Sydney

ALL ME Augmentation Mammoplasty

Scale is the bigger difference, not just what goes into the breast. Implant surgery is shorter, involves a single surgical site and has a quicker recovery. Moving your own tissue means no foreign material in the body, so nothing implant-specific can go wrong, but you are taking on microsurgery, a second wound on the abdomen and a much longer recovery.

Implants come with their own well-recognised problems. Capsular contracture, rupture and the likelihood of removal or replacement somewhere down the track are all part of the picture, and none of that applies if there is no implant. In its place sits the risk profile of free tissue transfer. The transferred tissue lives on blood vessels that can block off, the abdomen becomes a second wound, and both the hospital stay and the time away from work stretch out considerably. Neither path is risk-free. You are choosing between two sets of risks, not between a risky option and a safe one, and both sets should be put in front of you before you decide.

With fat grafting, fat is harvested by liposuction and injected into the breast, where it has to survive on whatever blood supply the surrounding tissue can give it. A DIEP transfer is different. It moves a block of tissue that brings its own artery and vein, reconnected under a microscope. Grafting is by far the smaller procedure, though it usually adds less volume.

Some of the grafted fat is reabsorbed, and how much survives varies from patient to patient, which is why volume is often built up over more than one session. Tissue moved with its own blood supply behaves differently and does not reabsorb in that way. On the other side of the ledger, fat grafting involves no microsurgery, no abdominal donor site, and a far shorter recovery. What suits you comes down to the volume you want, the donor tissue you have available and how much surgery you are willing to go through. Treat it as a real comparison. The bigger operation is not automatically the better one.

Two things need to line up: enough spare tissue on the lower abdomen for the transfer to work, and a genuine wish for abdominal surgery in its own right. Very slim patients with little excess skin or fat usually do not have enough to harvest. General health and smoking status weigh in as well.

The patients who tend to look at this pathway are those wanting post-pregnancy surgery, those having unwanted implants taken out who still want volume in the breast, and those left with loose abdominal skin after weight loss. Bring up previous abdominal surgery, any plan for a future pregnancy, smoking, diabetes and any clotting disorder early, because each of them affects suitability. Keep in mind too that the abdomen can be used once only, so this is not surgery you can repeat later if you change your mind about size. Whether there is enough donor tissue is something that has to be assessed in person, not online.

The surgery is done under general anaesthetic and runs in stages. An incision goes across the lower abdomen, excess skin and fat come away, and that tissue is then transferred to the breasts with its blood vessels reconnected under a microscope. A stay of around three nights in hospital may be needed.

Because of the microsurgery, the operation takes considerably longer than implant surgery. Afterwards the transferred tissue is watched closely. Blood vessel problems tend to declare themselves in the first 48 to 72 hours, and that monitoring is precisely why you stay in. Getting up and walking early is encouraged as soon as you are able, since it helps blood flow and lowers the risk of clots. Two useful questions before the day: how long is my operation expected to take, and what monitoring will be in place afterwards?

This is major surgery and the risks are significant. Broadly they sit in three groups: risks to the transferred tissue, risks at the abdominal donor site, and the general risks that come with a long operation under anaesthetic, blood clots among them. Every one of these should be gone through with you individually before you consent.

It helps to see the published figures. Abdominal bulging after a DIEP flap is reported in about 2 to 33 per cent of cases, hernia in up to about 7 per cent. Wound breakdown, seroma, haematoma, infection, fat necrosis and trouble around the navel all show up in the same studies. Clots are counted on their own. In autologous breast reconstruction, venous thromboembolism is reported at about 0.1 to 4 per cent; in abdominoplasty, 0.35 to 5 per cent. Longer and combined operations push that higher. Part or all of the transferred tissue can be lost as well. None of these figures forecasts your result. They are ranges pooled across many centres and many groups of patients, and where you sit depends on your health, your weight, whether you smoke and your anatomy.

Occasionally the blood supply to the transferred tissue fails. Caught early, a return to theatre may rescue it. If it cannot be salvaged, the tissue is lost and the breast volume goes with it, and further surgery would be needed to deal with the result.

That is the whole reason the first few days are spent under close observation instead of at home. Vessel problems usually show up inside the first 48 to 72 hours, which is when salvage stands the best chance. Losing a flap does not normally leave the abdomen available for a second attempt, since the donor tissue has already been taken. Put the question directly to your surgeon: what happens in that situation, what are the alternatives, and what would it mean financially? It is a fair question and any surgeon should be willing to talk it through plainly.

There will be permanent scars, and in more than one place: a long horizontal scar across the lower abdomen, a scar around the navel, and scars on the breasts. The abdominal one typically runs hip to hip, placed low enough in most cases to sit under underwear.

Scarring is more extensive than with implant augmentation, where the incisions stay on the breast. Scars generally look their worst in the first few weeks, then flatten and fade over the following months, and most keep changing for somewhere around 12 to 18 months. Keeping wounds clean, protecting healing scars from the sun and sticking to your wound care instructions all make a difference. Before the day, ask to see the planned incisions marked out, so the extent is clear to you in advance instead of a surprise afterwards.

Recovery runs substantially longer than after implant surgery. Once you are home from the inpatient stay, expect several weeks before normal activity resumes, with restrictions on lifting, exercise and anything that strains the abdomen. Remember that two surgical sites are healing at once.

Aftercare usually means keeping wounds clean and dry, wearing the support garments you are given, avoiding lifting and strenuous activity, and taking proper time off work. Walking early is encouraged, not discouraged, because movement helps blood flow and lowers clot risk. Abdominal tightness and altered sensation across the lower abdomen are common in the early weeks. Arrange help at home for the first week in particular, and ask for written timelines specific to your procedure covering driving, lifting, work and exercise instead of general figures.

Yes. What has been transferred is living fat, and it behaves like the rest of your body. Gain or lose a significant amount of weight afterwards and breast volume can go up or down with it. A stable weight gives the most predictable long-term result.

Implants do not work that way. They hold their volume whatever the rest of the body is doing. Some patients like the responsiveness of their own tissue, because the breast moves with them instead of staying fixed. Others find it harder to predict than they had imagined. Pregnancy and ageing go on affecting the breasts afterwards in any case. If significant weight loss or a pregnancy is on the cards, say so before surgery, since timing can matter more than technique.

Generally not, where the purpose is to improve appearance. The Medicare items covering abdominal flap breast reconstruction are written for reconstruction after mastectomy, not augmentation for appearance, and the abdominoplasty items carry their own specific clinical criteria that have to be met on their own terms.

That said, some patients on this pathway do have circumstances that attract a rebate. Implants being removed for a recognised clinical reason is one example; abdominal surgery that meets the criteria of a relevant item is another. Eligibility is assessed against the wording of each item and your individual circumstances, and it is never assumed from the name of the procedure. Because this operation combines elements, more than one item may need to be considered separately. Find out which items, if any, are being claimed, and get a written estimate covering the surgeon, assistant, anaesthetist and hospital before you commit.

Where this surgery is performed to improve appearance, it is cosmetic surgery and the Medical Board of Australia’s cosmetic surgery guidelines apply, including a cooling-off period of at least seven days after informed consent before the surgery can be booked or a deposit paid. A GP referral is essential in any case.

The accompanying requirements are a referral from an independent medical practitioner, at least two pre-operative consultations with one of them in person with the surgeon who will operate, and assessment for psychological conditions using a validated screening tool. Patients under 18 require independent evaluation and a cooling-off period of at least three months. Where the surgery is genuinely reconstructive, for instance as part of managing an implant complication, the position differs. Given the scale of this operation, taking more time than the seven-day minimum and asking for a further consultation is entirely reasonable.