# Breast Augmentation vs Breast Lift: What’s the Difference?

An episode of [Vain-ish](https://invisiblenetwork.ai/podcast/1824105551), 14 Oct 2026, 45 min.

Audio: https://enrichment.soundstack.com/4vjqq8/episode.flightcast.com/01M4FGXPZ80AWAQ3EG4SG8EJ9S.mp3

Boobie Month continues! Specialist plastic and reconstructive surgeon Dr Hamish Farrow explains the differences between breast augmentation and a breast lift, covering implant placement, recovery, scarring, implant lifespan, rupture and breast implant illness, plus pregnancy and breastfeeding after implants. For Breast Cancer Awareness Month, it’s a timely reminder to prioritise breast health and speak with a healthcare professional if you have concerns. This episode shares personal experiences and professional perspectives for general informational and entertainment purposes only. It does not recommend or endorse any treatment or procedure. Please consult an appropriately qualified health professional about your individual circumstances. Find us on Instagram: @vainishpodcast and thanks to our guest Dr Hamish Farrow Hosts: @becjudd and @jessierobertsx Producer: Liza Altarejos Audio Imager: Chris Marsh Video Producer: Justin Hill Find more great podcasts at LiSTNR

## Transcript

[0:02] a listener production.
[0:05] I'm Bec Judd.
[0:06] And I'm Jess Roberts.
[0:07] And we're done with the smoke and mirrors.
[0:09] Fainish shares honest stories about what it takes to look amazing because we did not wake up like this.
[0:15] And you should know the stuff that we chat about on this podcast is based on our personal experiences.
[0:21] We're sharing it for your entertainment.
[0:23] It's definitely not medical advice.
[0:26] And we'll always be clear with you when something is a paid endorsement.
[0:29] Please always chat with your qualified healthcare team before making any decisions about your health.
[0:49] Hi, guys.
[0:50] It's Bec Judd.
[0:50] And Jess Roberts.
[0:51] And welcome to Veinish.
[0:52] Today, we are talking... Oh, gosh.
[0:55] This one's been asked for a lot.
[0:56] Boobies.
[0:57] Boobies.
[0:58] Yay.
[0:58] We love boobies.
[0:59] We love boobs so much.
[1:01] We had to go and buy some.
[1:03] Yes.
[1:05] Everyone loves boobs.
[1:06] Girls love boobs.
[1:06] Boys love boobs.
[1:07] We all love boobs.
[1:08] Babies love boobs.
[1:09] Yeah.
[1:09] Boobs.
[1:10] Boobs, boobs, boobs.
[1:11] Yes.
[1:11] Yeah.
[1:12] Today, we are discussing breast augmentation as well as breast lift.
[1:17] Breast lift, the whole shebang.
[1:18] Yeah.
[1:19] Yeah.
[1:19] And we have one of the most experienced plastic surgeons in the game who is a specialist plastic and reconstructive surgeon who specializes in all things breasts.
[1:34] and he happened to do my boobs.
[1:37] And my boobs.
[1:37] So we know him well and he knows us well.
[1:41] We actually call ourselves, what is it, Hamish Angels?
[1:44] Hamish Angels.
[1:46] Or Pharaoh Angels.
[1:47] Yeah.
[1:47] Because there's a whole bunch of us that have gone and seen him.
[1:50] Lots and lots and lots.
[1:51] But he's a specialist.
[1:53] Yeah.
[1:53] Breast surgeon.
[1:54] So when we're thinking we're going to do a range of booby episodes, let's be a little bit more mature, breast surgery episodes that we needed to get someone super experienced in and we thought, who else but Dr. Hamish Farrow.
[2:06] Welcome to Vanish.
[2:07] It's lovely to be here.
[2:08] We have been busting to have you on here.
[2:11] We've had this like for a year now and we have kept the boob topic just for you.
[2:17] Under wraps.
[2:18] Yeah.
[2:18] Yeah, yeah.
[2:19] And I was like, when are you going to talk about breast implants?
[2:21] It's like we're waiting for our guy.
[2:23] For our guy.
[2:24] But we've got you on here.
[2:25] We would love to know your qualifications.
[2:27] So I graduated medicine and then did a fellowship in plastic surgery and then went to Canada and worked in Vancouver for about 18 months doing a breast fellowship.
[2:37] And then I suppose career-wise, I've worked at the Austin for about 20 years looking after their breast side of plastic surgery and now I'm just in private.
[2:45] It's great.
[2:46] Okay.
[2:46] So let's get right into it.
[2:49] What is the difference between a breast augmentation and a breast lift?
[2:52] Yeah.
[2:53] They're quite different.
[2:54] Essentially, an augmentation is filling up the bag of skin that makes your breast, and a lift is making that bag smaller, or not necessarily smaller, but higher.
[3:03] So if you want to plump up a breast and have a breast present higher and fuller, you either fill it up or you make it a tighter bag so the volume you have is actually pushed up north.
[3:13] Mm-hmm.
[3:14] And they're quite different.
[3:15] So a lift involves all the scarring that goes along with reducing the skin envelope, whereas an augmentation can do that if the breast is a reasonable shape just by filling it up.
[3:25] So with the augmentation, is there certain areas that you cut to put the implant in?
[3:32] You have to make a hole somewhere.
[3:33] But you know how it used to be like you could get through the armpit or then there was through the nipple?
[3:38] Around the edge of the nipple.
[3:39] Yeah, there's ways of doing it.
[3:41] And even through the belly button.
[3:43] Oh, yes.
[3:44] Was that how it was done in the 90s and the early kind of 2000s?
[3:48] It was never really done a lot.
[3:50] It was called a tuber, trans-umbalite, called breast augmentation.
[3:53] Yeah.
[3:53] You had to put saline in because you couldn't get a silicon through that hole.
[3:57] And every now and then it'd leave these indents in the tummy where the long tube went because it was a huge tube.
[4:03] Yeah, yeah.
[4:04] So it was just a thing.
[4:05] It's a bit like the underarm access.
[4:07] People that did it loved it.
[4:09] You know, you asked one of the golfers which clubs he plays with.
[4:12] Everyone has their own favourite way of doing it.
[4:16] But now I suppose by far the most common is underneath the breast.
[4:18] And it's about four and a half centimetres cut and there's actually a new technique that's being brought in to try and make that cut even smaller and down to just finger size basically.
[4:29] Because I remember watching that on a reality TV show.
[4:32] It was a plastic surgeon in the US.
[4:34] It's a good way to learn.
[4:35] And I just remember him putting that tube through the belly button.
[4:38] And it was just so rough.
[4:40] And he'd be shaking the body.
[4:42] I was just like, oh, they would wake up with so much bruising on their stomach the next day.
[4:46] Oh, yeah.
[4:46] Like this wouldn't be painful.
[4:48] Like the boobs wouldn't be – it'd be the stomach that was more painful.
[4:51] Oh, yeah.
[4:51] It was, yeah.
[4:52] Some of the surgery videos you see, they're like online.
[4:54] It's brutal, isn't it?
[4:55] Yeah.
[4:55] Oh, brutal.
[4:56] My husband did a, had a shot, one of his, he's had so many shoulder reconstructions, but one of them they kept him awake for into sitting in an upright position.
[5:06] And just like the hammering and the screws and the drills and... Just the noises.
[5:09] Just like the banging, like the full banging.
[5:12] It's like, I never want to be awake for that ever again.
[5:15] Yeah, yeah.
[5:15] Like you guys, like it's a bit of like...
[5:18] grunt work that you have to put in sometimes.
[5:20] Well, in the bones, certainly.
[5:21] Yeah.
[5:22] Jaws and sills.
[5:23] Yeah.
[5:23] Yeah.
[5:24] Wow.
[5:24] Back on the breast augmentation and the breast lift, you can have both done at the same time.
[5:29] Yep.
[5:29] Yep.
[5:30] What percentage, would you say roughly, does a breast lift you end up putting an implant in and doing an aug as well?
[5:36] So the concepts, I separate them.
[5:40] If you need more volume, then you have an augmentation.
[5:42] If you don't need more volume, but you just don't like where the breast sits, you have a lift.
[5:46] Mm-hmm.
[5:47] To do the combo, you've got to presumably want both.
[5:50] You need it to be higher and not just the elevation you're going to get from having an implant.
[5:54] So if you put an implant in, I explain to people that the nipple is like tied by a piece of string to your collarbone.
[6:01] And like pushing a kid on a swing, the swing rises.
[6:04] Mm-hmm.
[6:05] the nipple will rise when you push the breast forwards.
[6:09] So if you feel the breast from behind, you get a lift to a degree, as long as you've got enough tightness in your skin in the first place to cope with that.
[6:16] So to do two together, it's a bit of a juggle because you've got a breast, which is saggy, bad word, but we use it all the time.
[6:24] Yeah.
[6:24] What other word would you use after you breastfed four kids and for a long time?
[6:28] What did we say?
[6:31] Wind socks.
[6:32] Tennis ball in an empty sock?
[6:33] Yeah.
[6:33] Tennis ball at the end of it.
[6:35] Yeah.
[6:37] Burned out lycra.
[6:39] So if you have a problem with sag in the first place and then you put extra volume in, that material doesn't cope really well with that extra weight.
[6:47] Yeah, gravity pulls it down even more, right?
[6:49] So if you do a lift and then you put an implant in on the same day, you're trying to tighten it and you're trying to push it to stretch.
[6:57] And it's a bit of a tug of war.
[6:58] You never quite know which one's going to win.
[7:00] So some people, and the guys in Sydney all do this, they'll do a lift first, wait six, nine, 12 months and then come and put their implant in.
[7:07] Whereas in Melbourne, we're a bit more pragmatic and we go, okay, we'll do the two together.
[7:12] And there's probably 15% of people who don't cope with that very well.
[7:16] So you then have to come back and readjust or whatever.
[7:20] Do they not cope with it because it's painful?
[7:23] No, no, no.
[7:23] They don't cope because the skin can't hold the implant.
[7:25] Oh, okay, okay.
[7:26] So if the implant stays but the skin sags, you get this sort of melting off the front of the implant.
[7:31] You get this low nipple and high implant.
[7:34] People like the look in clothes but don't look great out of clothes.
[7:36] Yeah.
[7:37] Yeah.
[7:37] Or you get the other way around where the implant isn't held up and it falls like your potato.
[7:41] Yeah.
[7:42] Okay.
[7:42] So that 15% prior to surgery, can you usually pick it or is it you just don't know until the recovery where you go, oh, sorry, you're in the 15% that your skin didn't tolerate that as well?
[7:52] Yeah.
[7:53] You'd like to think you can.
[7:54] Yeah.
[7:54] It's not predictable.
[7:56] I warn everyone.
[7:56] I say.
[7:57] Yeah.
[7:57] And that's the thing with surgery.
[7:58] Like, at the end of the day, like, everyone heals differently.
[8:01] Yeah.
[8:02] And there's risks.
[8:02] Yeah.
[8:03] You come in with your gorgeous friend, you kind of hope you're going to have their outcome.
[8:07] It's not always so.
[8:08] Yeah.
[8:09] It's so true.
[8:09] So what is the most common reason women come to see you about their breasts?
[8:13] Yeah.
[8:14] I do all of breasts.
[8:15] So I'll range from cosmetic, purely want to be larger, want to be more showy, want to be bigger, want to be smaller, want to have less pain, want to have less swing, shoulder discomfort, born asymmetric, born weird.
[8:27] You know, there's a whole lot of congenital things that will give you a strange shape.
[8:31] And socially, you can be inhibited by that.
[8:33] But I also do the cancer stuff.
[8:35] So all the girls who've got...
[8:37] a new diagnosis or they've had a diagnosis and treatment, they need some reconstruction, or I've had a reconstruction a long time ago and it doesn't work anymore.
[8:45] Yeah.
[8:45] And so the most common would be breast reduction, actually, in Melbourne.
[8:49] Yeah, by far.
[8:50] Are you seeing more of that with GLP-1 use?
[8:53] Are you seeing the breasts?
[8:54] Are you seeing anything...
[8:55] It's a really good question.
[8:56] So the GLP-1 decreases your size and people that lose a lot of weight don't tend to tell me that their breasts get a whole lot smaller, but they do get looser.
[9:05] And that looseness gives you discomfort.
[9:08] So that's an interesting comment because looseness and swing is actually what makes your neck, back and shoulders hurt.
[9:15] People with big implants don't tend to get neck, back and shoulder discomfort because they don't swing.
[9:19] Mm.
[9:20] And so the girls with big boobs naturally go, oh, why would you do that?
[9:24] That's terrible.
[9:25] And yet the people with big implants go, what's the problem?
[9:28] Yeah.
[9:29] Because they're not swinging it, which is kind of cool.
[9:31] So the GLP-1s aren't driving up the number of people that have breast reductions, but that's the population that are in trouble in the first place.
[9:38] Yeah.
[9:39] And then we use GLP-1 to get their physique into shape before they have their reduction done because that gives them a much better proportions.
[9:46] Okay.
[9:46] If you lose a lot of weight after a reduction, you tend to look saggy again.
[9:50] Yeah, right.
[9:51] Going back on a breast lift, do you do anything in the muscle to lift it or is it just the skin that you're just kind of recreating?
[9:59] It's breast.
[10:00] You're trying to move and hold the breast without the skin having to be the job lifter.
[10:05] So if the skin is doing the job, skin's crappy by that stage, it's blown up, let down, blown up, let down, and the reason you're in for a lift is because the skin can't cope.
[10:13] Yeah.
[10:14] So then you try and get the breast to hold itself.
[10:17] So there's obviously so many ways of putting an implant in.
[10:20] So there's some that is under the muscle, over the muscle, half under the muscle, half, you know, over, you know, that whole thing.
[10:27] Sure.
[10:27] What is the difference?
[10:28] What makes you decide on where the actual implant should be placed?
[10:33] And what's the name for it?
[10:34] Like what are the things?
[10:35] It's like a projection and a, you know, like with a diamond, it's the three Cs or whatever.
[10:39] Like with breast implants, what are the key kind of?
[10:43] Okay, we'll do those two separately.
[10:45] So firstly, where you put it in, whether it's under the muscle or over the muscle, all relates to what look you want.
[10:53] The higher the implant is closer to the skin, the more obvious you're going to see it.
[10:56] So a skin, a gal who's got not much breast tissue, not much fat, and you can count it ribs.
[11:03] If you put it under the skin, it'll look like a tennis ball.
[11:05] If you put it under more cover, the more cover you put it under, the less you see the implant, the more you see just the shape.
[11:11] Like a natural look.
[11:12] Yeah, well, and people use the word natural and it's a bit broad.
[11:15] So just to make it a clearer understanding, I talk about a teddy bear on a bed.
[11:19] If I throw a sheet on the teddy bear, it looks like a teddy bear.
[11:21] Yeah.
[11:21] If I put two dunas on it, you can even feel it and you won't be able to tell it's a teddy bear, but it still has the size of the teddy bear.
[11:27] That's a good analogy.
[11:28] I like that.
[11:29] Yeah.
[11:29] So I talk about Doona a lot and people seem to get that because they're used to that.
[11:35] So if someone's thin, you want to, in my view, most of my patients are Malvin mums who want no one to know, you end up putting it under as much as you can to try and cover the implants so you don't see the implant.
[11:46] And it gives you that natural sweep as you described.
[11:50] The trouble is when you use your muscles an awful lot, you'll push on that implant because the muscle sits over the implant and it'll tend to displace the implant a little bit to the side or flatten it.
[12:00] And so people that are doing body sculpting or... Push-ups.
[12:03] Well, yeah.
[12:04] And if you go to the gym and you're doing pec flies and you're wearing lycra, you'll see it.
[12:08] If you wear a T-shirt, you won't see it.
[12:10] So it's a matter of whether they...
[12:13] happy to have that look or not.
[12:15] So I think it's really important to try and get an idea in your own head before you go and see someone about this, what look you want, what is the effect you want?
[12:23] Because it's, it's about shape and proportion and width and so forth.
[12:28] And I encourage people to actually try and make a little folder on their phones of, I really like this.
[12:33] And I'm not sure, I kind of like this, I'm not sure.
[12:36] So going back to the second question you asked, which was about the nature of the implant.
[12:39] So implants have a width and they have a projection.
[12:42] And again, I use analogies.
[12:43] But if I had a shot of vodka and I had it in a shot glass, it's pretty tall.
[12:47] So if you imagine that glass is lying on the chest, it's coming off the chest quite a bit, but it's not very wide.
[12:53] If I put it in a brandy snifter, the brandy glass is really wide
[12:57] the same volume would be very close to the chest.
[12:59] So the projection would be small, but the width would be wide for the same volume.
[13:04] So when you talk about the nature of the implants, it's what the surface is.
[13:09] So whether it's ruffle smooth, what the filler is, whether it's silicon or saline, and then what the silicon feels like, because there's different grades of how much it sticks together.
[13:19] And then width...
[13:21] as compared to how far it goes forwards.
[13:23] And they talk about projection.
[13:24] So low projection, medium projection, high projection, so forth.
[13:27] It's just going forwards and it does that at the excuse of width.
[13:30] So in my view, you have to fit the width to the patient to start with and then you can start adding projection.
[13:36] So when someone comes in and says, I want a high projection implant, I go...
[13:39] I don't know what you mean by that because you want these to be outstanding boobs, fine, but you don't want boobs that are so thin that they don't fit your frame because it doesn't look good.
[13:50] Yeah, because side boobs are cool.
[13:53] Enough, enough.
[13:55] It's really foxy.
[13:56] Did I remember...
[13:58] When, was it Kylie Jenner?
[14:01] She posted on social media her...
[14:04] Details.
[14:04] All the details and the project...
[14:06] I was like, no.
[14:08] Whatever she said.
[14:09] It could be 425 dual plane.
[14:10] I don't know.
[14:10] I'm just guessing.
[14:11] Yeah, I remember she put all the details.
[14:13] I was going to say, did you...
[14:15] then just get people bring that screenshot and say, I want Kylie Jenner's boobs and this is exactly what she did and where they put it and da-da-da-da.
[14:22] Because when she did that, then everyone started posting.
[14:24] Yeah, I went over under the breast muscle and then I went 440 cc's.
[14:27] I'm sitting there and I'm like, how is she standing?
[14:30] Because I would kill over on that size boob.
[14:34] That was a trend about 12 to 18 months ago.
[14:36] Did you see that in your practice of people coming in and going, I want Kylie Jenner?
[14:40] It's a bit of that.
[14:41] And it's a bit like when Angelina Jolie did her front cover of Time after bilateral mastectomies and reconstructions.
[14:47] People suddenly think that that's doable because this beautiful person is up there showing that to go.
[14:52] And it doesn't work that way.
[14:54] No.
[14:54] I mean, it's like, you know, you look great in that top.
[14:57] If I wore that top, I'd look really weird.
[14:59] Yeah, yeah, yeah.
[15:00] You have to disavow those things.
[15:01] You have to educate a lot.
[15:03] There's a lot of that.
[15:04] Yeah.
[15:05] It's not just like, hey, I want this.
[15:06] Do this.
[15:07] You're like, no.
[15:07] No.
[15:08] We need to fit your shape, frame.
[15:10] You need to make sure that your skin is a certain condition that you can carry that type of implant.
[15:14] So tall, thin girl brings in short, wider girl and short, wider girl says, I want the same boobs.
[15:18] You go, pfft, not going to happen.
[15:20] Good luck.
[15:20] Yeah, yeah.
[15:21] Well, you can't have it but it's going to look weird.
[15:22] I've got to break your ribs.
[15:23] Yeah, yeah, yeah.
[15:24] It's pretty painful.
[15:25] Wow.
[15:26] Okay.
[15:26] So how do you help someone – We don't do that, by the way.
[15:28] Sorry to you.
[15:29] We don't do that in practice, no.
[15:32] How do you help someone work out whether they're actually ready for surgery?
[15:37] I don't tend to have a big issue with that.
[15:39] The only people that aren't ready for surgery, the people that can't hear the problems.
[15:43] So when you give this discussion and you say, here are the bits we can do and this is the implications of that and there are implications which may cause problems,
[15:53] time, suffering, money, re-operation, that sort of thing, and they gloss over it all.
[15:58] I go, well, we're going to need to do this again because you're not hearing me.
[16:01] Yeah.
[16:01] It's almost like if someone, like, hey, I want to get my boobs done, and you're like, okay, so you're planning on having a baby in the next 12 months?
[16:06] Yeah.
[16:06] Oh, yeah.
[16:07] Well, you know you're going to have to come back after you breastfeed because it's got a – is that the type of person you're kind of talking – like that type of person.
[16:12] And they're just so excited about the product that they're not thinking about –
[16:17] Yeah.
[16:17] What impact it has.
[16:18] So there's not that many of them, but realistically, we never do this in one discussion.
[16:23] It's got to be more than one discussion in my game because I think you need time to actually cool off and go, right, what's the implications then?
[16:30] Yeah.
[16:30] What are we going to do?
[16:31] Speaking of what you just mentioned,
[16:33] surprise babies because I would imagine a lot of people, me included, would get a breast augmentation after they're finished having their babies and breastfeeding and that's it.
[16:42] And then, oops, get pregnant again, breastfeed again.
[16:45] Do you see a bit of that and how is the breast affected by that?
[16:48] You have to replace them?
[16:50] Yeah.
[16:50] Not critically, but you blow the bag up, you let the bag down, it always gets a bit more stretchy.
[16:56] Most women put on weight when they have kids and they will often progressively get heavier as 35 to 45.
[17:02] It's like a kilo a year.
[17:03] Yeah, like menopause peri-premium.
[17:05] They'll cope.
[17:06] They're doing it thicker.
[17:07] It doesn't so matter in a way.
[17:09] Yeah.
[17:10] I kind of figure you'd make these opportunities because it's right for you in your life at that time.
[17:14] The people that are really thinking they're going to have a kid don't often want to spend the money doing that because that's not their big thing at the moment.
[17:21] But, you know, life happens.
[17:22] I think you just deal with life.
[17:23] It's like, you know, I play tennis with my...
[17:27] tennis record on a slightly misty, rainy day and you go, well, I wet the strings and the strings are going to rub out.
[17:31] But I'd rather play tennis than not.
[17:33] So I'd rather have an implant now because this is who I am.
[17:36] Like you're never going to be 25 again.
[17:39] And if you're having a great time and you're dancing and you're enjoying it and you look good on the beach, fantastic.
[17:44] And if you happen to have kids at 27, well, c'est la vie.
[17:46] Yeah.
[17:47] There'll be a lot of people listening who want to know what the process is on the day when you go in for your surgery and what you can do in the recovery and what you can't do.
[17:59] Because a lot of people are like, I just need to be able to hold my kids and put them in and out of their car seats and their cots.
[18:04] I think like kids, I'm thinking of my kids, were they in a cot until they were two or something?
[18:09] So what's the recovery like now?
[18:12] Are we talking implants?
[18:13] Yeah, for implants.
[18:14] Yeah, okay.
[18:14] And then for a breast lift as well.
[18:15] Okay, so breast lift, I have no restrictions.
[18:18] I can lift and carry.
[18:18] Okay, you can lift straight away?
[18:19] Yeah.
[18:20] Yeah.
[18:20] It doesn't matter.
[18:20] It's a breast lift.
[18:21] Yeah.
[18:22] Oh, without an implant?
[18:24] Without an implant and reduction because you shouldn't see the muscles.
[18:27] So you should be able to use the muscles.
[18:29] I have no restrictions.
[18:31] If you put your implant underneath muscle, then you release some of the muscle to make room.
[18:37] As it were, if you imagine the hand of the muscle comes over the implant, if the hand pulls really hard, it'll tend to pull the implant towards your armpit.
[18:45] So what we do is we release muscle bit by bit down the bottom and this is where dual plane comes from.
[18:51] It's an expression like having a window shade.
[18:53] And if you lift the window shade a little bit, you see the bottom half of the window.
[18:57] If you lift it a bit more, you see half the window.
[18:59] The lifting of the muscle up over the implant allows the implant to be seen down the bottom half of the breast, which actually allows it to stretch that skin to the bottom part of the breast, which makes a nice shape.
[19:08] So some people...
[19:10] you release the muscle a long way to express that implant in the bottom half of the skin.
[19:14] Some people, you don't need to release it much at all.
[19:17] The more muscle you have injured, the more likely that is to bleed when you're active and busy and so forth.
[19:24] So I have a 10-day, 5-kilo maximum lift.
[19:29] Okay, so wait for 10 days.
[19:30] To lift more than five kilos.
[19:32] So you're domestically independent.
[19:33] You can get yourself dressed and out of bed and make a cab of two.
[19:36] Five days, something like that, if you're not in pain.
[19:39] So you need to be functionally able.
[19:41] I can move my arms everywhere and you need to be mentally able.
[19:44] I'm not on drugs to be a safe person behind a wheel.
[19:47] But some of them will restrict your peck work forever.
[19:52] And I don't see the point of that.
[19:54] Yeah, right.
[19:55] I don't think it makes it... Because at risk of popping a muscle, blowing a muscle open, for want of a better medical phrase.
[20:01] Changing the shape of your breast.
[20:02] Yeah.
[20:03] And again, if you're going to work on those people who love their muscles and work really, really, really hard on their muscles and want the shape of their muscles and their body fat to be low and their muscles to be impressive, then you have to often put the implant over the top of the muscle because otherwise it distorts too much.
[20:18] Okay.
[20:18] And it looks more obvious.
[20:20] Yes.
[20:20] Do you ever do like pec muscles for men?
[20:25] Peck implants?
[20:25] Yeah.
[20:26] I have done.
[20:28] It's not popular?
[20:29] Just work on it.
[20:29] Just work on it, boys.
[20:31] It tends to be for people, actually, there's a condition called pollens.
[20:34] I have heard of this, yes.
[20:35] Where you don't have all your pec muscle.
[20:36] You have none of your pec muscle, depending on who it is.
[20:38] And we've used implants to fix that.
[20:40] But I haven't worked on the Geelong...
[20:44] The mayor down there that had his abs.
[20:46] Oh, Darren.
[20:47] He used to be a pap.
[20:48] Darren Lyons.
[20:49] Oh, yes, yes.
[20:50] Darren Lyons.
[20:50] He was extraordinary.
[20:52] Yeah.
[20:52] That my family then owned.
[20:54] What's he doing now?
[20:54] Is he still around?
[20:56] He had the pink hair.
[20:57] Yeah.
[20:57] Yeah.
[20:58] I don't know where he is.
[20:58] Well, my family ended up buying that restaurant.
[21:01] Growlers.
[21:01] We used to be called Growlers.
[21:02] And then we called it Doc Hughes.
[21:04] Okay.
[21:04] My family has just sold that, yeah.
[21:06] Yeah.
[21:06] So you can put a static implant for them because they've got a part, but the other thing you can do is steal that dorsi muscle and swing it around and actually put it into the front and make a functional muscle and they can actually tense and do push-ups and so forth.
[21:18] But it's pretty rare.
[21:19] I mean, that's a congenital problem that's pretty rare.
[21:22] So no, I don't.
[21:34] question a lot.
[21:35] What is the concept of an internal bra?
[21:38] To be honest, I think it's just marketing.
[21:40] Yeah.
[21:41] If you have a space you want to put something into, you need to have a wall to stop that thing running away.
[21:47] So the implant running away.
[21:49] Yeah.
[21:49] So out to the side or whatever, then you may reinforce that with whatever, sutures, mesh, the various things you can do.
[21:56] If you want to describe that as an internal bra, you can market it.
[22:00] So you do that when you put in your breast implants and that is just.
[22:03] Everybody does it.
[22:03] Everyone does it.
[22:04] But you don't say, oh, I'll offer you an internal bra.
[22:07] Yeah.
[22:07] This is so interesting.
[22:09] Or I'm going to charge you $10,000 more because I'm doing an internal bra.
[22:12] I go to this guy because he does an internal bra.
[22:14] I know.
[22:14] I go to this lady.
[22:16] She has an internal bra.
[22:16] I'm like, what's an internal bra?
[22:18] I'm going to ask him.
[22:19] But they all do it.
[22:20] There you go.
[22:21] So it's just like a marketing thing.
[22:22] And how do you do it with sutures?
[22:24] If you need to, yeah.
[22:25] So most people have a nice form.
[22:27] You don't need that.
[22:28] Yeah.
[22:29] And, you know, in deference to the guys in, again, Sydney, the two big names up there, they may do something more, but I've never heard about it.
[22:38] Do you do a lot of fat transfer into the boobs or?
[22:41] At augmentation?
[22:42] Yeah.
[22:43] No, I think that's a fluff too.
[22:44] Yeah, okay.
[22:45] So fat injection is a way of making anything bigger or more filled and it's completely underwhelming.
[22:52] There's not a lot of...
[22:54] What is it?
[22:54] Blood supply, right?
[22:55] Like you need a really good blood supply for the fat to take?
[22:57] No, that's actually not the issue.
[22:59] Oh, what is it?
[22:59] It's the fact that you are – it's like throwing seeds on soil.
[23:02] Birds will eat some, some will wash away, some will dry out, and some will live.
[23:06] You get about 30% of what you put in.
[23:08] So in a thin little gal who needs something, they don't often have a lot of fat to steal.
[23:12] Yes, that's the thing.
[23:14] And so when you put in five grams –
[23:17] You're left with one and a half or two.
[23:19] Yeah.
[23:19] And so what you're trying to drive then is an improvement in the health of that tissue, which you're trying to improve health of tissue, and it's probably doing the same thing.
[23:28] Rather than actually filling the hole.
[23:29] Save it for your face, ladies.
[23:30] Yeah, yeah.
[23:30] Are you okay?
[23:32] The other thing is like when you put on weight and lose weight, a lot of girls do say, I know when I put weight on because I've put it on my boobs first or I've lost weight because the first place I lose weight is in my boobs.
[23:41] So it's like- Yeah.
[23:43] Oh, you.
[23:43] Especially you.
[23:44] Yeah.
[23:44] I'm like- She's pregnant.
[23:45] She's pregnant.
[23:46] I'm eating this or this or this.
[23:48] But the second I lose weight, it's always my boobs first.
[23:51] And what do you notice?
[23:52] I just notice that like- They're less plump?
[23:55] Yeah, just a little bit less full.
[23:57] But what I notice about you is they start growing out under your armpits.
[24:01] Yeah, I get the weight through here.
[24:04] And then the second I lose weight, it just goes.
[24:07] But, like, it still looks good weight on, weight off.
[24:09] But it's just that I notice that when I put weight on, the first place I put it on is my boobs.
[24:14] You're lucky.
[24:14] Actually, stop bragging.
[24:16] But it actually is.
[24:17] A lot of girls, like a lot of my girlfriends are the same.
[24:20] When they know they've put weight on, it's usually because I've noticed it in their boobs first.
[24:24] Mm.
[24:24] So I guess if you do put fat in that area, you're going to lose it pretty quickly because it's like one of the first places that girls do lose weight in.
[24:32] So it's just an adjunct.
[24:33] If you're actually trying to make a boob out of fat, it takes three goes, four goes, whatever.
[24:37] But you can do really nice work and it's actually soft and feels like a boob.
[24:42] So in a girl who has a congenital asymmetry where they don't need an implant because they're
[24:47] Again, I have a little theory that you should try and make both sides with the same materials because then they'll age the same.
[24:53] Yeah.
[24:53] But you can use fat for them.
[24:55] But it's just repeated effort.
[24:57] Okay, it's not just like a one-off thing.
[24:59] No.
[24:59] Yeah.
[24:59] Talk to us about the scars involved with a reduction and a lift.
[25:05] Are they in similar places?
[25:06] Exactly the same.
[25:07] Exactly the same.
[25:08] Yeah.
[25:08] And they look like a lollipop.
[25:09] Is that right?
[25:10] So you have to move the nipple.
[25:11] The nipple needs to go north in almost everybody.
[25:13] You have to reduce width.
[25:14] So you have a vertical scar below the nipple.
[25:17] That's the lollipop.
[25:18] And then what you do with the leftover skin at the bottom is negotiable.
[25:21] I go out to the outside and have no scar in the cleavage, but a lot of people would do a scar all the way across the cleavage.
[25:29] It's called an anchor.
[25:31] What are the biggest misconceptions women have about breast implants and breast lifts, do you find?
[25:35] They think they'll last forever.
[25:37] They are concerned that having a breast screening for their breast cancer surveillance will damage their implants.
[25:44] It's actually probably the other way around, that...
[25:47] when your implants break under that sort of environment, they're ready to be changed anyway.
[25:51] And so if the one thing you take away from this episode is keep having a screening because it's better to be alive and, you know, that's more important.
[25:58] And in fact, the implants should cope with that just fine.
[26:02] And if they don't, it's probably time to change.
[26:04] What about breastfeeding?
[26:07] It's a really lovely thing to do.
[26:08] Yeah.
[26:08] And you can still do it afterwards.
[26:10] In all those procedures.
[26:11] Because a lot of people think once you get any of those procedures or implants that that's it, you can't breastfeed anymore.
[26:17] So all the breast implant does is push the whole breast forward.
[26:20] So the whole mechanic should be still there.
[26:22] You know, it should work and still go erect.
[26:24] Whether you go over the muscle or under the muscle.
[26:26] It doesn't matter.
[26:26] You're still behind the breast.
[26:27] Yeah.
[26:28] The breast tissue and the glands.
[26:29] Yeah.
[26:30] Everything goes forwards.
[26:31] That's all you're doing.
[26:31] And to touch on breast cancer once more, having a breast implant doesn't change your risk of breast cancer.
[26:37] In fact, the population with breast implants has got a lower risk of breast cancer than the general population because they tend to be smaller-breasted women before we start.
[26:46] And some statistics come out on that, around 17% less breast cancer in the breast augmentation order.
[26:52] augmented group.
[26:53] But it's not a protective thing.
[26:54] So putting an implant in won't protect you, but it doesn't make your outcome worse.
[26:57] We use implants all the time with people with breast cancer.
[27:00] All the time.
[27:01] All right.
[27:02] Let's talk about leak.
[27:04] Like obviously people have, you know, implants that could explode and leak.
[27:08] What's the difference between – there's obviously a saline solution that you guys use and then there's also the – what's the other word?
[27:15] Silicon.
[27:15] Silicon.
[27:16] Yep.
[27:17] So when it comes to saline –
[27:20] You simply deflate.
[27:21] Okay.
[27:22] It's a balloon full of salt water and you get a hole for whatever reason and you simply deflate and you go flat.
[27:27] Straight away?
[27:28] Overnight.
[27:29] Really?
[27:30] And is that like just the device has failed or from a traumatic injury?
[27:34] It'll be the device failing.
[27:36] So a traumatic injury causing a break in an implant is really rare.
[27:39] I mean, it's usually demonstrating to you that the thing's had a problem.
[27:43] Yeah.
[27:44] Rather than being the problem itself.
[27:45] So you could, in a young person who's had implants for seven years, have...
[27:50] Not suggesting you do, but you could have an elbow or a car accident or whatever, you're likely to break and it won't.
[27:55] Yes.
[27:55] Because they're very tough.
[27:57] Yeah.
[27:57] But there was a period, was it about 10 years ago, where there was a batch that were prone to leaking?
[28:02] Yeah.
[28:03] Yeah, and also there's been a batch where the silicon gel inside was commercial grade or industrial grade rather than medical grade, which means that when it did leak, there was more inflammatory response to it.
[28:15] And so choose your surgeon and it's not all about money, it's about safety too.
[28:20] Yeah, so I'm assuming a cheaper implant.
[28:23] Yeah, so we have TGA here, really good.
[28:26] FDA, the European CE mark, you want your implants to be covered by all of them.
[28:31] Yes.
[28:31] And then you know they're safe.
[28:32] Okay, right.
[28:34] And then when there is a leak...
[28:37] What does that look like for you?
[28:38] It's often you don't know what's happened, right?
[28:40] So the surveillance of implants over time, I do nothing for the first 10 years.
[28:45] I say, go party, have fun, come back and see me in 10 years unless you notice something peculiar in the interim.
[28:51] So at 10 years you have an ultrasound.
[28:52] If you're looking good and you're feeling good and your ultrasound says you're fine, then I see you again at 12 years and then at 14 years and by 15 I think you should change.
[29:01] So why bother with that sort of timeframe?
[29:03] What happens is that your implant has a chance of leaking problems,
[29:06] roughly a percent a year on the core studies.
[29:09] So by 10 years, you've got maybe a 10% chance you'll have had a hole in your implant.
[29:13] And that incidence of leakage increases in the second decade and goes crazy in the third decade.
[29:19] So you can keep an implant for 20 years and you might be just fine, but the chances are starting to stack against you.
[29:24] So by 15, you've got a reasonable chance your implant will be intact and a small chance that it'll be broken.
[29:30] And taking out an intact implant, putting a new one in is like a doll.
[29:34] It's like a haircut.
[29:36] Yeah.
[29:37] I love it.
[29:38] That's easy.
[29:39] I love that.
[29:40] I know your haircuts can be challenging.
[29:42] I'm paying for five of them.
[29:44] That's when you know you're speaking to a real professional that's done a lot of boobs.
[29:48] It's like, it's easy.
[29:49] I love it.
[29:51] So if you have a leak and the leak is out, you may get no symptoms, but commonly you'll get some feeling or some change of sensation and then maybe your implant starts to go a bit firmer and a bit tighter because the scar around the implant called the capsule starts to respond to that and tighten up.
[30:06] Mm-hmm.
[30:06] And then you get this breast feels firmer and often goes north like a calippo or a sunny boy when you squeeze them and they go north.
[30:13] And these implants sit high.
[30:14] I think it was in the Mike Myers movie with a lot of vagina.
[30:19] Oh, yes, yes, yes.
[30:20] Can I say that on radio?
[30:21] That was her name.
[30:22] There's a girl in the spa and she's got a clear capsular contracture, which is where that scar around the implant is tightened and it's gone north.
[30:29] So that can be a sign that you've had a leak, although...
[30:32] You might not have that.
[30:33] You can also get lumps around the implant where the tissue tries to wall off the silicon leak, or you can get lumps in your armpit where the lymph nodes have picked it up.
[30:43] So you want to try and get to it before any of that happens.
[30:46] The leak can either be inside the capsule, intracapsular, or through the capsule, extracapsular.
[30:53] And the degree of work you have to do to fix that depends on how far that leak's gone.
[30:57] What's the trickiest one you've ever seen?
[31:00] Oh, I've seen them through ribs into lung.
[31:02] Oh, wow.
[31:03] Wow.
[31:03] And what's happened there?
[31:04] Like just devised?
[31:05] They've ruptured 25 years before.
[31:07] No, no, no.
[31:08] Oh, no.
[31:09] They're just old.
[31:09] They're just old.
[31:10] And people have put up with them.
[31:12] I've had them come through skin where little old ladies haven't done anything about it.
[31:16] They had implants 40 years ago and it's now worked its way out through the skin.
[31:20] That's messy.
[31:21] Wow.
[31:22] Wow.
[31:22] That's a big job for you.
[31:23] That is.
[31:23] That is.
[31:23] Well, it's an expectations job because by the time you start taking away skin, you're never going to get the same shape again.
[31:29] Yeah.
[31:29] So an early change is good.
[31:32] Yeah, right.
[31:33] Okay.
[31:33] Can that make you sick?
[31:36] So there's no link between silicon itself giving you anything more than a physical change on your chest or maybe your armpit.
[31:43] There's no disease associated with implants.
[31:46] There are people that complain of diseases and they range from skin being dry, memory being lost, autoimmune disease, melanoma, whatever, and they blame that on their implants in their mind and it's called breast implant illness.
[32:01] And there isn't a scientific link that we know of that can be
[32:05] sort of relates the implant to that disease per se.
[32:08] But these unfortunate patients get to the point where they're so convinced that's the way it's got to be that you then... Take them out.
[32:15] Take them out.
[32:15] And often these patients will go through a period of a fantastic relief and they feel better and their skin gets better and their memory gets better.
[32:23] It's a bit like falling in love.
[32:24] You know, you suddenly have energy and you feel great
[32:27] If you look at the markers for their disease, if they have markers for their disease like the autoimmunes, they get better and then they come back again.
[32:35] So by a year, they tend to have the same disease profile as they had beforehand, but now they don't have the implants.
[32:41] And often I see it as people just having to tick the box.
[32:44] I've tried to do everything I can to get rid of this.
[32:46] If it takes me taking up my implants, I'm going to do that.
[32:49] Yeah.
[32:50] And that's okay.
[32:51] Hamish, can you talk to us about the cancer that's associated with implants?
[32:54] Yeah.
[32:54] Okay, there's a really rare cancer called ALCL or breast implant associated anaplastic large cell lymphoma.
[33:02] This is a very rare cancer that's a bit like non-Hodgkin's.
[33:05] Sam Neill had a version of a lymphoma.
[33:09] This is a disease which can happen anywhere in the body without an implant.
[33:13] It can also happen associated with implants.
[33:15] It can happen associated with orthopedic implants.
[33:18] But there's a particular breed that occurs next to a breast implant and it's a proliferation of one sort of cell, a T cell, and it tends to present with fluid around an implant maybe seven years or thereabouts, but there's a range.
[33:32] Then you need to look to see if there's any solid tumor.
[33:35] There's about 13 million implants in the world, give or take, a couple of million.
[33:39] There's been 400 or thereabouts cases of this.
[33:42] We've had 12, 15 deaths, something like that.
[33:46] Yeah.
[33:46] Over that part.
[33:47] Yeah.
[33:47] In my career, I've seen one.
[33:49] Yeah.
[33:50] And the first stage of this is that you take out the implant, you take out the capsule.
[33:55] And if there's no solid tumor, if it's just the fluid.
[33:58] You've got it in time.
[33:59] Yeah, and it's essentially benign at that stage.
[34:02] So you want to catch them before they develop a tumor.
[34:06] And does the tumor grow in the breast?
[34:07] It grows in the capsule.
[34:09] In the capsule, yeah.
[34:09] And then it can spread.
[34:10] So to get to that stage...
[34:12] But it's not a breast cancer.
[34:13] It's a blood cancer?
[34:14] Very nicely said.
[34:15] It's not a breast cancer.
[34:17] It's a cancer of the capsule.
[34:18] Okay.
[34:19] And is this related to a specific type of implant?
[34:22] Type, yeah.
[34:23] It's related to textured implants.
[34:24] Yes, I remember this.
[34:25] I remember this because you told me.
[34:27] It's not been seen yet, ever, in someone who's only had smooth implants.
[34:32] Okay.
[34:32] So talk us through smooth versus textured.
[34:35] Okay, so historically we started with smooth and we found that the tightening of the capsule around the implant was a problem.
[34:42] All these implants would go in back in the 70s and they'd go hard and then it was like... You had to crack it.
[34:48] Yeah.
[34:48] And they did all that sort of stuff.
[34:49] My grandmother had to have that done.
[34:50] Oh.
[34:52] So then they developed the texturing and they figured the texturing was going to actually change the incidence of capsular contraction.
[34:58] And I think probably more likely what it was is we got better and better shells with multiple layers so you got less leak of the oil or the silicon out there.
[35:05] So now we don't see a big difference between...
[35:09] a capsule contracture in any of the implants.
[35:11] But the texturing has a secondary value in that it tends to stick to you a bit like Velcro and you could then make a teardrop shape and put it in and expect it to stay where you put it rather than spinning.
[35:23] So a teardrop shape only textured?
[35:25] They have to have something to stop them spinning.
[35:26] Spinning them around, yeah.
[35:28] So you can't get a smooth teardrop?
[35:32] They can, but they've got these nanotextures, which is like really, really close to smooth, but not quite smooth.
[35:39] And they've put tabs on the back of them to stitch them to the person so that they hold the orientation.
[35:43] The trouble with those tabs is they hurt, you know.
[35:46] When you move, they pull on you.
[35:47] So essentially the teardrop shape needed a texturing and needed a pretty firm texturing to make it not rotate.
[35:54] And they've still got some rotation in about 30% or 40% of them.
[35:58] But they were the ones that ended up with the ALCL problem.
[36:01] And you can't get them in Australia now because you need a TGA special approval to do that.
[36:08] So are textured in all forms banned in Australia now or just the teardrop textured?
[36:12] They're not banned.
[36:13] It's just they're not freely available.
[36:15] So you can get them, but you need to apply with a rationale as to why.
[36:19] So then there's degrees of texturing.
[36:21] And as you get less and less prominent texture, so the roughness on the implant...
[36:26] your ALCL risk drops dramatically.
[36:29] So there are textured implants which are not anywhere near what those Allagan ones were, but they still work.
[36:35] So you can still get teardrop implants and you can still get a textured teardrop implant, but it's a low-grade texture and even better, I think.
[36:43] I just don't want to go there.
[36:45] So I use smooth.
[36:46] And I think you can get the same aesthetics in a smooth.
[36:48] It's how much space you have at the bottom of the breast for the implant to fall into.
[36:51] If the implant has no room at the bottom, all of it's going to get pushed to the top like a push-up bra.
[36:57] If you have plenty of room in your bra, your boob falls to the bottom of the bra, the top doesn't look so full.
[37:01] It's exactly the same with an implant.
[37:03] So do you, for want of a better word, do you just like dig out that space?
[37:06] So you create that space for it to fall into or you just work with your natural body?
[37:10] You work with the natural body.
[37:12] You have a certain amount of space according to your anatomy.
[37:15] If you try and make more space, you have to break walls to do that.
[37:20] Yeah.
[37:20] And then you have to refix those walls.
[37:22] Yeah.
[37:23] And you have that unreliability of it not working.
[37:26] So there are some surgeons who love breaking the fold at the bottom.
[37:30] I almost never do.
[37:31] I do.
[37:32] So you just kind of put it in there and let it kind of go into space.
[37:34] And then how do you mould it into a better position?
[37:37] Is that when you start doing your sutures and stuff?
[37:39] I could tell you, but don't you know?
[37:41] Oh, it's okay.
[37:42] The secret herbs and spices.
[37:43] Can we turn off the... Yeah.
[37:47] Big Mac sauce.
[37:48] Yeah, yeah.
[37:49] What is it?
[37:51] So mostly it's your anatomy.
[37:52] Your anatomy will have a certain amount of space.
[37:54] And that dual planning, that lifting of the window shade thing, allows the implant to stretch that bottom skin better.
[38:00] But the way I describe it to people is once you have done that and you've opened up the bottom and you've filled up that bottom half with implant, any more implant you put in will actually push out the top.
[38:11] So you can then grade what your top looks like by how much more volume you put in.
[38:17] So if someone comes and says, I want 400 cc's and they've got a small –
[38:22] frame, you know they're going to be explosive at the top.
[38:25] If someone says, I want 400 and they're big and loose, you know there's going to be nothing at the top.
[38:28] Yeah, yeah.
[38:29] And then you go, well, if you want 400 in that loose bag, we're going to need to make your bag smaller so that it looks good.
[38:36] And that's where the lift thing comes in.
[38:37] Okay.
[38:38] You don't always put the same size implant on one side to the other.
[38:44] Why is that?
[38:45] Yeah.
[38:45] Because girls are beautiful.
[38:48] But it's like, is it because of like one boob has more breast tissue than the other?
[38:52] Or is it just, you know, scoliosis?
[38:55] Yeah.
[38:56] So, yeah.
[38:56] All of those things.
[38:57] Yeah.
[38:58] And so rarely do you find someone who's truly a symmetric person.
[39:02] Yeah.
[39:03] So rarely.
[39:03] So I actually...
[39:05] chatting to a chest surgeon today, I figure that about 80% of women have a slightly different chest on the two sides.
[39:12] And it's common that the left chest has a more prominent sort of bow to it.
[39:16] And the right side is a flatter, more laterally pointing breast.
[39:20] And if you look at where your nipples sit and you put your hands in the air, you'll often find the right one just tilts out a little bit.
[39:27] But it means that you get a different shape.
[39:29] especially when you put an implant in, you reveal the shape of what's underneath it more than perhaps you were aware of.
[39:35] And so many people don't actually know what their shape looks like.
[39:37] So many people are used to seeing themselves in the mirror, but you show them a photo and they go, whoa, I'm that uneven?
[39:44] And it's quite fantastic.
[39:45] They go, what do you mean?
[39:46] I've got different size boobs.
[39:47] And so when you then put an implant in, it's a bit like trying on a shirt.
[39:52] And it either fits you or it doesn't.
[39:53] And if it fits on the left but doesn't fit on the right, you need to put something else in the right.
[39:57] And so with that, do you have to, because it would be so hard doing surgery of a patient lying down, do you have to lift them up to kind of see and then go, oh, yeah, that needs a little bit more projection and lie them back down to do it again?
[40:08] What fun we're having to do.
[40:09] Do you just have the remote and then you put on Tom Dollar?
[40:12] I know, I know.
[40:14] And then when the beat drops, you're like...
[40:17] It's fantastic.
[40:19] We all do this.
[40:19] I can watch one day.
[40:20] Like when you redo Jess, I'm going to scrub it.
[40:22] I'm just going to watch it.
[40:24] I'll bring the lasers.
[40:25] Find a friend that consents to that.
[40:26] We'll see how it goes.
[40:27] I will.
[40:27] Yeah.
[40:28] Vice versa.
[40:29] Vice versa.
[40:29] Yeah, yeah.
[40:30] I'll scrub it.
[40:31] I'll scrub it.
[40:31] We love blood and guts.
[40:32] We're fine.
[40:32] We're fine with that.
[40:33] That is so simple.
[40:35] So that's, sorry, we sign quested again.
[40:37] No, no, no.
[40:38] You tell us what it's like in your theatre, how you work out.
[40:41] So it's entirely professional in my life.
[40:43] We have no visitors and no observers unless you pay.
[40:46] No, no, no, no.
[40:49] But that process of setting people up is a very important process.
[40:52] And the thing about any expert is you get better and better and better at actually being able to assess that.
[40:56] So I very rarely set people up unless I'm in challenge.
[40:59] But I will occasionally do that.
[41:01] But when you were younger and starting out, you might have done it more often?
[41:04] Every time.
[41:04] Every time.
[41:05] Every time.
[41:05] But you can actually push your breast on the chest downwards and you get an idea what the bottom half is going to do.
[41:13] But sometimes when you just can't tell, you sit them up.
[41:15] But it's, yeah, the thing about sitting someone up in theatre is you have to be careful with the blood pressure because if you sit someone up and they're fully anaesthetised and their blood pressure is low, you're not giving a lot of blood to the brain at that stage.
[41:29] So you need an anaesthetist that's used to this.
[41:32] We set everybody up on the table to be safe and in a good position and we put a pillow under your knees so your hammies don't go tight if we sit you up.
[41:40] We strap your arms onto boards.
[41:41] You look like you're in the Easter position.
[41:42] Yes.
[41:43] And then we sit you up for the minimal amount of time.
[41:45] So it'll go up and down.
[41:47] And then you only need to do it once, maybe twice to check.
[41:50] There's obviously different techniques.
[41:52] And when you've stitched your patients up, some have drains, some don't have drains.
[41:57] How do you determine that?
[41:59] So I would never use drains in breast augmentation, just haven't in my career, unless you're taking fish oils and all those sorts of herbs and spices which make you bleed.
[42:09] So really you shouldn't have a whole lot of that sort of stuff and you should tell your surgeon before you get there as to what you normally take, including all of your peptides now.
[42:16] Yeah.
[42:18] The idea of a drain is that if you're going to produce more than you can easily reabsorb inside, then you'll progressively fill up whatever bag you have.
[42:27] So if you can make it sufficiently dry before you finish and you have no great expectation they're going to weep a lot, you don't need a drain.
[42:34] So when patients go home after a breast augmentation, really we just send them home on ibuprofen and paracetamol.
[42:39] They don't need anything else.
[42:40] And they have it for two days maybe and they feel tight, but they can move their arms wherever they like.
[42:46] They can have a shower.
[42:47] They can sleep on their side.
[42:48] I don't really care.
[42:49] They wear a little crop top and that's about it and drive, as I said, in five days or so if they're fairly functional.
[42:55] But...
[42:56] You hear a whole lot of stories about people who have horrible pain or drains or whatever.
[43:01] And I just think there's a professionalism and a care in the surgery to avoid, don't touch the ribs.
[43:06] Ribs are really sore, you know, so keep off the ribs.
[43:09] Don't touch the muscle in a way that's anything but kind.
[43:12] If you can do that and make sure everything's nice and dry before you finish, you know,
[43:16] And you shouldn't have a lot of pain.
[43:17] Yeah.
[43:18] Don't be rough.
[43:19] Yeah.
[43:19] Surgeons, don't be rough.
[43:20] Yeah.
[43:21] You're not rough.
[43:22] It's a bit like that.
[43:23] Yeah.
[43:24] And so the drain is then used to deal with excessive fluid.
[43:29] So if you're having a reduction, again, I don't use breast...
[43:32] drains in breast reductions, but I may use a drain.
[43:34] For example, you had a leak and I'm digging and digging and digging to get stuff out.
[43:38] I'm in territory that will weep and therefore I'll put a drain in.
[43:41] But the drain will stay until the amount you produce into the drain is less than the amount that you can happily reabsorb.
[43:48] Yeah.
[43:48] And then you pull the drain out.
[43:50] Okay.
[43:50] But you remember the drains because you're awake when that comes out.
[43:53] Ouch.
[43:53] Yeah.
[43:54] Oh, yeah.
[43:54] I had, yeah.
[43:55] You breathe in.
[43:56] Yeah.
[43:57] Oh.
[43:57] That's right.
[43:57] Run away, run away.
[43:58] So do you use strains more into, if someone's having a second surgery?
[44:05] More commonly.
[44:06] Yeah, more commonly.
[44:07] Yeah, because they've had like a leak or something of their implant.
[44:10] Okay.
[44:10] And the secondary surgery requires you to go to places you wouldn't necessarily go with the first surgery.
[44:15] Yeah, if it's near the ribs or whatever.
[44:16] Yeah.
[44:17] Or you're changing planes or putting it under the muscle if it was over or that sort of stuff.
[44:21] Well, that was awesome.
[44:21] That was so awesome.
[44:22] Learned so much.
[44:23] I know.
[44:23] It's fascinating.
[44:24] I love boobs.
[44:25] I love boobs.
[44:26] How good do you get to work?
[44:27] Me too.
[44:27] You get to work with boobs every day.
[44:28] Growing up, did you love boobs?
[44:30] Always.
[44:31] I think every man loves boobs.
[44:34] I reckon my husband, if he'd had his time again, he would have had your job.
[44:38] Yeah, actually I think Vahazel would have done as well.
[44:39] Maybe he would have done Brazilian butt lips.
[44:41] Yeah, he's a butt boy.
[44:43] With a butt, butts and boobs, double Bs.
[44:45] Yeah.
[44:46] So thank you so much.
[44:47] That was awesome.
[44:48] So nice to see you.
[44:49] Terrific.
[44:51] It's been great.
[44:52] Thank you.
[44:55] We'll see you soon.
[44:57] We'll see you soon.
[44:59] Bye.

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