For those of you who missed Dr Rubinstein’s popular FB Live session we’ve got the video and the transcript here for you – this is one for any woman either thinking of having or who already has breast implants.

Implants Background

Dr Rubinstein: Okay. Hello. Hi, Trish, how are you? And Tan, and Nadia. Okay. Tonight we’re going to talk about the Motiva implants, which I think are going to be excellent. Hello, Nadia. And I think implants have certainly come a long way since 1961 and 1962. So just a quick question, can everyone hear me speaking? Hello, Fiona. I’m just checking that we can hear. Can we hear? Good, all right. So I want to give a little bit of a background, if I may. The implants were first created in 1961, 1962 by Cronin and Gerow in America. And the original implants was quite a reasonable implant. But then what happened is, they tried to make an implant that was very, very soft and very, very natural. And the problem is, they made them so soft and so natural that they didn’t have any structural integrity, and they ruptured.

Implants Evolution

They had very liquid silicone that caused a lot of problems. So there’s been a lot of evolution, as you can imagine, in 50, 60 years or so. So when I started in private practise nearly 20 years ago, the state of the BI implant was a saline implant. You can see, this is a saline implant. And the problem with saline implants is that if you don’t put enough salt water in them, they collapse. If you put too much salt water in them, which everyone does, so they don’t collapse, you look like Tori Spelling. And a bigger problem than that is, because they’ve got no form stability, they stretch out the tissue, they stretch out the skin. So even though they may give a good short-term result, they give a very poor long-term result.

This was an implant that I removed from a patient, probably two or three weeks ago. I take out quite a few saline implants. I take out quite a lot of implants. My practise is obviously primary breast. That’s all it is, is breast and tummy. But I also do a lot of corrective surgery. So saline implants, I can’t see any … it’s an obsolete technology. And in the civilised world, almost nobody uses them, except the few people who maybe I could say, don’t know any better. But I don’t recommend them, so it’s not good. So then there was an evolution, and Allergan came up with some excellent products. And this was a Star 110, and it was actually a good implant. This was 15 years ago, this might even be considered state-of-the-art. But the problem with these implants is, because they were underfilled and because they had a coarse texturing, they would collapse. They cause rippling and creasing.

And that rippling and creasing not only gave a poor aesthetic result, but the other problem is, when they folded they had a point … sorry, I’m trying to show this. They have a point of weakness, which is a point of failure, and they rupture. So it was a good idea, but as with many things, it’s come and gone. There was a craze for a while of putting in anatomical implants, or teardrop implants. Now, the logic of a teardrop implant might be good, in that they might look more like a breast. But the problem with teardrop implants, or anatomical implants is, they could rotate. So they could go like that. That was a big problem. So this is an implant that I removed from a patient, at least I think it is. And the reason I took it out was because of rotation.

So firstly there’s rotation, which is a problem, and that can occur short-term, medium, or long-term. So I’m not saying these are bad implants, and I still use them very, very occasionally, but it’s not my preference. And the other point too, obviously, is most women want to have some fullness up top, not flatness. So this in my practise would be very, very rare, because I think it gives not a desirable result. It’s got a high rate of complications. And the problem to it is also, although I can’t demonstrate, they don’t feel very good. They’re quite rubbery. So I wouldn’t be recommending those, except in very exceptional circumstances. The next craze was polyurethane, and there was some logic to polyurethane, that they adhered, and they stayed in position.

So in some people these do have a role, but I was using these for a little while, I didn’t have a particularly good experience with them. There were a number that I had to take out and replace. And that was quite a while ago. So I think except for very exceptional circumstances, I would not be recommending them. And the other thing that’s been in the news for a while now is what’s called ALCL, or anaplastic large cell lymphoma. And there’s quite a high instance of this still rare cancer, but cancer nonetheless, in polyurethane, in textured implants. I don’t know if you can see them. That’s a polyurethane. I don’t recommend those. I haven’t used these for actually many, many years.

And actually the company I think is no longer producing them. I know their factory burned down. There are a few dubious things. So I wouldn’t recommend those. So really, the implants that I’ve been using to date have been METRO and Allergan. They’re still a superb product, there’s nothing wrong with them. This happens to be a [sizer 00:06:57], I think you can see that there. This is a MENTOR implant. They’re a good implant, and I literally put in thousands of them. It’s an excellent product, and I still use them. But I think there’s a product that offers some advantages. This is a Motiva. Now, Motiva are a relatively new company. When I say relatively, I believe the company has been around for 20 to 30 years. But in terms of implants I believe it’s coming up to 10 years now. And I’m not an early adopter of new technologies.

I’m not an early adopter of new technologies for quite a few reasons, but the least of it is, when a new product comes along it can have problems, which may not be recognised for a number of years. And that was the evidence with the PIP implants, which were a cheap French implant. And we never, ever, ever put in … I didn’t put in one, because actually I didn’t trust them. And it turns out they were putting industrial gel instead of proper medical gel. The director I believe has gone to jail. It was quite an unpleasant experience. But I never used them, and I didn’t because they were cheap, and that’s not the point of the exercise.

Motiva and Nano-Technology

And thank goodness we never used PIP, because a lot of those people who put PIPs in, then had to take them out. In fact, I took out a lot of PIPs. So Motiva, they have now been, according to the company, over 600 thousand put in around the world. I have just started using them, so I’ve only put in 40. But it’s only been a short period of time. And the advantages are, I believe, several. Firstly, they have a barrier inside, so the amount of gel leakage is minimised or prevented. That’s very important. Now, to their credit, MENTOR and Allergan also have similar technology. But I think Motiva does this very well. They’ve got a special coating on the outside, it’s a nanotechnology. And the aim is to minimise or decrease the risk of capsule. Capsule is where the body is doing what it’s supposed to do, is putting down scar tissue around the implant.

And that’s what every body will do when there’s an implant. A little bit is good, but what happens when the body overreacts, and it puts down too much scar tissue? Then their implants become hard, round, painful, and we need to do surgery or take them out. So Motiva implants don’t stop all capsule, but they claim an 80% reduction. Now, if we can have 80% less complication, that justifies it in itself. So that’s going to the company. What I personally like about the implant is, they’re extremely tough. You couldn’t break them, even … well, if you tried, you could. But they are really, really, really strong. They’re very, very tough. But the most important thing about them … or actually two more important things. Is one, they’ve got a very good gel. The gel in them is excellent.

Really, you can’t fracture it, it’s a mono-block. So the gel is bonded to the outside layer, as with the other implants, but probably more so. So to break or rupture them is extremely hard. And even if they do, the gel stays completely inside. It’s a terrific technology. I’ve got a broken one, so I’ll show you in a tick. But the thing that I really, really like about them probably more than anything is the way they feel. They just feel really nice. Now, again, feel is something that can’t be demonstrated over a telephone, but they feel very, very good. So I like them a lot. As I say, I’ve only put in 40, so it’s a relatively small number. So far, in a short period of time, it’s only been a month or two, I’ve had no issues, no problems. I’ve been extremely pleased with them. Again, when I recommend an implant, I don’t have any vested financial interest in those. I don’t get paid. I don’t have any commission.

Motiva’s Implant ID Tags

So the only reason I’d recommend an implant, is if I thought it conferred some advantages, which I believe these do. And so far, in a relatively short period of time, I’ve had what I believe are nice results. And that’s been in breast augmentation and mastopexy augmentations, which is a combination of lifting and implants. So I’ve been very, very pleased with them. They just feel nice, they look good. The patients who I’ve put them in so far, have been very, very pleased with them. Now, I’m gonna preempt, because there are some questions that I believe people are going to ask, so I’ll get on to them early. If you can see at the back of the implant is that tiny, little copper thing. That’s a little tag, and that has been put in there deliberately, because it’s an ID tag.

So with this device, which is provided to surgeons who use them, if I put it on, and I can hold it over the implant, it actually … I don’t know if you can see that well, but it comes up with a number. So the tag doesn’t have any data as such, it’s just got a number. So by putting this special device over that tag, it’ll come up with a number. And that number can then be correlated with a catalogue or an app, and that will tell you exactly what the implant is. Now, in my situation that’s not so important, because we’ve kept all of our data for over 20 years. It’s all backed up. It’s backed up, upon backup, upon backup. But if that data weren’t available, then you can find out what it is.

Now, that’s important, because I also do a lot of fix-up surgery from Thailand and Sydney, and Berwick, and places like that. Third-world countries, really. And often I can’t get the notes. It’s not available. The surgeon doesn’t keep them, lost them. They’re not available for whatever reason. So I can always find out what it is. And no, you can’t be tracked. No, it won’t go off through an airport. No, no one can tell where you’re at. So it’s got none of those things. It’s just a little number tag, which can be identified by that purple device. So that’s there. I think I have some specific questions. Do you lift and place implants at the same time? Actually that’s a very good question. That’s a very large part of my practise. Yes, I do. That’s called a mastopexy augmentation. Mastopexy means breast lift. Masto is breast and pexy is fix.

So mastopexy is breast lift. Augmentation is to make bigger. I will tell you, it is a technically difficult procedure, and there are many people who don’t do them. Because either they don’t know how to do them, they don’t want to do them, or they can’t do them. So if you do get it done, whoever you go to, you want to go to a person who does a lot of them. It’s not for the occasional player, it’s got a high rate of complications. It’s got to be done very carefully. And if you go to somebody who’s very, very experienced and very competent, you still have to accept that you might need further surgeries in the future. I do a lot of them, but there’s a lot you need to know before you even consider it. You want to be very motivated before you do so.

Positives and Negatives of performing a reduction, lift and augmentation in the same surgery

Now, there I’ve got some more questions. What are the negatives and positives of performing a reduction, lift and augmentation in the same surgery? The big advantage is to get two surgeries done at the same time. And for some people, they like to do that. In fact, most people like to do that. But the difficulty of doing the two at the same time is that we’re doing two opposite things. So as I tell all of my patients, it’s a silly example, but if I said to you, could you stand on a basketball, your first response would be, that’s a really strange question. But you’d say, maybe. But if I said, could you stand on a basketball on top of another basketball, that’s not twice as hard, it’s much harder.

So when I’m doing an implant, I’m making the breast bigger, heavier and wider, when I’m doing a lift, I’m making the breast smaller, lighter and higher. So it’s doing two things, they’re in opposite directions. But having said that, I have strategies to go around that. So I don’t talk too much, but essentially when I do the markings and measuring beforehand … and that can take half an hour. What I do is, I mark and measure as if I was gonna do an implant by itself, mark and measure as if I was gonna do the lift by itself. Then insert you when you’re asleep. Put the implants in. Sit you up, check them, adjust them, getting them perfect. Close it up, and then I recheck on my markings, and sometimes I have to redo the whole lot.

So it’s actually a fairly slow, careful procedure. But to be done properly, that’s the only way to do it. So although it has a re-operation rate, if you do the two separately, then the advantage is, you’re letting it settle. For example, you’re making the building, letting it settle, and putting the penthouse on later. But you’ve got a 100% re-operation rate. Whereas if you do the two together, there is a re-operation rate, but it’s not nearly 100%.

Are Motiva Implants available Australia-wide?

Janine has asked, are these available in Australia-wide? Yes, they are. Now, my understanding is, the company has assured they won’t provide them to cosmetic surgeons. So they’re only provided, if what they say is correct, to plastic surgeons. In other words, people who are being trained, who have an official qualification. I hope they maintain those standards.

I know that they are slowly taking off, but there are a number of very, very good surgeons who are quite enthusiastic about them. I recently went to Singapore, and I caught up with a surgeon over there who I think has done several thousands. And he raves about them. In fact, that’s all he does. He doesn’t do anything else. I can put in any implant you want. I have no vested interest. I can do saline, I’ll do whatever you want. But obviously I’ll guide you, because what I want you to do is to get the best result. And if there’s one that won’t give you a good result, then I won’t do it. So it’s easy.

Adelaide, Janine, if I was in Adelaide, I’d come to Melbourne. Actually I did my training in Adelaide, I’d come to Melbourne. But I just love Melbourne. There are probably some good surgeons in Adelaide too. I don’t know. Maybe some from Melbourne’s gone there. “I’ve had surgery this year, and it’s life-changing. Craig is there for the whole journey. Just book and have a chat.” Oh, that’s not a question. Thanks, Tan. But you’re boss. But I will take the compliment. Thank you. Do you do video consultation? Sarah, it’s a good question. I really don’t. I’m probably not the world’s greatest person on video.

I think I’m probably better in surgery. So I generally don’t. If you want to give me a ring, I could have a talk to you. But really, I’m a 3D sort of person. I like to talk to a person face-to-face. Because for a consultation, my first consultation is 45 minutes. I do a lot of measurements, checking, calculating. There’s a lot, a lot of things we need to go through. And this small point too. For the first consultation it’s normal … we don’t actually even charge for further consultations. You can come as often as you want to, whenever you want to. Because what I tell everybody, and I’m a bit of a cracked record, is, big mistakes are made in a big hurry. Best time to get things right is the first time. Best way to get things right the first time is the right person having the right surgery at the right time for the right reason. So it’s a bit laborious, but come to Melbourne. It’s pretty good. We make good coffee.

Are implants safe for someone with lupus?

Sarah, are implants safe for someone with lupus? The answer is, I don’t believe there has ever been any association with implants with any systemic disorders. Which in plain English means, I don’t believe it causes any of those things. And when you think about it, implants are probably the most studied product on the planet, or one of them. They are all silicone. And every time you put on lipstick, you’re getting a mouthful of silicone, or some silicone. Every time you have a blood test, silicone. So the answer is, to the best of my knowledge, it should have no effect on lupus. And I have looked after some patients with lupus, and other considerations.

So I can’t answer that 100% emphatically, but I’m not aware of any contraindications. How long is the first consultation for a lift with you, and do you do them on certain days of the week? My first consultation is 45 minutes. In fact, all my consultations are 45 minutes. And I just wish there are about 100 hours in a day, because it’s not enough time. But if we don’t cover everything, we’ll get you back. Also, that’s 45 minutes with me. But you also talk to the nurses. We have Vectra, we have photographs, we have simulators, we have sizes. There’s a lot, a lot of things to go in, to doing it properly.

Cost of implants

What else do we got? What do you think about these companies that charge $6 thousand for implants? Are they safe? It’s sort of hard to know, really, because our base costs … like, the actual, actual cost that we have , but we use an absolutely top quality hospital. We use the absolute best implants, which I think currently are probably Motiva. I still like MENTOR. I’m not gonna criticise MENTOR. But the implants are $2 thousand. We use a proper anaesthetist. We have proper surgeons. Well, that’s me. I’m one of five other surgeons.

So I don’t know, but I think it’s like negotiating to get the cheapest engagement ring, or the cheapest … I think, two, five, ten years down the track, when those people have disappeared as they tend to, you’ve got a problem. Now, I’ve had people who’ve I looked after 15 years ago. They’re only done on Friday, I saw them on Monday, they’re fine. And I think going to Thailand or Sydney or places like that, I got to be a little careful saying this, but I think we’re not really keen to see those people anymore. Because if the only thing that you’re worried about is price … and I know we live in the real world, so I fully understand that. But if the only thing you want is price, then maybe we’re not the surgeons to look after you. We do things properly.

If I travelled to Melbourne for my surgery, how long a stay would it be?

If I came to Melbourne, how long a stay would it be? I’m post-gastric bypass, so I’m needing a big one. Jenny, it really depends on what you want to do. I’m a huge fan of not rushing things. And the thing is, people ask, when can I fly? There’s actually no reason you couldn’t fly the next day. I’ve looked after a lot of air hostesses, and they’re all back at work within a week or two, and they’re lifting bags and opening doors. So the flying itself is not an issue.

But if there’s a problem, I need to be able to look after you. So I really like you to be around for a little while. If you can stay around for a week, because we do all the dressings, we actually provide laser, we provide, everything, it’s all included. Because we do have people flying from interstate and overseas, and so on. So usually for about a week. But you need to, if necessary, come back. Now, that’s not very likely. With social media you can send photographs and Facebook, and things like that. Something I personally still struggle with.

Will flying after a breast augmentation surgery rupture my implant?

… asked me the same question, can you fly after surgery? Again, the pressure differential on an aeroplane is not zero, but it’s minimal. It’s enough to make the food taste terrible, but when people say, flying, could I rupture my implant? The answer is, not even close. Now, if the pressure was that much, your ear drums would have gone first. So flying is not an issue. It’s just, if you go away on some romantic holiday, and you need to see me, it’d be tricky. But worst case, you can always come back. Looking at a lift reduction and implant. Is that even possible to have these three? Well, keep in mind too, all reductions are a lift as well. It’s not like they are separate topics.

And the reason is, when I do a reduction, all excessively big breasts … or all big breasts, I should say, are all gonna droop with time. So they all get a lift. And a lift is almost as important as a reduction. And what I think of as a male, if I had a backpack with the straps too long it would pull me back. So what I do is, I pull the straps in. And women do exactly the same thing with their bras, they pull their bras in tight. This is for reduction. But what they do is, they swap the problem here, and they get the neck and the shoulder pain.

And I sometimes even inject a little bit of fat into them to fill them out. So a lift reduction, implant, that would be not an uncommon procedure. So the answer is potentially yes. How long does it take for a first consult to having it done? It really depends on what you’re going to have done. But I like to slow people down a little bit. I always say, big mistakes are made in a big hurry. Best time to get things right is the first time. I think there are now guidelines that it has to be at least a week. We never do it surgery within … It does take time. You need to be well informed, not rushed, not pressured. Take your time. So even though it takes a little bit of extra time, rushing I find stressful. I like to slow things down, get it right.

Because remember, you’re gonna potentially have those for the next 5, 10, 20, 30, 40, or more, years. And you’re gonna have the benefits, hopefully, of surgery for the rest of your life. So it just takes a little bit of time. I know I didn’t answer your question, but it depends on a number of factors. But in terms of how quickly you can get surgery, my first answer is, it’s not a matter of quick, it’s getting it right. But it’s a little bit of time. If you actually ring my rooms, they can tell you. Because my team, they run my life, which is actually true. Travelling from Mackay, how long is the stay in Melbourne post-lift? Again, Michelle, probably if you could stay around for a week, that’ll be great. Longer is better, shorter is okay. I mean, you could actually fly back the next day. But as long as you understood that if there were to be a problem, you’d come back. Again, if you’re overseas, I can’t look after you. And the whole reason why you want to come here is, we look after people.

Which implants are better, silicone or saline, and what is the difference?

“Which implants are better, silicone or saline, and what is the difference?” I went through this briefly before. But again, saline, this is a saline implant. It’s full of salt water. It still got a silicone shill. Don’t put enough salt water, they collapse. Too much, which everyone does so they don’t collapse, you look like Tori Spelling. You get ripples and creasing. I took this out of someone. I don’t know, it’s a few weeks ago, I think, or whatever. They’ve got no form stability, so they stretch the tissue out. When you look at the people who are good, who do a lot of implants, almost nobody does saline implants. Almost nobody. And in Melbourne there are only two people who do them.

And I’m not gonna comment on my colleagues, but I haven’t put a saline implant in for many, many years. It’s compromised. There’s no reason to do it. It’s an obsolete technology, which gives a bad result. I don’t see any advantages. Amanda, Caesar said I’m great. Thank you. I hope so. That’s something to live up to. You can make that decision. Price range, I can’t go through that, because actually it just depends on what you’re having done. And price is not just a matter of how much is it? There’s a whole lot of things, what’s included, what’s not included? It has to include the anaesthetist, the implants, stay. There’s a lot, a lot of things. But if you ring my rooms, they can give you a pretty fair idea. So no secrets, but it’s involved answered. So saying like, ring up a real estate agent and saying, how much is a house, or how much is a car? Comparable to that. So it really, really varies. Sarah, do you want to come to Melbourne?

Look, why would you not come to Melbourne? Greatest city in the world, greatest place anywhere. Great coffee, got the MCG. We’ve got everything. And I guess, me as well. Actually I did my training in Adelaide, and I had a really good time. I enjoyed it. But I like Melbourne, and if it was me I’d come to Melbourne. Well, I guess I did come to Melbourne, so I’m praising the pudding. Basic BI price, please? Reneé, again I’m a little bit hesitant to say, but it’s somewhere between 10 and 15 thousand. We don’t compete on price. My price is around about, I think it’s just under 15. But there’s a lot that’s involved in that. We basically back up our work. We guarantee it, all future visits. If there’s a problem we fix it. And that includes bras, laser, actually everything you need.

So there are certainly people who are cheaper, but I’ve decided I’m not gonna compete with them, because I think there are more important things. And we look after people, we do the right thing by people, and that can’t be done cheaply. Not if you want it done properly. What is it? You can have it quick, proper, or fast, cheap or proper. But you can’t have all three. I know that. I really seek surgeon, glad to know you aren’t in a hurry to operate on people. Big, I hope that is true, that’s not what I did medicine for. I think my experience is, if you’re pretty straight down the line, tell people as it should be … And I had someone who … the reason why I’m a little bit late is, I saw someone who I saw, who happened to be a friend of a friend. I mean, two-thirds of people are actually word-to-mouth referral.

And I told her I didn’t think surgery be for her, because I didn’t think she would get the result that she wanted. Some of my biggest supporters, I guess, in some ways, are people I said, I don’t know that surgery is for you. Surgery is not for everybody. But if you get honest, correct, truthful advice, you can decide if it’s for you, or not. So it varies from person to person. I’m trying to read these questions as well. But I love what I do. I have enough to do. The other thing is, if anyone knows any good surgeons out there, we’re actually desperate for more surgeons. But we only choose people who are quality, who’ve got ethics and honesty. There’s a lot to becoming a surgeon, it’s not just technical excellence. I mean, that goes without saying, although it’s not for granted.

But it’s looking after you, it’s giving the right advice. It’s doing the right thing. The before and after surgery is as important as the surgery. It’s something I’ve always wanted, and need, but could never afford. I guess that is an issue. If it’s important enough, but it may not be the right time for you. Remember, if it’s not the right time, it’s not the right surgery. Janine, “Can I be cheeky and ask if you know Dr Phil Gryphon? I’m meeting him for the first time tomorrow in Adelaide.” I know Phil well. When I was a trainee in Adelaide he was my senior. He gave me a really, really bloody hard time. But I’ll tell you what, he’s a good surgeon. He’s ethical, he’s decent. I actually like Phil.

So if I’m missing on work, because you’re going to Phil, then you are in safe and you are in good hands. Anyhow, you need to see his work. I don’t know how many he does. But as a quality person, Phil is very careful. And if that’s his interest … and I don’t know, because I haven’t spoken to him for a while, but he’s one of my colleagues who I have a lot of respect for. So, no issue. Although he did give me a hard time. So when you go and see him, say, Craig said you gave him a hard time. But maybe I’m a better surgeon for it.

“I have sensitive skin, I don’t think my body likes artificial things. Can I get a lift if I don’t have a lot of tissue, and still have shape? I just have saggy breasts after losing weight.” I will always try and avoid an implant, if I can. An implant is only if you need it. What a lift will do, it’ll give you a result as if you were wearing a bra. No more, no less. So if you like the look of your breasts in a bra, it’ll achieve that. So when I do a lift, think of an apple pie. We take a wedge at the bottom of the apple pie, put the nipple in the middle of the apple pie, and then close the apple pie. It’s a lot more than that. That’s the LaJour, the lollipop technique, which is what I do. Now, it’s the same apple pie, so you’re not gonna have fullness, you’re not gonna have firmness, you’re not gonna have size. That is only gonna happen with an implant. But doing implant and lift together, it really depends on what you need. And keep in mind too, the result you get always depends on three factors. What you have to start with, what’s added, and how the adding is done. So if you got plenty of breast, a lift reduction, or just a lift, might be appropriate. If there’s absolutely nothing there, it may not be appropriate. It really, really depends.

What made me want to do plastic surgery? Well, I always wanted to do medicine, because I just did. There was nothing more on the planet I wanted to do than medicine. I guess, having a medical family has probably to do with it. But I think it’s just, the just comes. And my father was an anaesthetist. We used to work together, but that’s a separate story. It was pretty acrimonious. As in, he thought he was the boss, and I knew I was the boss. We’re both pretty strong people. And really, plastic surgery was just the best. The thing with plastic surgery, you can make things better. And I love surgery. With surgery, general surgery, you can cut out cancers, and they’re critical, and I used to do lots of those things too.

But plastic surgery can take something, you can make it even better than before. Plastic surgery is … I know plastic surgeons are not meant to say this, but it’s cool. It’s the best. It’s great. I wouldn’t do anything else. Do you do side flanks and neck lifts? No, I don’t, Belinda. I went to America, and I did a year of them with one of the best in the world. But when I came back, there was Bryan Mendelson, who is still probably one of the best in the world. We’ve now got Mr [Minami 00:29:38], who is absolutely superb. There are some really good people. You can’t specialise in everything, so even back then I thought, why should I do a few facelifts, when he does hundreds? So I do just breast and tummy, nothing else. And it’s a bit of a compliment. He actually sends breasts to me, and he’s looked after a number of my patients for faces.

He’s very, very, very good. But, no, I don’t do that. I only do breasts and tummies. That’s enough. “Awesome, thank you for being honest with me. If I’m not happy with him, I’m going to travel to you.” Janine, I think you’d be in good hands either way. I think you should come and see me. But honestly, Phil is good. And there is something to be said for seeing a local surgeon if you have a problem. Phil is a good guy. He’s a good surgeon. He’ll be careful. Just take it [solid 00:30:18]. “Do you do fat transfer to add a bit of shape?” The answer is, it’s a [longish 00:30:22] answer, but essentially not very often, as in almost never. And the reason is, adding fat certainly does have a role, but it’s not without risks and complications. It’s something, I’m a very conservative surgeon. Now, 20 years ago, when I heard about fat crafting, I thought, yes, I’m gonna learn it, and sort of be king of the mountain. But there were some issues.

In fact, our insurance company initially said we weren’t allowed to do it, because of the risk of maybe causing cancer, or mucking up mammograms. You think it wouldn’t, but it’s now been proven that it doesn’t. So I think fat does have a role. I am doing it very occasionally, as I’ve probably only done very few, probably less than … I’ve only done a few, so not many. I’m certainly not an expert on it. I think it does have a role in certain circumstances. But again, I’m still just waiting a little bit. I’m being a little bit slow on that one.

So it probably is a good thing, and I probably should be doing a bit more, but I guess I’ve got enough other work, at this point. But I think it has a role. I haven’t quite worked out what it is yet. Okay. Sarah? Sarah, as in …? I’m not quite sure what that means. But, okay. Maybe explain. Shawn, “I’ve had two kids, and looking getting BI done at the end of the year. I’m not sure whether I need a lift as well or not. Obviously surgery, tell me.” There are some guidelines as to when you need a lift. Now the first thing is, you don’t actually need anything. It’s just, if your breasts are droopy, and you put an implant behind the droopy breast, then the breast will droop over the front, giving an appearance like a Snoopy. Whereas if you’re trying to lower the implant, so it sits behind the nipple, which is where it should be, you can get what’s called a double bubble.

So you get the outline of the breast, you get the outline of the implant. It looks terrible. It’s almost unfixable. So as a rough rule of thumb and guideline, if the nipple is below the level of the crease, if you can put two pencils or two fingers behind your breast, or when you put your hands on your head, if the crease still is quite strong, then you’re not likely to get a good result. What some people do is, they put a huge implant in front of the muscle. Now, that looks good in the short term, but if you fill a plastic bag with a bowling ball, it might look good in the short term, but not in the long term.

Because keep in mind, the reason a breast is drooping, is because gravity is greater than the strength of the breast holding itself up. And when you think about it, gravity is always going to win. You put a huge implant in, and that’s what a lot of these $6 thousand places do perhaps, and then they look great, and they go on Facebook. And they look amazed, look amazed. Then they come here and we have to take them out, making them smaller and do a lift. So I think that answered that question. Is there a government subsidy for people who’ve lost over 50 kilogrammes? Someone mentioned it, if not sure. It’s a bit of a long one in the answer. I don’t know, but probably no. There is Medicare and private insurance, but they’re all changing and they’re in flux.

So I don’t know of a subsidy per se, although it probably wouldn’t be a bad idea. So I don’t know if there’s a subsidy, and it just depends on whether Medicare and/or your insurance will cover it. And that needs to be, every single person is different. I mean, 20 years ago in America they used to knock people back just routinely. Now in Australia, that’s coming, which is a pity. So Jacky, I haven’t really answered your question. You ring my rooms, and talk to one of my team here. They can probably give you a bit of a better idea. You sound very passionate about your job. I don’t know how passionate I am, I just had a whole day of first consults. I only saw 11 people. So I’m a bit exhausted. But it’s a good day, and I’m lucky to do what I do. “I’ve lost 80 kilos from gastric surgery. I have four children in four years. I certainly consider going to you for breast infusions 00:33:53]. I’m from Wagga Wagga.”

Janine, I think you’ve done the hard work. I mean, losing the 80 kilos, the hard stuff. I do the surgery. But there’d be certainly a number of challenges. I’m gonna come a bit closer, because I can’t read it. There’d be a number of challenges, but you need good information. Whoever you go to, you wouldn’t want to go to someone who was an occasional player. That’s quite a biggie. And four kids. Good. Just wait until they’re teenagers, you wonder why you ever did it. But that’s a separate topic. Oh, Sarah Jones. Oh, that’ll make sense.

Renee, what days do you consult? I say jokingly, but it’s true, the team here tell me what to do. I just do what I’m told. It varies. I consult when I’m not operating, obviously. So I have three kinds of days. One, when I’m operating, they’re my favourite days. But I have … I think it’s my wife saying what time I’m gonna be home. Probably late will be the answer, for a change. So it varies. It’s variable days during the week. It’s during the week. I don’t consult … occasionally I operate one-in-four, but actually I do need my weekends. I get a bit tired as well. But if you ring up, that can be organised. From Shaun, thank you for answering my question. I was a little confused however. You said that if there is too much that not much can be done, even with …? No, no. Not at all. No. Sorry, I didn’t qualify that.

I find it easier drawing a piece of paper, I can’t do that now. No, a lift will tighten the skin and elevate everything. So I didn’t understand it. So a lift will lift … a lift will by [inaudible 00:35:19] giving an appearance similar to a bra. So put a bra on, if that’s what you like, that’s what it will achieve. If you want fullness, firmness or size, you need to put an implant in. And when I say need, you don’t need to do anything. But the only way to achieve that, is with an implant. There’s a lot of information before you need to do that. I used to take four consults to do it, now I do one or two. But there’s a lot of information. So it’s not just a simple yes/no answer. Purse string gluteoplasty, what’s your thoughts on that procedure?

Gluteo sounds like the bottom, which is not anywhere where I go. Purse string, I think I saw something like that at one of the seminars. I’d be a little bit cautious about that, if that’s what we’re talking about. I don’t do body lifts. I do a lot, a lot, a lot of tummies. But I think a body lift, for a select person is an appropriate procedure. There are some people in Melbourne who do body lifts on everybody. It’s a lot of scarring. It’s a lot of time. It’s got a lot of complications. And if you’re gonna be on the table for four, six, eight, or more, hours, the risks are very high. I never operate for more than four hours on a single patient, because I actually get a bit tired. And four hours is enough.

And body lifts can take six or eight hours. And gluteoplasty, I try not to give answers on things I don’t know a fair bit about, so I can’t really answer. But it doesn’t sound like something I’d be very excited by. So I’m sorry, man, I’m not very helpful on that one. And Sarah Jones, if I do tummy tucks, arms and legs. Tummy tucks, absolutely, because tummies and breasts are complimentary. A smaller tummy can emphasise a breast. A nice breast can de-emphasize a tummy. So, yes. Arms and legs I don’t do. And basically because I used to hate doing them. It’s a lot of surgery. Not that that’s a big deal, I do a lot of surgery. I did 12 hours yesterday. But arms, I just didn’t get great results. There’s a lot of scarring. There’s [inaudible 00:37:02]. The people I did I think got good results, I hope. But arms and legs, it’s not my passion. It’s not my enthusiasm. It’s not what I do. I can’t specialise in everything. We have a group here at Cosmetic Surgery for Women, of six surgeons.

We have an absolute dedicated eyelid specialist. All he does is eyelids. We have body surgeons. We have specialists for everything, but arms and legs is not me, unfortunately. [inaudible 00:37:28] implants, where is the best place for the incision? All I can do is talk on my experience, but I have used every approach, except the belly button, which I think is a silly way. I’ve never done it, and I don’t know anyone sensible who does. I go exclusively in the little crease beneath the breast. That’s called the [infomemory 00:37:43] crease.

I used to go exclusively through the nipple, and that was a good approach, but it’s very hard to go through the nipple beneath the muscle. Although, that’s the way I used to do it. But it’s not necessary. The problem going through the nipple is, you can get a bad scar around the nipple. You probably increase the risk of losing nipple sensitivity. Probably increase the risk of losing the ability to breastfeed. Probably increase the risk of infection, probably increase the risk of capsule. And there’s no need to do it. The incision, because I used a Keller funnel on everybody, without exception. It’s a special funnel, which I have got but I can’t get now. So I use a Keller funnel.

So my incision size is about three centimetres. Sometimes it’s two, two and a half, three centimetres. So it’s a small incision. It’s in the crease. It fades nicely. It’s not a problem. And as I love to tell patients, when you’re 90, your breast is down to your belly button, you won’t see that scar anyway. Sorry, that’s my attempt of humour, it’s getting late. I don’t go through the armpit, because it’s really hard to get it right, it’s easy to get it wrong. If you get a bad scar under the arm, which is not likely but possible, every time you lift your arms up, people go, oh, what’s that? It probably has an increased risk of capsule. It probably has an increased risk of infection.

And I see a fair number of people that were through the armpit, and it had to get revised. So even the person who I do know, who does quite a bit through the armpit, I’ve had to fix up quite a number of his. I’m not saying it’s a bad procedure. I did a few, and I never really liked it. I got all stressed by it. So I don’t. I used to offer things … I don’t offer things if they’re not good anymore, because I don’t see the point, really. Shawn, no worries. From Nitty, “I’ve had an apronectomy, and lost my belly button.” Well, you shouldn’t have. “Now I’m thinking about getting it reviewed, and a breast lift as well.” I actually very, very occasionally make belly buttons. Because in the past general surgeons used to do abdominal plastic and tummy tucks. And when I learned how to do them, they all fell to bits. That was a general surgeon, I thought that was normal, until I saw plastic surgeons do them, and that is not the way. So I’ve actually completely made belly buttons out of little skin grafts and things.

I’m not a belly button making expert, but I have done a few. And so far they’ve done okay. But a belly without a belly button looks really strange. So we always try and do a nice belly button. Women actually often ask me, will it be an innie or an outie? Well, never in the history of mankind is anyone an outie. They’re always innies. I try to do a little smiley face, so they look nice. I mean, a nice belly button can look good. Sarah Jones, you’re amazing. Thank you so much. Sarah, you’re a very perceptive person. I completely agree, so thank you. That was also an attempt to humour, but that’s a nice thing anyway. Philomena, thank you. Any other questions? I’m sort of warming up now. A bit tired, but it’s all looking good. From Beck, no worries.

And Nitty, look, I hope that was helpful for you. There’s a lot of information. With all these things, I can talk about them for hours. In fact, I do talk about them for hours. But really, the best way to do it, at the risk of being sort of [mercenaries 00:40:26], is to come and see someone, someone like me, or hopefully even me. Because face-to-face, so I can actually give you some specific advice, because general advice … And that’s also the thing about forums, you’ve got to be a little bit careful, because these days everybody is a world expert, and everyone gives an opinion.

And some of those opinions are good, but if you’re gonna get it done, go to somebody who knows what they’re talking about, who gives you a straight answer. And they can give you the answer for you. From Carla Tomasson, where are you located? We’re in Hawthorn, that’s in Melbourne. I might have mentioned, that’s the best city in the world. I think it’s true. Although, yeah, there are some other ones that aren’t too bad. I mean, Queensland is getting a lot better now that Melbourne people are going there. I mean, 759 Burwood Rd. it’s Hawtorn, but you can look up Cosmetic Surgery for Women, or plasticsurgeons.com.au. CSFW I think we are, dot com, dot au. Pasticsurgeons.com.au. Melbourne, Crystal [Barrens 00:41:18], yeah, Melbourne. Melbourne, and Crystal Barrens says thanks here. Yeah. So if you just Google us, or give us a ring, because we’ve got a really, really good team, and they answer questions probably better than me.

Sarah Jones, go to Mighty Hawks. Now Sarah, you were rising high for a while. Not that I’m all that [inaudible 00:41:36], but I used to have a number four for Royce Hart. Tigers, they’d be variable, but there we go. Hawks, yeah, they be probably … I don’t know. Do the implants need to be changed over time? That’s a good question. And I tend to answer questions [inaudible 00:41:50], I think is the word. What I say is, nothing lasts forever. And I say it facetiously, implants, replaced. Although, just 29 years, it does seem like 30. So nothing is forever, but if you use a top quality implant, and you have a good surgeon who’s gentle and knows what they’re doing, they should last, I say, a minimum of 10 years.

But they really should last a lot longer than that. So when an implant is ruptured early, people blame all sorts of things. It’s probably a technical error when they’re put in. I’ve actually seen a surgeon who actually put a needle through one. At least, to his credit, he’s acknowledged it, and he replaced it. But I don’t think I’ve ever … well, I’ve never done that. So really, implants, they should last a minimum of 10 years, and with the Motiva implants … look, MENTOR are good a implant. I’m not in any way dismissing them. I’m really enjoying using Motiva, but I still use MENTOR. And Allergan too provided a superb product, so we’re not to dismiss those. But the Motivas I’ve had, let’s say … we’ll not say a minimum of 10 years.

I’ll actually say, hopefully a lot, lot longer. Crystal, you’re in Adelaide. Well, I did my training in Adelaide, and I used to drive to Melbourne. If you really want a seriously good coffee or a lemon [reign 00:42:57] pie, it’s probably still worth it. So for something that important, I’d still come to Melbourne. I still say, go to the Hawks, I live in Brisbane. Sarah, we do need to talk. We do need to talk. I think that’s everything. Are there any more questions? What do I do for that? Do I push that? How do I do that? Sorry, I’m clearly … what do I have to press? Ah, there we go. Yeah. There we go. I’m not very familiar with this, because I tend to spend my time .

Trish Hammond: Hey. Thank you so much for coming on tonight. Has everyone’s questions been answered?

Dr Rubinstein: I hope so. I think so. All of these questions, they’re generic questions. What you really need is, you need personal questions for you. So if you want to do that, you’d be welcome. How is Trish doing, anyway?

Trish Hammond: Yeah, I’m doing really great. Look, I just want to say to you, on behalf of everyone in the group, a real big thank you, because I know that you’re really, really busy, doing operating. Thank you so much for taking the time out to talk to us. It’s been really helpful.

Dr Rubinstein: Is that the kind of information that you’re … is that helpful?

Trish Hammond: Yeah. Oh, absolutely. For all you ladies out there, if you want to find out a bit more about Craig, you can ring his offices. And I found that … because I’ve had surgery with Craig myself. I had my tummy tuck revision done with him a couple of years ago. And he’s got a patient advisor on the phone, so they can answer all the questions that you’ve got as well. And as he said, he just does tummies and boobs, so you know you’re getting someone who is passionate about it. So I want to say thanks from all of us.

Dr Rubinstein: Trish, can I talk a little bit about you? Because you were actually gonna have surgery by a non-specialized plastic surgeon, weren’t you?

Trish Hammond: I was. I was actually booked in to have surgery in Adelaide. And then I met you, and I was like, no, can’t. I’ve got to go and see Craig.

Dr Rubinstein: Well, I sort of locked the door so you couldn’t leave. But the surgeon who was gonna look after you, I know him. And he’s a very good surgeon, but that’s not what he does. I think it’s fair to say, what he would have done would not have been the right operation for you. Whereas we completely modified, and I think we did achieve what we wanted to, didn’t we?

Trish Hammond: Well, I told you what I wanted, or what I thought, this is what I needed. And you actually told me what needed to be done for me to get what I wanted, which was entirely different to what I thought.

Dr Rubinstein: And look, it’s not that there is right and wrong. There are thousand different ways of doing things. But I guess, in the end we just carefully worked out what you wanted, and addressed it slightly differently. So I think, when you go to a surgeon who does literally 500 cases a year, or he’s been doing it for 20 years, it’s not that he never sees new things. But with experience you can say, well, actually you could do that, but have you considered so and so? I think that’s right. I think, really, we live in a world where it’s not for the occasional player. And if you go to a surgeon who does this occasionally, you could still get a good result. But you can go to people who, that’s all they do. Every operating day of my life. I’m operating this Saturday. We’re doing … what is it we’re doing? Two breast reductions, two abdominal plastic. A pretty long day. So I have days of reductions, days of augmentations, days of [inaudible 00:46:41]. Whatever it happens to be, I like [two 00:46:43] days of things. Now, Token Token, what’s wrong with Adelaide?

Trish Hammond: Nothing. Yeah.

Dr Rubinstein: I think Adelaide is a nice place to visit. So there’s nothing wrong with Adelaide. I think if you’ve seen everywhere else in Australia, it’s probably not … no, I’m joking. I spent three years in Adelaide. In fact, our second son was born in Adelaide. That’s [Olly 00:47:04], the [wall 00:47:04] child. I actually like Adelaide, so I was being a little bit tongue in cheek. Adelaide is beautiful. There are a lot of good things about Adelaide. I just like Melbourne, because I live in Melbourne. But there’s nothing wrong with Adelaide. And I guess we’ve got enough Melbourne people there to sense some civilization anyway. No, I’m joking. There’s nothing wrong with Adelaide.

Any place in Australia is bigger than any place else in the world, so we’re very, very lucky. Crystal, good will, I’ll make you a coffee. But if you’re lucky I might make you one anyway.

Trish Hammond: And Craig, do you mind, the last time you were on, you were actually … you stayed on for a few days afterwards to answer some questions. Do you mind doing that again this time?

Dr Rubinstein: Now, totally. Yes. You mean, right now?

Trish Hammond: Oh, no, no.

Dr Rubinstein: Or later?

Trish Hammond: I mean, the next couple of days. If you kind of stick your head in the group, and see if there’s any questions, and feel free to ask them, because I think they might [love 00:47:49] that.

Dr Rubinstein: Yeah. I’m totally happy to do that. As long as I’m not treading on anyone’s toes, or anything. No, I really enjoy doing that, because as I’ve said, people with good intentions give advice, but unless they actually know what they’re doing, the advice might not be the best advice. I’m not saying mine is the best advice, but it is based on what I do. If you agree, I think that was really helpful for some, at least the [inaudible 00:48:11] was.

Speaker 1: Yeah, the ladies loved it.

Dr Rubinstein: Oh, Token, I didn’t realise. Sorry, darling. I didn’t realise. Cool. All right. No, there’s nothing wrong with Adelaide. I mean, as I say, if you had no one else to visit on the world, I think Adelaide probably be up there. It’ll be fine. And there are things you actually can … you can get reasonable coffee on [Hanley 00:48:31] St. Is that enough? I don’t know. I’m operating tomorrow, so I’ll better get home to my good wife. Dinner will be cold. Actually I didn’t know what to do with it. So hopefully that was helpful. Beck says, you’re interested. Beck, if you want information, just give us a call or whatever you want to do. I think we’ve covered everything, so I better get home. Trish, thanks for organising this. I’d love to do some answers. If anyone is to send us a text, or whatever it is, then I’ll do what I can.

Trish Hammond: Thanks, Craig. And you’re also on again on the 3rd of July. I don’t know if you know that. But you’re on, on the 3rd of July.

Dr Rubinstein: I’m sure Rachel, who’s nodding her head, will organise everything. I’ve got no idea. They will put it in front of me, and I will do it. Bye, Trish.

Trish Hammond: Thanks, Craig.

Dr Rubinstein: Nice to see you.

Trish Hammond: See you later. Bye.

Dr Rubinstein: All right. See you. Bye.

Trish

Trish is a plastic surgery blogger. She is passionate about wellbeing, health and beauty, and doesn't mind a little bit of 'help' from the amazing cosmetic and beauty procedures that are available today. Trish spends her days talking to women and men who are looking for suggestions and advice on procedures that are available to them. Cutting through the sales pitch and hype, a down-to-earth response on general information is what you will get.

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