Trish: Hey, so welcome everyone. I’m here today with Dr Angie Taras. Dr Taras is a highly skilled aesthetic surgeon who is actually from the USA and she’s just moved to Australia. She’s Board-certified in the US for general surgery including breast and endocrine surgery. She’s working with Avenue Plastic Surgery in Victoria. Welcome.
Dr Angie Taras: Thank you.
Trish: Yeah, so I was quite … I was talking to a lady in your office and I was quite excited to hear about a new procedure that you’re doing at Avenue Plastic Surgery…
Dr Angie Taras: Yeah.
Trish: I’ll get you to tell us about it, but just to tell everyone it’s just basically a breast augmentation but it’s done under the arm so that there’s no scarring is that right?
Dr Angie Taras: That’s right. It’s a transaxillary breast augmentation, is what it’s called. That means I go through the armpit and that’s where I make the incisions.
Trish: Okay, so tell us a bit about it? Why? Is it better than having it done the other way?
Dr Angie Taras: I just like to offer a lot of different options. It’s basically up to the patient for the most part just where they want to have their scar. As most people know, you can put the scar underneath the breast in the fold, or you can go around the areola, around the nipple, as long as your nipples are a certain size. It just depends, if it’s large enough to get the scar there to make it look good when it heals. Another option is through the armpit. Some patients just don’t want to have any scars on their breasts, because that’s the area that we’re trying to make more beautiful, and they would rather have the scar under the arm.
It actually heals really nicely, because I put the incision in one of the skin folds and it’s very difficult to see. Someone would really have to study your armpit to tell that you actually had an incision there.
Trish: Does it make them too high? How do you get it down into the pocket where it should go?
Dr Angie Taras: Yeah, so I have a special instrument; it looks kind of like a long, curved cannula or metal tube I guess is how I can describe it. Basically that lets me reach the bottom part of where the breast folds, then I can release everything there that I need to release in order to create the pocket so that the implant sits where it’s supposed to. It’s pretty easy with the instrument that I have, and I brought that over from Chicago. Actually one of the surgeons who trained me made this instrument and had patented it, so he gave me one which was really nice.
Dr Angie Taras: Yeah.
Trish: I have heard it is a much more difficult procedure, like it’s really technically demanding apparently?
Dr Angie Taras: Yeah, but once you’ve learned. I trained, I’ve done so many of them. That was primarily what we used to do in the practise that I trained in. The patients just really liked to have them done that way. Once you learn how to do them … For me I feel like they’re pretty easy for me to do. I just think that they’re not offered very much here. It’s a pretty new technique. I’m just happy to be able to offer it here in Australia.
Trish: Alright. One thing that someone asked me is what about the lymphatic nodes that are … Is it under the armpits that you actually do it?
Dr Angie Taras: Those are pretty deep, and so I stay above the lymph nodes. The lymph nodes are actually pretty deep in the armpit, so I don’t even get close to them. I’m pretty much under the skin when I first get in, and then after that just make my way under the pectoralis muscle which is the chest wall muscle. That’s way above where the nodes live. The nodes are quite a bit deeper.
Trish: Okay. Does that mean whenever you do it, it’s always under the muscle?
Dr Angie Taras: It doesn’t have to be. I do like to place the implants under the muscle. I just think it looks more natural because you’ve got extra coverage. If you do it just under the breast and the skin, you can sometimes see the folds of the implant. That’s when people get that rippling effect, or you can see the little wrinkles outside just around the circumference of the breast implant. If you put it under the muscle you get an extra really nice layer that covers the implant. I just think it looks nicer that way.
Yeah, you can do a transaxillary also and put it over the muscle as well, if that’s what a patient prefers.
Trish: Okay, so it’s like a scarless breast augmentation really?
Dr Angie Taras: Pretty much, yeah. Yeah, exactly.
Trish: Okay, so does it take longer for patients to recover?
Dr Angie Taras: No, pretty much the same recovery. It’s just where your incision is is where you’ll have the incisional pain; so instead of having the incisional pain which is pretty minor anywhere after breast augmentation, instead of it being on the breast it’s under the arm. It’s not really much of a difference. I wouldn’t say that there’s more pain associated with having it done transaxillary, or even less. It’s very similar.
Trish: If that’s the case, no muscle is cut at all, is it?
Dr Angie Taras: Yeah.
Trish: It’s just like-
Dr Angie Taras: It’s just lifted. The muscle is just lifted off the chest wall, it’s not cut.
Trish: Alright. In that case, that wouldn’t affect breast feeding either, would it?
Dr Angie Taras: No. That’s another great thing about doing it transaxillary. Breastfeeding can be affected especially if you go around the nipple or the areola when you make your incision to do a breast augmentation, because that’s where all the ducts are. So you start cutting the ducts. It’s a little more likely that you would have issues with breastfeeding after that. Second in line would be under the folds, under the breast. Then the third would be the transaxillary, just because you’re not anywhere near where those ducts are. If you’re under the muscle you’re far away from the ducts anyway. The patient shouldn’t have any issues at all in relation to breastfeeding after that.
Trish: Okay. Does it have any effect with regards to mammograms? Someone said to me that it just makes mammograms better to read?
Dr Angie Taras: Yeah, for anyone who’s had any breast augmentation regardless of which way you put the implant in, we usually have to have an extra shot on the mammogram. They’ll take an extra picture just to get the implant out of the way so they can assess all of the breast tissue. It doesn’t make a difference whether it’s transaxillary or under the folds or around the areola in terms of that.
Trish: Is it true that … What happens with you know how some breasts can bottom out?
Dr Angie Taras: Yeah. I find that … It can happen with any way that you go in to put the implant. I find it more so with the incision that goes in the folds, because if you think about it that’s where you’re basically making the opening to put the implant in and it’s at the bottom of your breast. That would give you the highest chance of bottoming out.
It’s mainly related to how you dissect the muscle, so how you lift the muscle off the chest wall. So if you just do a really careful dissection and you don’t lift the muscle too much, then you shouldn’t get bottoming out. That’s no matter which way that you go to place the implant. Especially with transaxillary, because I’ve got that special tool so I’m pretty careful on how much I lift the muscle. So I don’t really get much bottoming out from the implants after I do a breast aug.
Trish: Is there the same risk of the possibility of capsular contracture? Or is that-
Dr Angie Taras: Yeah, pretty much the same. Sometimes we can’t always predict who is going to get the contractures. It would be amazing if we could, or if we knew what caused it, because then we could prevent it before we even do a breast augmentation. I think some of it is related to technique, so if you get bleeding, if you really are just moving around and doing a lot of dissection I think that gives you a chance of bleeding-
Trish: Excuse me.
Dr Angie Taras: That’s okay. That can increase your chances of a capsular contracture. I don’t think there has been shown any difference between doing it transaxillary and any other method of placing the implant that changes that. It’s all just doing a good, careful technique.
Trish: Yep. Anything to do with rippling or wrinkling?
Dr Angie Taras: Yeah, those are the same. I think mainly just putting it under the muscle is going to help prevent that. Some patients just don’t have a lot of their own breast tissue, and then they have a higher chance of getting that rippling because you don’t have a lot of coverage. The more breast tissue you have and the more fat you have … So really thin girls with small breasts who get implants I always tell them that they should definitely consider putting it under the muscle, because they need that extra coverage to hide anything otherwise you’re going to see everything through the skin because they don’t have a lot of fat and they don’t have a lot of breast tissue. That’s why you put it under the muscle, to help hide it so that they don’t get that rippling.
Trish: Okay. I know that Dr Kalus does lots of fat transfer to the breast.
Dr Angie Taras: He does, yeah-
Trish: Do you combine the two together? Or?
Dr Angie Taras: You can, yeah you definitely can. Or you can do one or the other, it just depends what the patient’s looking for. The fat transfer is actually … It’s beautiful, so I think it’s great for patients who don’t want to go really large with their implants. If someone tells me they’re an A cup and they want to be a DD and they want a really big implant in, they want a really big breast, then I say go for the implant. Because you’re probably not going to have enough fat for me to get you that increase in size just from doing the fat transfer.
But for someone who just wants to go up one or two cup sizes, I think the fat transfer is a beautiful option. Mr. Kalus … We do quite a bit at Avenue. He probably does the highest volume in Melbourne.
Trish: Fantastic. That’s so good to hear. I’m really glad that you’re working there with him, because I know that Dr Kalus is really excited to just be able to have that something else to offer-
Dr Angie Taras: Yeah, it’s wonderful. Yeah, it’s great.
Trish: Great. Well, I wanted to mention as well you’re also doing some injectables on a Saturday, is that right?
Dr Angie Taras: That’s right, yeah. I’m there on Saturdays and so if patients who are really busy during the week and just can’t get in after the workday, yeah it’s great to offer some hours on the weekends. I’ll be there on Saturdays doing injectables.
Trish: Thank you so much for taking the time to talk to us today, Angie.
Dr Angie Taras: Thank you.
Trish: No worries. Listeners if you’re out there and you’re wanting to see Dr Angie Taras, you can either drop us an email at firstname.lastname@example.org or you can visit them in Windsor, call 03 9521 1777.
Thank you for your time today.
Dr Angie Taras: Thank you.
Don’t forget, Angie also does injectables on a Saturday upstairs at Avenue Advanced Skin Care, phone 03 9521 5533.