I recently attended a conference in Melbourne focusing on Cosmetic and Reconstructive Surgery of the Breast.
The two major guests were very eminent American Breast Surgeons. Both gentleman widely acknowledged for there scientific and clinical expertise in the areas of Breast Augmentation and Breast Reconstruction. They gave three days of excellent in-depth presentations relating to breast enlargement/augmentation, breast reconstruction and breast reduction along with presentations relating to the correction of breast deformities.
There is no doubt that these men are great thinkers and great technicians. They have a wealth of experience.
One of the interesting things that I learned at this meeting however was that Australian surgery for the breast in the areas of breast enlargement/ augmentation, breast reconstruction and breast deformity is at least on apar, if not more advanced than the surgery provided by our colleagues in the United States.
This is because in the United States the moratorium on the use of silicone forbreast surgery has only recently been lifted and in fact only partially lifted. The moratorium on the use of silicon for breast surgery in Australia has been in the process of a progressive lifting by our TGA since 1996.
Perhaps one of the best things to come out of the concerns related to silicone in the late 80’s and early 90’s was in fact the development of a large number of much better, much safer prostheses for use in breast surgery. The availability of these prostheses to Australian Plastic Surgeons has enabled us to step well ahead of our American colleagues in the results that we can achieve, and perhaps the safety with which we can achieve them.
Whilst the Americans by and large are still confined to the use of saline filled prostheses for both cosmetic and reconstructive purposes and they are only able to use a limited number of silicone filled prostheses and then generally only in clinical trials, we have had a variety of very good prostheses now for many years.
Since 1996 we have had what are described as form stable implants, both round and anatomically shaped for cosmetic and reconstruction purposes, as well as double lumen silicone/saline expandable prostheses for reconstructive purposes. This has allowed us as Surgeons a much greater versatility in what we can do. We can use a wider selection of tissue planes in which to put the implants. We do not have to put implants underneath the muscle simply because they are saline but can put them in the other multiple planes available for surgery. As we have access to multiple shapes of prostheses, we are able to achieve a more individualised result for a given individual even on a purely cosmetic basis let alone on a reconstructive basis or a correctional basis for breast deformity.
Furthermore the double lumen prostheses can be used as a one stage prosthesis in reconstruction. This allows the patient to reduce the number of operative procedures required. Otherwise she would generally have at least two operations, one to put in a saline style expander and one to have that expander removed and replaced by a more definitive prosthesis (once again probably saline) as would happen in the United States.
It is important to understand that this is not a criticism of American Surgeons and their technical abilities but what I am saying is that we do have a wider spectrum of choice and with that choice we are developing a greater technical experience and at th is point in time we have a broader expertise and a broader spectrum of surgeries to offer.
In many things medical we overly presume that the United States is at the forefront. In the circumstance of breast surgeries, I think this can lead to some problems for patients.
I see a number of patients who wish to consider breast surgery and come in with a pre-determined concept of what is to be done because they have naturally done their homework on the internet. Unfortunately the American internet sites can portray what in Australia would be considered to be surgery that is up to a decade out of touch. Patients can be quite surprised when I inform them that in fact there options here are broader and often better.
I guess I would finish off by also citing breast reconstruction where a patient’s own tissues are used. Obviously the Americans are not held back by technology in this circumstance. The most recent advances in own tissue reconstruction often involved microsurgery. Once again Austra lia can be a little proud as our Plastic Surgeons did indeed lead the world in the development of microsurgery.
In short Australian Cosmetic Plastic Surgeons are up there amongst the best in the world. Even reputed Surgeons such as were our guests at the recent meeting envy our circumstance.