shown that collagenase injections can improve finger extension in many patients, often achieving complete straightening of the affected fingers. It’s important to note that there is a rate of recurrence ranging from 20% to 50% within 5 years after treatment, but this can be the case with surgery too.

Collagenase injections for condition of Dupuytren’s contracture are considered safe and well-tolerated. As with any medical procedure, there are potential risks and side effects, including swelling, bruising, and pain at the injection site. Some patients may also experience temporary numbness in the fingers. There is a small risk of more serious complications, such as tendon rupture or nerve injury, but these are rare.

Q3. What is the procedure for manipulation after injection? What can be done to minimise complications?

After the injection of collagenase, the procedure for manipulation involves a manual straightening of the affected finger(s) within 1-7 days. This manipulation is performed to break the weakened collagen fibres and improve finger extension. During the manipulation, pressure and gentle stretch is applied to the finger(s) for straightening. This is usually performed under local anaesthesia or nerve blocks.

There are potential complications associated with the manipulation procedure. One possible complication is skin tears which can occur more frequently if the skin is fragile or in cases of more severe contracture.

These risks are minimised by careful injection and manipulation techniques, clinician expertise and experience. Close postoperative care including hand therapy, intermittent immobilization, splinting and wound/swelling management as needed.

Q4. What are the long-term follow-up results for patients who have had collagenase injection for Dupuytren’s?

There is now really good data looking at long-term follow-up for patients who have had collagenase injection for Dupuytren’s contracture, and these largely show extremely positive outcomes. Studies generally report that collagenase injection effectively reduces contracture and improves hand function in the majority of patients. We are really proud that Australia has been at the forefront of much of this research.

Q5. Collagenase injection sounds like an effective treatment but it doesn’t seem to commonly performed in public hospitals. Why is this the case?

Until recently, Collagenase was being used quite broadly in both public and private sectors in Australia. This was occurring at a rapidly increasing rate as good data on its use was more widespread as experience grew. However, the cost of the drug increased several years ago, and its listing on the PBS in Australia lapsed, which meant the procedure is no longer rebatable under Medicare. Research demonstrating the cost advantages of Collagenase injection over surgery will help current advocacy efforts in having this drug re-listed on the PBS, so that it can benefit more patients in the future.

Learn more about Professor Rozen’s research here, or to find his contact details follow the link to our find a surgeon page.

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Q1. You have a research interest in sensation-preserving breast reconstruction for women after mastectomies. Can you tell us why sensory preservation is important?

When women undergo reconstruction after mastectomy, it is quite common to lose sensation in their reconstructed breast. This is of major concern to women and negatively impacts quality of life, self-confidence, and sexual function. Two separate patient advocacy groups brought this issue to the attention of our team during the pandemic. We undertook a period of investigation collaborating digitally with colleagues overseas that had pioneered the techniques for nerve preserving breast reconstructions and began prospectively collecting data on our cases in 2021.

We recently analysed our results after 2 years (average of 12 months follow up) and found significant improvements in women’s sensation when the nerves had been re-joined and a new nipple and areola had been reconstructed using the DIEP flap. Our research has confirmed earlier return of sensation to areas of the breast that might normally not get sensation at all; that is the area that makes up the new nipple and areola. It was also quite clear from our data that those who have had DIEP flap reconstructions had better skin sensation than those who have had implant-based reconstruction for skin-sparing and nipple-sparing mastectomies.

We believe that placing healthy living tissue under the native breast skin in a DIEP following mastectomy, gives rise to regenerative properties that are not present when using an implant. While we have more work to do, we are now able to inform women that reliable restoration of sensation is possible with tissue reconstruction but less so for implant-based reconstruction. This data has been presented at numerous international meetings in the last 6 months and is currently being prepared for publication.

Q2. Is this type of surgery suitable for all women considering autologous flap breast reconstruction?

Sensation-preserving mastectomy is potentially possible for all women considering autologous breast reconstruction if careful mastectomies are performed in the first instance to avoid damage to the sensory nerves. Sometimes, nerve sacrifice is unavoidable, so we may not be able to preserve skin sensation in those patients. It is tricky because the sensory nerve branches are so tiny that we are not able to image their exact location prior to surgery by methods such as ultrasounds or MRIs. 

However, we know that sensory nerves usually run on either side of the breast. As surgeons, we look for potential nerve supply coming around from the lateral side of the breast and running up from the mid-chest. In the vast majority of cases, we can connect these nerves to those located in the abdominal flap reliably using microsurgical techniques. 

Q3. Does sensation-preserving reconstruction add to the operation time of a standard autologous flap breast reconstruction?

Nerve reconstruction surgery does make DIEP Flap surgery longer by roughly 20-30 minutes, which is minimal in the course of what is already a lengthy operation. The addition of surgical time doesn’t significantly affect someone’s recovery after the operation. As my colleague and co-researcher A/Prof Mak says, “what may be 20 minutes more in the operating room for me is a woman’s lifetime of sensation”. 

Q4. How do you test skin sensation? Are the sensory effects immediate or delayed and are all sensations restored?

We test skin sensation using Semmes Weinstein monofilament testing. This is a non-invasive, standardised method of testing patients’ skin sensation to light touch using fine filaments applied to the skin. It can be difficult to delineate what degree of sensation recovery is due to re-joining the nerves and what is due to natural regeneration from a skin-sparing or nipple-sparing mastectomy. This is because the skin of the breast is still attached to the chest wall and therefore some restoration of sensation may occur even without the nerve reconstruction.

It takes 3-6 months to start to see re-innervation in the body, including re-innervation coming from the chest wall or from the nerves that have been connected during surgery. Overall, our findings indicate the maximum amount of re-innervation of the nerves and sensory return happens around 18 months post-surgery. These results are very encouraging. 

Interestingly, we have seen some patients regain temperature sensation although at present we don’t have a method for systematically testing this. We have not seen a case of nerve pain or hypersensitivity attributed to this technique nor have our colleagues internationally which is reassuring.  

Q5. Do you think sensory-preserving breast reconstructions are the way of the future?

Work with nerve-preservation operations started in the late 70s and into the early 80s. Since then, nerve connection techniques have drastically improved.  Our equipment, such as microscopes, are of a superior quality, thereby broadening the possibility for making these kind of nerve connections. These operations have very limited downsides. There are no increased rates of pain or other kind of nerve problems associated with it so we offer sensation-preserving reconstruction to women who require mastectomies in our practice. We are also seeing an increasing number of surgeons taking up this approach. In the future, we would also like to use nerve allograft to enable more connections to be made but this is a technique that is currently not available in Australia due to regulatory constraints. It is an exciting time for sensation-preserving surgeries in breast reconstruction. Watch this space!

Learn more about Dr Dusseldorp here, or to find his contact details, follow the link to our find a surgeon page.

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Optimising your health before and after surgery can improve your surgical outcomes and reduce the risk of complications. It is particularly important to manage chronic health conditions and obesity so that your body is in the best possible shape for surgery and recovery.  There are a number of modifiable factors that you can control, such as diet and exercise, so consult your surgeon to see if any improvements can be made. Below are some general guidelines:

Before Surgery

Manage Chronic Health Conditions: If you have chronic medical conditions like diabetes or hypertension, speak with your general practitioner or specialist to ensure they are well-managed before surgery. Discuss all medications and supplements you are taking with your surgeon in case modifications need to be made close to surgery.

Weight Management: Healthy weight is important for surgery as obesity can increase the risk of complications during and after surgery. If weight loss is required, aim for stable weight loss over time through diet and exercise. Avoid crash diets. Being underweight can also cause problems and slow down recovery after surgery. Seek help from your health professional if you need specific advice on appropriate diets.

Diet: Your diet and nutrition needs will depend on your age and general health. Prioritise a balanced and nutrient-rich diet that includes plenty of lean proteins, fruits, vegetables, whole grains, and healthy fats. Good nutrition can help support your immune system, minimise inflammation and promote wound healing.

Hydration: Stay well-hydrated. Avoid excessive caffeine and alcohol intake. Remember you may need to follow instructions from your surgeon or anaesthetist to fast in the hours prior to your surgery.

Exercise: General exercise recommendation for healthy adults is 30 minutes of moderate intensity exercise most days of the week (5 days per week), plus 2 resistance training sessions per week. If your exercise routine falls short of these guidelines, it may be worthwhile improving your fitness and training your muscles before surgery. As a general rule, doing some physical activity is better than doing none, as the rest period following surgery may result in reduced conditioning and muscle loss.

Smoking, Vaping and Alcohol: If you smoke or vape, it’s advisable to cease or at the very least. reduce these habits before surgery, as they can strain your heart and lungs, impair wound healing and increase the risk of complications such as blood clots and infections. Nicotine replacement therapy can help reduce the nicotine cravings and can make a big difference in quitting smoking. Alcohol should not be consumed in the 24 hours before an anaesthetic. Alcohol stops your body healing well and can make it more difficult for the anaesthetic to work. Heavy alcohol use can cause bleeding during surgery. If you regularly drink 3 or more standard alcoholic drinks a day, reducing your alcohol intake for at least the 4 weeks before your operation can reduce the risk of surgical complications.

Mental Health: Address any anxiety or stress you may have about the surgery. Consider talking to a health professional such as a psychologist or counsellor if needed.

After Surgery

Follow Medical Advice: Follow your surgeon’s post-operative instructions so that you can heal faster and avoid complications.

Exercise: Depending on the surgical procedure, gradually reintroduce physical activity and exercise following the instruction of your surgeon. Keep in mind, return to exercise timeframes may differ depending on the type of surgery you have had. Generally, start with gentle movements and progressively increase intensity as you heal. Movement and exercise help prevent blood clots, improve breathing and reduce muscle wasting/weakness. With time, aim to return to the recommended adult exercise intensity and duration guidelines as per before surgery.

Diet: Continue to focus on a balanced diet rich in nutrients to support your body’s recovery. Incorporate fibre-rich foods and fluids to promote regular bowel movements in the post-operative period.

Hydration: Stay hydrated, as proper hydration is essential for wound healing and for bowel movements.

Medication: Take prescribed medications as directed, including pain management medications.

Wound Care: Keep surgical wounds clean and dry as instructed. Watch for signs of infection, such as redness, swelling, or discharge. Contact your surgeon if you are suspicious of an infection or if the wound site is slow to heal.

Rest: Get adequate rest and sleep to allow your body to heal.

Follow-up Appointments: Attend all scheduled follow-up appointments with your surgeon to monitor your progress.

Remember that every surgery is unique, so it’s essential to tailor these guidelines to your specific surgery by speaking with your surgeon and healthcare team. Your surgeon will provide you with pre- and post-operative instructions based on your surgery type and your individual health needs.

For more information

Royal Australian College of General Practitioners Healthy Habits Resource

Hunter New England Health – Get Ready for Surgery

Australian Government – Physical activity and exercise guidelines for all Australians

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A Breast Augmentation or Boob Job is one of the most popular aesthetic surgeries. It’s a great way to feel more confident about your body image and can improve your quality of life. However, the recovery process after breast augmentation surgery can take a number of weeks and needs lots of rest.  This blog is about how to sleep better after a breast augmentation and can help you get the best recovery and best results after surgery.

What to Expect during Recovery from Breast Augmentation? 

A breast augmentation surgery is usually an inpatient procedure done under general anesthesia. Most breast augmentation patients are kept overnight in hospital for observation. You can expect to be discharged by your care team the following morning. It is also possible to have the surgery as a day stay, however this is patient dependent.

During your first week or so, soreness, swelling, and bruising are expected. You will notice your surgical incisional scar beneath the crease of your breast. The soreness, swelling, and bruising should be completely gone in a month or so following your surgery, and your incisional scar should become unnoticeable over time. It is crucial during your recovery period to follow your plastic surgeon’s instructions: from wearing a supportive bra to how to sleep throughout the night.

Why Is Sleep Important During Recovery from Breast Augmentation?

Getting enough sleep is vital in the process of recovery after breast augmentation, or any surgery for that matter. As you close your eyes and slip into bed, you may feel that your body is shutting down, while in fact, sleep is the time when your body is at its busiest repairing and rejuvenating.

Being able to sleep well allows your brain to attend to areas in your body that require healing, this includes the incisional sites. Your brain will trigger certain hormones that promote tissue growth and repair of blood vessels. This allows the restoration of sore or damaged muscles and helps you heal faster after your breast enhancement. Sleep can also help boost your immunity, reducing chances of possible infections.

Getting enough sleep help your body to release hormones that will slow down your breathing and help relax your sore muscles. This may reduce the swelling in your breast tissue, and help you recover faster after your surgery.

How to Sleep Comfortably After Breast Augmentation?

Like any other surgery, breast augmentation is a progressive journey. You should commit to certain steps and follow tips to ensure you get the best results. As mentioned above, sleeping is essential to the recovery process of breast augmentation, but getting your standard 8 hours of sleep isn’t enough. Here are some dos and don’ts to sleep comfortably after a breast augmentation surgery without any concerns.

1. PREPARING EARLY

If you’re one of those tummy or side sleepers, you should start preparing early to ensure a seamless transition to sleeping on your back after breast surgery. This change in sleeping position can be difficult, so you must persist. You can use extra pillows and place them under each arm, many people reported being more successful to sleep on their back after surgery.

2. SLEEPING ON YOUR BACK – ELEVATED!

In the first six weeks after breast augmentation, it is vital that you sleep on your back for a safe and speedy recovery. This will put your new breasts in a relaxed position, with minimal strain on your chest, allowing the incisions from your breast augmentation to heal and the implants to settle. However, just sleeping flat on your back isn’t the best sleeping position after breast surgery. Keep your upper body elevated at a 30 to 45 degrees angle while on your back further to reduce any swelling and pain after your boob job. This allows your blood to circulate away from your tender new breasts. To sleep better after breast augmentation, consider investing in a few soft pillows to prop under your back, or get a recliner bed if possible.

3. SLEEPING ON YOUR SIDE

Not all patients can commit to sleeping on their back after a breast surgery for long periods of time. After 2-3 weeks of your breast enlargement surgery, you may be allowed to sleep on your side. However, it’s important to take extra precautions if you decide to do so. This includes wearing an approved surgical bra and placing pillows underneath your breasts. This way, you can avoid unnecessary pressure on your breast and help keep your implants and incisions in place while still managing to sleep comfortably.

4. SLEEPING ON YOUR FRONT

Some people prefer to sleep on their front; however, it’s absolutely not recommended after breast augmentation surgery. Sleeping on your tummy adds pressure on your new breasts, possibly causing damage to your results. Always wait for approval from your plastic surgeon before deciding to switch positions to sleep better. You can usually be allowed to sleep on your belly approximately 12 weeks after your boob job.

Tips to Sleep Well After Breast Augmentation

Besides correct sleep positioning, here are some other useful tips that can help you sleep well after a boob job:

• Walking: Although you may be fatigued after your breast augmentation surgery, moving around is important from day 1. Lightly walking about your house can improve your sleeping pattern and help you sleep better. It also reduces the risk of blood clots by boosting your blood circulation. Just don’t over do it.
• Support Bras: After your breast augmentation surgery, your plastic surgeon will instruct you to wear a support bra for at least a month, even at night. Support bras help hold your newly enlarged breasts in place, ease tension on your surgical incisions, and reduce swelling. This can ease any worries you might have of ruining your boob job while asleep.
• Warm Showers: Everyone likes a nice warm soak after a long day, and while warm baths should be avoided in the first weeks following your surgery, warm evening showers can help prepare for sleep. They can help decompress and relax your muscles allowing you to sleep comfortably. Make sure you ask your surgeon when you can shower.
• Sleep Disruptors: Avoiding sleep disruptors like caffeinated beverages (coffee, coke, tea…), alcohol, sugar, and electronic screens especially in the evenings can help you to get enough sleep, instead of being left wide awake throughout the night.
• Medication: You should never be expected to endure unnecessary pain post-op, this rule applies to breast surgery as well. Your plastic surgeon will prescribe pain medication to provide symptomatic relief and help you sleep better. A sleeping aid is rarely needed but may be prescribed if your sleeping pattern is severely disrupted after your breast enlargement surgery.

More questions?

Your Specialist Plastic Surgeon and their team can help you through your entire plastic surgery journey so please reach out to them if you have any questions or concerns.

Written by Dr Craig Rubinstein – MBBS, FRACS (Plast)

The post Member Blog: How to Sleep better after Breast Augmentation Surgery appeared first on Australian Society of Plastic Surgeons.

The world is forever a changing place of information.  Before thinking about making your first appointment with your surgeon, no doubt you have thought about having surgery, and have researched it – these days it is common to have consulted close family and friends, along with searching the internet for extra information, before and after photos, just to say the least.  How trustworthy is the information out there?  How do I know if my friend’s surgical experience is applicable or relatable to me?

When a patient sees me for the first time, I always ensure they leave with a thorough understanding of:

• What their presenting complaints and concerns are

• What treatment options are available to address their concerns

• The advantages and disadvantages with each of those options

• The risks and complications of the surgical procedure in question, along with recovery and expected short term outcome

• The long term expected outcome, and potential need for revision surgery

Believe it or not, there may be multiple ways to solve the same problem.  More often, your own personal preference, medical and social circumstances, values and wishes may all influence which option might be better for you than others.  More importantly, sometimes what you think you need may not solve your concerns, and it is my job as your surgeon to point out the potential obstacles with your initial choice, how I might overcome or prevent those hurdles, or better still, suggest an alternative option.

A perfect example is a young lady in her thirties who comes in requesting a breast augmentation.  The key to ensuring that a patient has the correct procedure, is to address their concerns thoroughly.  In this patient’s case, her main concerns were sagginess, loose skin and deflation after having children some time ago, and more importantly – when the implications of using an implant was discussed, she clearly did not like the thought of needing to maintain her implants for the next few decades of her life.  She was however, under the impression that implants were what she required to “lift” her breasts back into a more youthful position – which is true, to an extent.  However, the excess amount of loose skin meant she actually needed a lift at the same time, where an implant alone would not be sufficient to give her the result she wanted.

So here we are, a patient who now wants to book in for a different procedure than what she thought she needed in the first place.  With all of these bits of information and explanation written down on paper in her hand, all of it seems so plausible and sensible when she walks out of my practice and heads home.

Then the uncertainty begins – the huge amount of information struggles to sink in.  You start to question your decision making process, and you may even forget bits and pieces of the consultation despite having it written down on paper.  Your immediate family wants to hear all about what was discussed during the consultation and you aren’t even sure where to begin because it was over an hour of information overload.  You may even be so surprised with new bits of information that you are contemplating a second opinion from another surgeon just to be sure – which is very normal and is also a great idea.

No matter how certain my patients are that they are “good to go” with their surgery after their first consultation, most will have burning questions to ask, things they want reassurance about, and therefore they come in for a second consultation.  You may decide to bring a family member along for support if you did not get the chance to initially, or get a friend to help look after your toddler so you have another chance to be fully engaged because you were distracted the first time.  During the second consultation, we repeat your implant sizing for breast augmentation to make sure you have not changed your mind.  We re-discuss your options in case you forgot the rationale behind your choice.  I measure twice to cross check we have ordered the correct devices.  All these are reasons why your second consultation is just as important as your first.

More questions?

Your Specialist Plastic Surgeon and their team can help you through your entire plastic surgery journey so please reach out to them if you do happen to have any questions or concerns.

Written by Dr Marion Chan FRACS

https://www.marionchan.com.au/

The post Member Blog: Breast Surgery – The second chat is just as important as the first. by Dr Marion Chan appeared first on Australian Society of Plastic Surgeons.