Plastic Surgery

A patient with a disfiguring condition went to Sydney plastic surgeon Dr Kourosh Tavakoli to have her breasts transformed. Lauren Alexander reports.

Sydney plastic surgeon Dr Kourosh Tavakoli's patient approached him for surgery to correct her abnormally shaped breasts. He assessed her as having grade three to four tuberous breasts, an unusual condition that affects the way breasts develop.

The patient says she was concerned about the shape of her breasts and felt they didn't look normal. She says their condition prevented her from wearing v-necked styles of clothing and that she didn't feel comfortable wearing a swimsuit and avoided going to the beach.

She had an initial consultation with another doctor who told her what needed to be done but, she says, 'I didn't feel comfortable with him so I started looking on the internet. Dr Tavakoli was the only doctor who had before and after surgery photos of tuberous breasts like mine.'

She says when she met Dr Tavakoli he immediately put her at ease and she was impressed by his friendly manner and felt confident about his ability to help her. Dr Tavakoli took her through two consultations. During the first he assessed her breasts and explained what would be needed to correct the tuberous condition and talked her through the whole procedure.

Then she says he showed her with the implants in her bra what the final result would look like. She could see that they would provide a solution to her problem and decided to have the surgery.

During the second consultation Dr Tavakoli talked her through the procedure again, asking her if she had any questions about the surgery before going ahead with the procedure.

The procedure took place at a private hospital and required an overnight stay. Dr Tavakoli's patient says her recovery was very straightforward. 'I was fine; there were no side effects. The first thing I did when I regained consciousness was to ask for food!'

She says she only needed to take painkillers at night for three days and after that experienced minor discomfort. 'I thought it was going to be a lot worse.'

Dr Tavalkoli's clinic recommended some gel patches to assist with healing and she is now using a specially formulated oil to help the scars disappear completely.

She says her new breasts have helped her to feel much more confident and that she immediately went shopping for new clothes. 'I'd recommend the procedure to anyone with a condition like mine. They look so natural that no one beyond my immediate family and boyfriend can tell that I've had it done.'

Click here for Before and After Breast Augmentation Images

In the first of a two-part series, Sydney plastic surgeon Dr Kourosh Tavakoli explains the key elements of a natural-looking breast augmentation.

The number of breast enlargement operations is on the increase, and the demand for natural-looking results is even more apparent. As a plastic surgeon specialising in breast augmentation and lifting procedures, I have been privileged to treat a large number of patients every year in my Sydney clinics. Therefore, I have drawn from this wide experience to develop the formula for successful and attractive breast augmentation.

Telltale signs

There are three main telltale signs of unnatural-looking breast augmentation to be avoided:

1. Breast implant margin:

This should be soft and imperceptible, as obvious implant edge visibility, especially in the midline, will resemble the look of Tori Spelling or Posh Spice's implants.

2. Breast implant size:

An implant that is too large for a small frame is usually an obvious giveaway that a patient has had a breast augmentation. The best example of this is Pamela Anderson-style breasts. Women wanting to go from an A cup to a full D cup need to understand this point.

3. Perkiness:

An augmented breast that is too perky will tend to look fake, as a small amount of droop is natural. When a patient lies on her back, the breast implants should roll to the side like natural breast tissue and not sit up in rigid peaks.

Before undergoing surgery, it is beneficial for the patient to review photographic examples of the breasts they would like and to convey their wants to the surgeon so there is a clear, visual understanding of the desired result.

Clinical parameters and key considerations

There are six main clinical parameters for breast implants on initial consultation:

• Patient's body build and height
  


• Natural breast size, shape and symmetry
  


• Nipple position in relation to the breast
  


• The quality of breast skin
  


• Chest wall shape and dimension
  


• Patient's desire for new cup size and shape
  

After establishing the crucial parameters in the clinical examination, the process of tailor-making the right breast augmentation begins.

I believe there are six key considerations for a surgeon when customising a breast augmentation to gain a naturallooking result:

1. Incision placement

There are three choices about where to make the skin incisions for breast enlargement. They can be in the breast fold (inframammary), around the nipple (periareolar) or underneath the arm (transaxillary). These incisions can all produce scarring. Although patients may voice some initial concerns about the location of their scars, they are ultimately far more concerned with the final shape and size of their breasts.

2. Breast implant shape

The choice of implant varies from round to teardrop shapes. The round implant comes in both low and highprofile varieties. The shape variation is in the width and projection of the implant for any given size. The spectrum of breast implants available to the surgeon can therefore provide great versatility in achieving a more natural look.

Use of the teardrop (anatomical) shape depends on the patient's desired outcome, as well as her breast shape. In general, there are two groups of women who benefit from teardrop-shaped breast implants. It can be the ideal choice for women who have droopy or tuberous breasts. Mild elevation of the nipple in relation to the breast mound can be achieved without the need for extra scars on the actual
breast (unlike breast lift scars). In these cases, the implants will be inserted in a subglandular or subfascial pocket (under the breast tissue). In severe cases of droopiness, breast lift must be performed to restore aesthetic shape.

Secondly, some patients specifically want less fullness in the upper quadrant. Teardrop breast implants certainly offer less fullness in these particular situations. It should be noted, however, that this request tends to be very personal, as most women are seeking breast augmentations in order to obtain upper pole fullness.

It should be noted that teardrop or anatomical implants do have tendency, estimated at about 5 percent, to rotate. Unfortunately, this problem can only be corrected by secondary surgery.

3. Breast implant fill

I use both the cohesive silicone-gel and saline-filled breast implants. The new generation silicone-gel breast implant is very safe and generally feels and looks more like a natural breast. The gel is always my first preference.

The gel usually comes in low and high cohesiveness (soft or firm), and patients should ask their plastic surgeon for different samples at the time of the consultation so that they can make the most informed choice possible.

Welcome to the next generation of cosmetic treatments. Subtle changes that equal major impact, courtesy of groundbreaking technology and these doctors.

The best breasts

For many women, our breasts symbolise our most feminine physical characteristic. But for various reasons - lack of development, postpregnancy changes resulting from breastfeeding, radical weight loss, ageing - you may be considering breast augmentation.

A successful breast augmentation shouldn't necessarily look obviously different... in fact, the success hinges on the doctor's surgical technique and attention to detail. Renowned Sydney plastic surgeon Dr Kourash Tavakoli has developed a specialised breast practice and his reputation is based on understanding the essentials of natural breast augmentation.

Dr Tavakoli uses his extensive experience to treat not only poorly developed or shaped breasts, but also sagging breasts, common in women after breastfeeding and/or weight loss.

The Australian-trained plastic surgeon also promises minimal scarring and ensures his patients feel comfortable with what is an intimate procedure. Further reason why Dr Tavakoli has one of this country's busiest breast implant practices.

One of the most commonly performed cosmetic surgery procedures is the rhinoplasty. This procedure represents
the greatest fusions between art and science. Sculpting a new nose requires an in depth knowledge of nasal anatomy and function as well as a true sense of the patient's sense of beauty and ethnicity. The nose you end up with should fit
easily into the shape of your face and in fact should not be distinguishable from any other feature.

A well recognized successful rhinoplasty is that of Ashley Simpson, American Pop star. Her new nose was so right for her face that it really accentuates its true beauty.

Rhinoplasty can improve the tip of the nose and its projection and the removal of the hump on a nose can change the length as well as the shape of that nose. Most Rhinoplasty procedures can be performed as day only cases requiring a week off work.

Successful rhinoplasty is a combination of careful patient selection and planning, accurate operative technique and thorough postoperative care.

Sydney plastic surgeon Dr Kourosh Tavakoli's case study shows how cosmetic procedures can be combined to reduce costs, anaesthesia and recovery times. Gillian Samuel reports.

Sydney plastic surgeon Dr Kourosh Tavakoli's patient says she had a bump high on the bridge of her nose that, while it didn't bother her unduly, always caught her eye when she saw herself in a mirror.

She says the bump is a family feature shared by her father and aunt and as she found herself noticing it more and more in her mid-twenties, she began to think about having it corrected. When she consulted Dr Tavakoli about a rhinoplasty, she mentioned during their discussion that she had always wanted a breast augmentation. At more than 180cm tall, she says she has always felt she was completely flat-chested.

Dr Tavakoli explained she could have both procedures at the same time and the convenience strongly appealed to
her, so she made arrangements to take two weeks off work in August this year.

'The breast augmentation is something I'd always thought about. I used to talk about it with my mum and we'd joke that we'd do it together,' she says, adding with a laugh that her mother is jealous of her now she has gone from an A to a D cup.

She said that Dr Tavakoli reassured her there wasn't any extra risk involved with undergoing the two procedures simultaneously. Her rhinoplasty and breast augmentation operations took about three hours and she says she went into day surgery at 7am and was at home by 2pm.

Dr Tavakoli removed the bump from the bridge of her nose and also performed a septoplasty to narrow it. She says she is very happy with the result.

He also inserted high profile, round silicone-filled implants behind the pectoral muscle to provide some forward projection and to give her fullness in the upper pole of her breasts, giving her the bustline she had always dreamed of having.

She says that even Dr Tavakoli has been impressed by the speed of her recovery. 'From the moment I woke up and he was holding my hand and telling me that everything had gone very well until now, which is five weeks later, I've had no pain at all, just a little tenderness with my nose.'

She says she took a prescription painkiller for a week and a half after the surgery and that although all the work on her nose was internal, she did have bruises over her upper eyelids, which faded in a week.

Her breast augmentation incisions were relatively small and are healing very nicely. Overall she is extremely pleased with the outcomes of both procedures.

'I don't think it's changed me as a person, I just feel so much more comfortable when I look in the mirror and the breast augmentation has given me a lot more confidence about wearing summer clothes,' she says. 'I haven't needed to buy more clothes, the ones I have still fit, they just look better!'

Dr Tavakoli says the safety of modern procedures and technologies means patients can combine procedures for two-in-one cosmetic results.