Sydney

Breast Surgery

Yes. A GP referral is required to see A/Prof Bish Soliman for any type of surgery. Medical Board of Australia guidelines make a referral mandatory before a cosmetic surgery consultation, and the doctor who writes it cannot be the one performing your surgery. A referral is also needed if you want to claim a Medicare rebate on your consultation or procedure. Your GP can send the referral directly to the practice, and a referral form is available on the website.

Yes, for cosmetic breast surgery. Medical Board of Australia guidelines require adults to wait at least seven days after deciding to proceed before booking surgery or paying a deposit. Patients under 18 have a three-month cooling-off period and must also be assessed by a GP, psychologist or psychiatrist. You will have a minimum of two pre-operative consultations, at least one of them in person. The cooling-off requirement does not apply to medically indicated procedures such as breast reconstruction after mastectomy.

It can be, when the surgery is medically indicated rather than purely cosmetic. Three MBS item numbers apply. Item 45523 covers bilateral reduction mammoplasty for patients with macromastia who have neck or shoulder pain, without insertion of any prosthesis. Item 45520 covers unilateral reduction with repositioning of the nipple in the context of breast cancer or a developmental abnormality. Item 45522 covers unilateral reduction without nipple repositioning. Eligibility is assessed individually and requires examination, documentation and photographs. Private health insurance only contributes where an MBS item number applies.

Sometimes, depending on whether there is a current medical indication. Item 45548 covers removal of a breast prosthesis as an independent procedure. Item 45551 covers removal together with excision of at least half the fibrous capsule where there is a medical reason such as capsular contracture, a mass within the capsule, or BIA-ALCL, with tissue sent for histopathology. Items 45553 and 45554 cover removal and replacement following complications such as rupture. Implants originally placed for cosmetic reasons can still qualify if a genuine complication develops. Removal purely to change size or appearance does not attract a rebate.

Breast implants are not lifetime devices, and most patients will need further surgery at some point. There is no fixed expiry date, and the common belief that implants must be replaced every ten years is not accurate. Replacement is usually prompted by a specific problem such as rupture, capsular contracture or a change in shape or position, and the likelihood of rupture increases as implants age. Regular implant checks help pick up changes before they cause symptoms. A/Prof Bish will discuss what ongoing monitoring is appropriate for you.

Most patients take one to two weeks away from work, and return to strenuous exercise at around four to six weeks. After breast augmentation or a breast lift, many people manage light duties after about a week. Breast reduction usually means wearing a surgical bra for six weeks. DIEP flap reconstruction is a much larger operation, with several days in hospital and a recovery of roughly six to eight weeks. Recovery varies from person to person, and your own timeline depends on the procedure, your general health and how physically demanding your work is.

All surgery carries risks. For breast surgery, these can include bleeding, infection, swelling, scarring, fluid collection, skin discolouration, temporary or permanent changes in nipple sensation, asymmetry or an unsatisfactory result, reduced ability to breastfeed, damage to deeper structures, the need for revision surgery, and complications related to general anaesthesia. Where implants are used, risks also include capsular contracture, rupture and BIA-ALCL. Smoking and a higher body weight both increase the chance of complications. A/Prof Bish will go through the risks that apply to your circumstances at your consultation, and full details are set out on the risks and complications page.

BIA-ALCL, or breast implant-associated anaplastic large cell lymphoma, is a rare cancer of the immune system that develops in the tissue around a breast implant. It is not breast cancer. A TGA review of Australian cases reported through the end of 2021 estimated the risk at around 1 in 1,800 for polyurethane-coated implants, 1 in 2,400 for macro-textured implants, and 1 in 18,000 for micro-textured implants. No confirmed Australian cases involve only smooth implants. Polyurethane and macro-textured implants are no longer listed on the ARTG. In 95 per cent of cases, the condition appears between three and 14 years after insertion, and the first sign is usually late breast swelling. The TGA does not recommend removing implants in patients who have no symptoms.

Many women can, but breast surgery can reduce the ability to breastfeed and the outcome cannot be predicted reliably beforehand. Breast reduction carries a higher chance of affecting milk supply, because breast tissue is removed and the nipple is usually repositioned, which may disturb milk ducts and nerves. Breast augmentation is less likely to interfere with breastfeeding, though it is not guaranteed to leave it unaffected. If you are planning to have children, tell A/Prof Bish at your consultation so that it can be taken into account when your surgical plan is made.

You should continue routine breast screening after breast surgery. Implants can obscure part of the breast tissue on a standard mammogram, so tell the radiographer that you have implants and additional implant displacement views can be taken. Breast reduction and breast lift leave scarring and areas of fat necrosis that may show up on imaging, which is why the radiologist needs your surgical history for accurate comparison. Mammograms remain safe and appropriate for women with implants. Keep a record of your implant type and surgery date.

DIEP flap reconstruction rebuilds a breast using your own skin, fat and blood vessels taken from the lower abdomen, without sacrificing the abdominal muscle. It is a microsurgical procedure for women who have had, or are planning, a mastectomy. Because the reconstruction uses your own tissue, it changes naturally with your body over time and does not carry the implant replacement considerations that come with implant-based reconstruction. Reconstruction can be immediate, at the same time as the mastectomy, or delayed until other treatment is complete. A/Prof Bish Soliman holds two consultant microsurgery positions at major Sydney tertiary referral hospitals.