Dr Mark Vucak from Queensland Plastic Surgery – why his patients are his most important concern :)

Trish Hammond: Hey, podcasters. I’m really excited today, I’m talking with Dr. Mark Vucak from Queensland, who’s a specialist plastic and reconstructive surgeon. Dr. Vucak is based in Townsville, and he services Townsville, Rockhampton, Mackay and Cairns. Today, we’re gonna just be talking about the procedures that he does, and why he does what he does, and kind of what got him started as well. So, welcome Dr. Vucak.

Dr Mark Vucak: Thanks again.

Trish Hammond: Thanks so much for taking the time to talk to me today.

Dr Mark Vucak: My pleasure, thanks Trish. I think, today we really wanna talk about why we’re here, the directions we’ve taken so far, and what we like doing, and where we want to go. We’ve had a massive practise over a long period of time. I think one of the things that’s interesting when you’re talking to somebody about their job and their life and their interests, is really drilling down to find what’s important to them, and how they came to be in that situation. When I was just a kid, my mom used to work in hospital in New Guinea. I first was interested in medicine probably by her. She was a secretary then, and I used to ride my bike around. I’ll never forget the smell of the hospital, and that was one of my first experiences in medicine. It’s interesting to reflect on how things come to be.

Trish Hammond: Oh, totally. And you’ve been doing plastic surgery for 26 years, is that right?

Dr Mark Vucak: Yeah, I finished in 1990. And then, plastics was a pretty … In my day, because it’s been going for a long time now, plastics was a complicated business because, generally, we’d get on surgery first, and so we’re pretty experienced surgeons, and then we did plastics, and then in the 90s, everybody went overseas to train. So, I went to train in Atlanta in Georgia at Emory.

These days you can just get straight out of Uni training and just go starting practise. So, the surgeons who are in their 40s and 50s, generally, in my experience, have had a broader experience to train because we have general surgery. We were general surgeons first by and large, and then we’ve done the plastics fellowship, and then we’ve gone on to do postgraduate plastics training overseas. And so, we understand how people in Europe operate and people in the US, and we have a lot of friends there, and when the people are interested in your procedures, I think, guys, surgeons in their 40s and 50’s are probably a little bit more on top of it than the guys who are coming up these days in their training.

Trish Hammond: So, am I right, you’ve had over 40,000 patients that you’ve operated on or treated?

Dr Mark Vucak: Yes. In our last patient, I think we just ticked over 48,600 patients that I’ve treated. Naturally, we’ve seen a lot of people, and we’ve done a lot of operations. For example, now I’ve put in 10,000 breast implants, and there’s only a select group of guys who’ve done that in Australia. And I’ve done 800 tummy tucks and 800 breast reductions and hundreds of rhinoplasties and facelifts.

Trish Hammond: Wow.

Dr Mark Vucak: That 48,000 people is a lot of people. That’s by Ian and myself. And so Ian, Dr. Tassan in our practise, focuses more on skin cancer reconstruction, and I tend to do more the aesthetic stuff.

Trish Hammond: Mm-hmm (affirmative). So, basically, your specialty is the aesthetic procedures?

Dr Mark Vucak: Yeah, I just do aesthetic procedures. When I first came to … training first, and after I came up from Atlanta, I came to North Queensland, and we’re snowed under, straight away. Good thing you have your training, you get overseas training, but then you get a lot of experience because you have to do a whole host of different operations, and so you become pretty versatile.

We started a practise in Cairns, and then I was in working in Mackay as well, so as I established practises I got other people to come work with me. So now they’re working in those centres. So they come out working as part of our practise – all under the GPS umbrella.

Trish Hammond: Your main head office or main clinic is actually in Townsville and you travel…

Dr Mark Vucak: I go to Mackay, and Malcolm goes to Cairns and Rockhampton and Tristan is in Rockhampton, and Ian goes to Townsville. So we have a pretty broad reach through Queensland. Especially in rural areas.

Trish Hammond: Yeah, that’s good, because sometimes it’s really hard for people that live out there to get someone close. You’ve got a big area there that you can capture.

Dr Mark Vucak: It’s really important. If you’re having a major surgery it’s hard not to have it at home because … if you’ve got the guys to do it, because pain relief is more manageable. It’s nice to be surrounded by family and friends. You don’t have to fly back for four visits. And if there’s a complication, which can happen with any surgery, we can sort it out where you live. You don’t have to keep on flying to see if we can get that sorted, we can just deal with it.

Trish Hammond: Yeah, totally. One thing that I really enjoyed reading about you, Dr. Vucak, is the fact that you’ve got a bit of a holistic approach to patient care, and understanding. Can you tell us a little bit about that?

Dr Mark Vucak: I think that just comes down to doing plastics for a while. The thing is, when you first start in any job, especially in medicine, as a specialist, you really focus on forwarding your career and making a name for yourself and proving that you can do it. And what that means for the young guys especially when I was there, because I know. What that means in most instances is that you’re very focused on yourself, because you really focus on the technique and whether you’re doing the right thing. And as time goes by and with experience you find that you don’t really have to prove yourself anymore, because you’ve got such a big practise. People are coming to … You can’t stop people coming to you, because they like what you’re doing. As time goes by you make less mistakes and the thing is that you’re not focused on yourself anymore. You’re focused on other people.

Now I’m kind of like, well, my first time I was really interested in how to do it. Now I’m interested in what the patient feels, and making sure that they’re happy and getting a good outcome for them. I think all surgeons should look to the holistic and learn from that kind of experience. Because people are initially very focused on themselves, but then their focus changes and then the patient becomes the most important thing instead of you being the most important thing. That something that only comes after doing it for a long because you feel confident in your own skin. I really want to help people and make sure that their happy with their outcomes, and that I understand what they want to get out of it. Rather than telling them what to do.

Trish Hammond: That’s true. Repetition is the mother of skill. So the more experience you’ve got in the procedure the better you’re going to be at it. That’s all there is to it. The more you do it, the better you’re going to be at it.

Dr Mark Vucak: Yeah. So our specialty is pretty interesting because they’re set operations, but one thing I learned in the US working with the guys over there who are quite famous is that they’re inventing procedures as they go along. Establishing that mark in the work and improving them. So really it’s to taking what we do know, and then continually trying to transform, to make it better.

For example with breast surgery when it comes to, say for example, breast reduction surgery, my preference is always to use a vertical mastopexy, which means you just do around and down about 90% of the time. So I try to have no horizontal incision at all where I can. About 9 out of 10 people that’s great. It’s a great operation. But in Australia our goal is pretty much to get around, down and side to side. So there’s a big horizontal component to the surgery, but if you can refine it and do it enough of times you get the finesse to be able to just around and down, the cut is shorter. That’s a very important part of breast reduction surgery and with mastopexy if you have an implant, as well. If you have a scar or stretch mark that’s just around the nipple and down you can wear a bikini or you can wear an evening gown and you don’t see that scar coming up from underneath the breast. A really important part of surgery is to minimise the scarring. That’s part of the whole aesthetics.

If you’re doing a tummy tuck, for example, a lot of people in Australia have adopted French techniques from the guys in Lyon. We do high superior tension abdominal plastic. If you look on the net, for example, when you look at a tummy tuck. Most tummy tucks are too full on the top and very flat at the bottom, well that’s just not the best way of doing it. The better way, perhaps is to elevate the tissues, do a little liposuction and with the high superior tension, which means you get a lot of tension of the abdomen, we carry all that to the bottom of the tummy so you’re flatter from top to bottom. So our tummy tucks seem to be quite different from other people because the whole of the tummy is flat not just the bottom of the tummy is flat.

Making those sort of subtle approaches and advances, they’re kind of fun to do and a lot of that stuff you have to … You can go to meetings and see what people are doing. A lot of that stuff you have to feel out what it’s like through repetition and [inaudible 00:10:01] procedures to get the best outcomes.

Trish Hammond: That’s true. [crosstalk 00:10:05] I’ve seen you at some of the conferences. No matter how much … You’re always prepared or open to go out and learn about new things that comes out or new techniques or wanting to know what’s going on. Because you do attend the conferences. So that’s really important as well isn’t it?

Dr Mark Vucak: Yeah I try to get two or three meetings a year. Going to Salt Lake City in a year’s time, then we’re going to Auckland in August for the HS meeting, and then we’ll go to [inaudible 00:10:39] in November or December and possibly go to a New York meeting. With any [inaudible 00:10:46] to know to keep on. I have to [inaudible 00:10:52] in the setting of other people. You don’t need to be at the wheel. Other people can tell you what to do, but you just make your decisions. But interesting to see how other people do it so you construct your practise as part of that whole process.

One point to note is that … about that for example is that with breast reconstruction or if you do a tummy tuck or thigh reduction, for example, there’s a lot of guys that have adopted the French technique where we like to suction first in lower areas and placate the fascia and put the skin in a particular fashion.

Dr Mark Vucak from Queensland
Dr Mark Vucak from QLD Plastic Surgery

It’s interesting to see the professor that came out from East Coast of the US, and then showing his techniques that they use, which is completely different than [inaudible 00:11:45] and so forth. That’s the kind of thing, sort of purporting to be new techniques but that’s the stuff we used to do about 15 years ago. So we’re not going to go back to that. We’ve got better stuff. It’s not only hearing what other people have to say, but it’s taking on board things that work and things that don’t work.

Probably the best example of that situation is the guys came out from San Francisco to talk about rhinoplasty at the Melbourne Meeting last January. When we would do a rhinoplasty, most Australians surgeons, you would just the [inaudible 00:12:23] we would chop right through that and then they’ll cut the upper lateral cartilage of the septum, which are the things which can obstruct the airway. So a lot of people after rhinoplasty in Australia have breathing difficulties. These guys in San Francisco are really at the top of the game at the moment in rhinoplasty. We’ve further met with the guys from Dallas who have become the focal point. So these guys are talking about preservation of the cartilage will do screw [inaudible 00:12:53] grafts, which means we’ll take that lateral cartilage and we’ll fold them down onto themselves but we’ll preserve the width of the upper airway. The noses are not quite as narrow as previously, but the airway is really good. I’ve been doing that for a few years now. Just phenomenal the difference it makes in rhinoplasty in terms of improving the nasal airway compared to the standard one practised in Australia.

So you need to take all these ideas [inaudible 00:13:20] and find out which is the best way forward.

Trish Hammond: Of course. I suppose when you see stuff like that, it’s really good to know that you’re on the leading edge of everything. You think, “Yep, that’s what I’m doing already.”

Dr Mark Vucak: Yeah that’s what it is. It’s kind of fun really.

Actually when I was in [inaudible 00:13:36] on train when I was a fellow in Atlanta. We first wrote and discovered the use of endoscopic surgery in plastic surgery. So we’d use a telescope to go and do endoscopic surgery, which we still do in the brow these days. So we kind of invented an operation there. It was interesting, because nobody had ever done that before. We’d had workshops in Atlanta for all of the surgeons, so we had all the guys, all the big names from New York and from Los Angeles, and they’d come and we’d show them how to do this operation. Then they’d gone forward and written papers. Being at the base of all that experience working at … it was interesting to be at the base, the beginning of all that sort of structure. Seeing how it progresses forward, so you can see how the changes are made for the best.

The fact a face lift has gone through the [inaudible 00:14:30] for surgeries were for skin only and then we went to the [inaudible 00:14:36] which is a deeper way in and what the guys [inaudible 00:14:39] And now we’re using more composite techniques, so we go deeper into the face. It’s a little bit trickier, because you’re close to the facial nerve but being able to hold up the tissue like a big X, much deeper fixation, it looks much more natural. The whole concept of a face lift has changed now. So instead of trying to be tight what we want to do is try to restore youth by neck grafting, doing a deep plane tissue so it looks natural and [inaudible 00:15:05] rather than just tight and flat.

We’re working with new techniques and trying ourselves and [inaudible 00:15:13] and that’s how you come up with the good results as you go along.

Trish Hammond: That’s exactly right. Have you noticed in the last year or two years any particular procedure is being asked for more by patients? For example, skin rem …

Dr Mark Vucak: In the US, plastics tends to follow the US quite a lot. Probably the commonest part of plastic or reconstructive surgery in the US is post-bariatric surgery. Which means, after people have massive weight loss or gastric sleeves they’ve got a lot of excess skins, so they have lax tummies, lax faces and arms and legs, thighs and so forth. As it turns on January, with 31 gastric sleeves and [inaudible 00:15:59] on January. So all those 31 patients, half of those patients are going to come to surgery at least. So we’ll be doing tummy tucks or thigh reductions.

I think probably the trend now, a lot of us [inaudible 00:16:14] is to really focus on poly contouring surgery, which involves a tummy tuck, body lifts, thigh reduction, and breast reductions and brachioplasty, that’s kind of like the second bread and butter of actually a plastic surgeon these days, which is kind of interesting really.

There’s a big difference when we do a tummy tuck from somebody who’s had just normal, like a post-pregnancy tummy tuck, where they’ve had twins for example and the tissues are very tight and the way they attract and tighten the muscle up and everything goes wrong, those last 40 or 50 kilos, and they’ve had a gastric sleeve, and they’ve got the tissue tones lax because, first of all, really much bigger surgery to cut a lot of tissue off, a lot of liposuction, but because the tissue tone is poor, almost 100% of these patients come to some sort of revisionary surgery to do a retype type of procedure.

Originally thought, you know, with a body lift or a tummy tuck, but now with the bariatric surgery a lot of these patients need some sort of revisionary surgery, so people have to understand what the limits are in their own body before they go into the surgery.

Trish Hammond: Oh, that’s so true, I see that all the time in our groups, like a girl who’s just had a baby, and a year got the loose baby skin is gonna get a far different result to someone whose lost 50 kilos, is got excess skin, and might end up with a little doggy ears on the side that need to be cut off again later, and there’s just no way of … you know, everybody’s different, you just don’t know what the outcome is gonna be.

I suppose it’s about the patient dealing with their own expectations as well, hey?

Dr Mark Vucak: You hesitate, because massive weight loss is such a big deal these days, there’s kind of like different operations. You have to approach operations a bit differently that you might do if she’s just had a baby, or if you’ve just got the droopy breasts, you need to have a lift for example, because normally when we do a breast surgery, just go around and down, which is the vertical method actually, but if you had a gastric sleeve, and you’ve got a heavy droopy breast, around and down is not good enough because the tissue the side of it could also slide down, so if you’re doing a gastric sleeve, you’re doing a breast reduction or lift from a gastric sleeve, pretty much always you need to go around down, and side to side, which is different from augmentation or [inaudible 00:18:39] lift after just having a baby.

With a tummy tuck for example, if you’re doing somebody whose lost 50 or 60 kilos, which is a whole lot, traditional tummy tuck also doesn’t work so well because you’re loose in a vertical direction, which is what the tummy tuck is good for, but you’re also loose in the horizontal direction, so if you do a standard tummy tuck and you just pull down it’s gonna be too loose around you.

In that situation you might need to have a different type of tummy tuck, which is fleur de lis, which is where we make a cut down the middle of your tummy, underneath and pull the whole thing together because we need to get horizontal tightenings or vertical tightening. You have to have lost massive amount of weight for that type of tummy tuck to happen, but some people just need it.

Now, one of the things which has come about in the last sort of five to 10 years is sort of the concept of body lifts, and some people will do it and some people won’t do it. I actually quite like it, you start with your prone, laying on your tummy and we do [inaudible 00:19:43] on your bottom and your thighs, we take out a huge amount of tissue from your back and then roll you over, then do a pair of back incisions rather than the front so we can [inaudible 00:19:52] tissue of your front as well. This year, I took from the tummy tissue of one patient, took 16 kilogrammes off their tummy.

Trish Hammond: Oh my God!

Dr Mark Vucak: Pretty massive excavation in terms of tummy to get that sort of body mass. Even if people lost [inaudible 00:20:11] of weight there’s so much shedding skin and the tissues can still be quite heavy if you get all that out, so once you start talking about that kind of volume there’s, some people are gonna have more risks for complications than other [inaudible 00:20:24] which is to say where you stand on the spectrum of complications and risks are.

Trish Hammond: That’s so true, and once again it’s the patient understanding that it’s gonna be a lot bigger recovery than someone who’s had, say, a tummy tuck.

Dr Mark Vucak: Yeah, I think that’s the case.

Trish Hammond: And we’re all different too. We all recover differently as well, so.

Dr Mark Vucak: I think one of the interesting, the things about breast augmentation these days is [inaudible 00:21:00] when we do an augment, when we’re establishing what to do, size wise, and volume wise, and technique wise we can use a vector machine which can analyse on the computer, but now, actually I’m a bit old school and I like to do a little bit more one to one with the patient and put the implants into a bra and show them photographs of exactly how it’s gonna be, and measure them up, and do everything. One of the misconceptions about breast augmentation these days is that you get a good result when you go subglandular, which is underneath the breast tissue, so that is always never any good for most people because if you do subglandular, which is certainly the cheaper way of doing it and the easy way of doing it, [crosstalk 00:21:50]

Trish Hammond: Sorry, is subglandular above or below the muscle? That’s above isn’t it?

Dr Mark Vucak: Above the muscle, yeah.

Trish Hammond: Okay.

Dr Mark Vucak: [inaudible 00:21:57] above the muscle, [inaudible 00:22:01] people think it’s the way to go, but actually what we’re seeing now is a lot of rippling, capsular contracture hardening, and so forth, and so generally we wanna put the implant underneath the muscle to get the most natural sort of look. Certainly if you’re going to a plastic surgeon, which is different from a cosmetic GP, for example, who maybe a cosmetic surgeon without any surgical training, because they’re not surgeons they’re not allowed [inaudible 00:22:27] in hospitals, so they have to put the implant in front of the muscle, so naturally that’s the only route to go because putting the implant underneath the muscle you need to have a general anaesthetic.

The cosmetic result is so much better, the complication rate is much lower, the aesthetics are so much better. You have less hardening and capsular contracture, and there’s really no comparison between those two in terms of the following result.

Trish Hammond: Yeah, okay, so because they don’t really have that surgical training, and they’re not allowed to have … sometimes a general anaesthetic, that’s why they would go over the muscle-

Dr Mark Vucak: Correct. That’s right.

Trish Hammond: I didn’t know that, we’ll there you go, makes so much sense.

Dr Mark Vucak: Yeah. So, you know there’s a lot of guys who put the implant in front of the muscle but then it’s just skin then implant, so you see a round tennis ball stuck on your chest, but if you can put the implant underneath the muscle, [inaudible 00:23:15] body get a more natural appearance. You’ve got a bit of [inaudible 00:23:19] with the breast. You can get any shape you want and it doesn’t, even if you use a round implant underneath the muscle you can still get the teardrop sort of look.

It’s a much better operation. One of the issues these days is Anaplastic large cell lymphoma, which is going to be a big deal, you know, in years to come because this last Christmas I had 350 women with ALCL, which is acute Anaplastic large cell lymphoma, and of those 350 women, nine of them have died, so it’s a pretty important disease.

What we’ve found so far, is that in those number of women almost no women had ALCL with smooth implants, two had micro-texturing, and the vast majority had macro-textured implants, so a macro-texture implant is [inaudible 00:24:15] polyurethane, some [inaudible 00:24:21] silicone, so the risk is small, but in the polyurethane it appears it’s gonna be about one in 4,000 women with polyurethane implants will get ALCL, which is a pretty big deal. With a metal texturing it appears to be one in 60,000 women are gonna get ALCL, but with the smooth implants there is a very [inaudible 00:24:44] number of people who’ve had this problem.

I think nowadays the trend for a lot of people, a lot of my colleagues is to move back to smooth plants over textured implants, and the reason which is coming about is because on the surface of the smooth implant there’s not many bacteria form, on the surface of the textured implant, macro-textures especially, there’s 70 times more bacteria, so the particular bacteria on a textured implants surface, which seems to be causing this cancer.

Just this year, just in the last few weeks, two American university hospitals announced that they’re not using textured implants anymore. This is the start of something important in [inaudible 00:25:22] surgery because what we’ll find, in last year we had 350 women, in a couple of years time we’ll have a couple thousands, and 10 years time we’ll have 20 thousand, that’s just the way things go in medicine, so people that are persisting with macro-texture implants are probably doing their patients a disservice I think at this stage of the game because we’ll find in years to come that there’s a higher and expected incidence of lymphoma from macro-textured implants.

If you have a surgeon telling you to have a macro-textured implant, like [inaudible 00:25:58] or polyurethane then I think they’re doing a disservice at this stage of the game. Knowing what we do know now, even though it’s early days. My recommendation is to go to a either smooth implant or micro-textured implant because there’s very low incidence of [inaudible 00:26:15] in those implants.

Trish Hammond: And the [inaudible 00:26:17] now have got the next generation, nano-textured implants as well [crosstalk 00:26:23]

Dr Mark Vucak: Has the micro-textured implant.

Trish Hammond: Yeah, so it’s all changing isn’t it. It pays to go to someone who is up to date with everything and knows what’s going on as well.

Dr Mark Vucak: I think it’s also the responsibility of the surgeon because a lot of guys who are using [inaudible 00:26:43] and the polyurethane haven’t changed their ways, they’re not moving with the times or going with the flow [inaudible 00:26:50] their patients because, you know, if my wife wanted a breast augmentation I wouldn’t recommend those implants to her, but are happy to … there’s a lot of surgeons will just persist because they’ve gotta deal with the supplier, getting things cheap, and so that’s what you’re gonna get without actually taking into consideration what the real issues are.

You’ve got to look for some understanding and concern for the patient well being in trying getting the best possible outcome with it all along.

Trish Hammond: Yep, that’s so true, so true. Oh, that’s been really interesting because I didn’t know about the … actually I did know that, I thought people preferred above, you know … sorry, unders or overs, I didn’t actually realise that there was … I thought it was just the patient that decided whether they wanted them to be over because they wanted them more obvious, or under because, you know, not to be so obvious, but it’s not like that at all, so that was a real eye opener for me then.

Dr Mark Vucak: It’s not like that at all. The issue is that in Australia it turns out, as in the US, because no GP and cosmetic surgeons who have no surgical training, because there’s so many of these guys around, just in the medicine, they can only promote in front of the muscle as the only way to go because that’s the only thing they’re allowed to do, or can do. [crosstalk 00:28:14] more popular to do that because that’s when you look on the net, you see oh, in front of the muscle, and so many people are doing that, but the people that are doing that don’t have the option to go underneath, so if you went to see a plastic surgeon who, for example, who’s only [inaudible 00:28:28] they can give the option of going below or in front of the muscle.

The only reason that you might wanna go in front of the muscle is if you have a droopy breast and you want the implant to go lower because if you go behind the muscle of a droopy breast sometimes it can get pulled up and the breast falls away.

The problem about going in front of the muscle with an implant is that [inaudible 00:28:50] when you go in front of the muscle, when you lean forward the upper part of the implant can fall away from your chest, especially with a tear drop implant, to the point where you can actually put your hand behind the implant and the front [inaudible 00:29:04] which is [crosstalk 00:29:07]

To solve this problem out, which can potentially happen, I went to Rio, to operate with these guys who do a lot of these type of implants, and what we did in Rio was to instead of putting the implant in front of the muscle that they would implant, what we do is make a transverse incision through the pectoralis major, so take the implant as a tear drop shape and put it up underneath [inaudible 00:29:37] underneath the muscle, and the bottom of the implant can be in front of the muscle underneath the breast tissue.

That way your half muscle and half breast tissue, and that works out as sort of the sip muscle technique, which I learned in Rio, and that really helps because if somebody’s got a droopy breast we don’t wanna do a lift, we can put the implant partially in front of the muscle. In most of the cases underneath the muscle is by far the way to go. If you put the implant in front of the muscle it looks good for a little while, but then if you think about it, once the skin has to take away from the implant, so next thing you now after five years, after 10 years, after 15 years your implant has descended down to your belly button because you don’t got the muscle to support, to hold it up.

[inaudible 00:30:21] in front of the muscle implants will descend down to your belly button before you know it, whereas if you go submuscular you’ve got the fascia, and you’ve got the ligaments in the bottom of the muscle [inaudible 00:30:30] there’s less descent over time. Less capsular contracture, and if you do get capsular it’s much less obvious. The time we go in front of the muscle is if you’ve got a droopy breast and we might use a tear drop implant to push the breast forward.

Pretty much all other times, you pretty much wanna go underneath the muscle.

Trish Hammond: Well that makes so much sense. What about though, for girls that do a bit of weight lifting and that? How does, like, if there under the pectoralis muscle how does that effect? [crosstalk 00:31:01]

Dr Mark Vucak: My thoughts on the whole thing has changed over the last 20 years because [inaudible 00:31:08] you think, oh because they’re doing weightlifting we should always go in front of the muscle, but the problem is that because they’ve got such low body fat, five percent, eight percent body fat, you’re just see two tack on tennis balls when you go in front of the muscle, but the problem if you go underneath the muscle when you’re bodybuilding, and you divide [inaudible 00:31:28] so it’s along your sternum and then a little bit on to your ribs, but traditionally what we do is if you go underneath the muscle, divide the pec major, underneath the ribs, and a little bit below the sternum.

The problem if you’re a body builder and you put it right underneath the muscle, the end of the muscle, when you divide it, can flick up and join onto the skin. When you’re doing a show and you’re contracting, and you’re pulling your hands close together and you’re showing your pecs off, the problem is you get an indentation in the skin beside the sternum if you’ve got low body fat because the end of the muscle can join up to the skin instead of [inaudible 00:32:02] the sternum [inaudible 00:32:04] what I found in body builders, the best thing to do is not to go subglandular, but to do submuscular, but not with a division up along the sternum, just do a low pec major release, so you’re still getting some muscular placement, which works pretty good. And you’re getting a more natural look than that stack on tennis ball because of the low body fat.

But, you’re not getting the muscle [inaudible 00:32:24] onto the skin on the inside, which can be a problem when you’re doing [inaudible 00:32:27]

Trish Hammond: Yeah, so when it comes down to it, it depends on the patient as to what you’re gonna do doesn’t it?

Dr Mark Vucak: Depends on the patient what we’re gonna do, also depends where they are in their career because some people it’s a long time ambition, but some people are ending the careers and [inaudible 00:32:45] might be an off season, and if you haven’t got long to go because everybody has a period of time to do as fast as you can [inaudible 00:32:57] if you can.

Trish Hammond: Well, that’s been great, that’s been so interesting, thank you so much for that.

Dr Mark Vucak: I mean I love what I do, it’s just so interesting, but the main thing is that once you’ve got a handle on the technique the main thing is just really listening to the patient, understanding what they want, and giving them something that they’re happy with, and if they’re not happy you fix it up until they are happy. You know, I don’t like to leave them scarred, I wanna make sure everybody’s happy and … but, that’s the thing I mean you live in a place, in a rural environment, I mean, we have the technique and the expertise, we have the patients, but if you’re not a good surgeon then everybody knows about it.

Trish Hammond: That’s exactly right.

Dr Mark Vucak: Word of mouth. If you live in Sydney, or you live on the Gold Coast and you’re a bad surgeon we’ll no one knows about it, and you can keep on going, but if you’re in a small town everyone knows about it [inaudible 00:33:52] has to be good.

Trish Hammond: It’s true, that’s true, yeah. You gotta really look out. I mean, everyone has to look after their patients anyway, but yeah, especially in a small town because yeah people talk.

Dr Mark Vucak: [inaudible 00:34:02]

Trish Hammond: Yeah. Oh, that’s been awesome, thank you so much, and I hope you don’t mind if we call on you another time to do another podcast, that would be amazing.

Dr Mark Vucak: Okay, that would be great.

Trish Hammond: Awesome. All right, well thank you, ladies and guys out there if you’re up in far north Queensland, anywhere from Townsworth through to [inaudible 00:34:23] through to Rockhampton, and you’re looking for a surgeon, definitely don’t go past Queensland Plastic Surgery, you can get them through the plastic surgery hub website or drop us an email to [email protected] or just Google Queensland Plastic Surgery, easy.

So, thank you so much Dr. Vucak.

Dr Mark Vucak: Great super, thanks again.

Trish Hammond: Thank you, bye.

Dr Mark Vucak: Bye.