Interview with Plastic Surgeon Dr Nicholas Moncrieff about Breast Surgery

For those of you who missed Dr Nicholas Moncrieff’s interview Facebook live recently, here it is again to watch or read. It’s a wealth of information on not only what Dr Moncrieff and his team at the well respected Hunter Plastic Surgery in Newcastle do, but also on breast augmentation, breast lifts, breast reductions, Vectra imaging and a whole lot more including pricing.

Amber: Hi everyone.

Dr Moncrieff: Hi everybody.

Amber: Hi everyone. Hopefully this is showing up now so maybe if you just write a little comment just so we can see that you’re seeing us and that the live video stream is working.

Dr Moncrieff: Yep, here we go, we’ve got one.

Amber: We can see that they’re there. So if anyone just wants to comment and just confirm that you can hear us and see us.

Dr Moncrieff: Yep.

Amber: And then we’ll get started in the next couple of minutes.

Dr Moncrieff: Excellent, thanks guys.

Amber: Oh yeah, thanks Ashley, thanks Blane, high five, thumbs up so that’s terrific. Thank you very much, oh I can see yes, that quite a few people are joining so thanks Jess, Jess is our practise manager so she’s watching in another room so great to see that, Taylor hi, everyone is joining. So hi Emma, hi Jake, oh wow, it’s a really big crew, thanks everyone.

So I’m Amber Moncrieff, I’m not the plastic surgeon, the lovely gentleman to my right is and so yeah, so we’re the Moncrieffs, so Dr. Nicholas and Amber Moncrieff and tonight, what we’re going to show you is a lot of stuff about breast augmentation. So, we’ve been working quite hard haven’t we?

Dr Moncrieff: Yes.

Amber: I’ve been testing you so some of the questions, that the lovely Trish from Plastic Surgery Hub worked so hard to make Plastic Surgery Hub what it is, then through lots of your questions. And, what we’ve tried to do tonight is incorporate them into a bit of a presentation and answer them as we go but also we’ve got some that we’ll answer at the end.

So our goals from tonight, I guess based on what Trish asked us to do, talking about breast augmentation but not just the easy cases but some of the more challenging aspects of breast augmentation and so we’ll do that. We will show you lots of pictures, I think we’re probably both quite visual people and so if you can see something, I think it makes a lot more sense so I will bring the laptop a little bit closer to the screen when I’m trying to show you a few things.

Just keep in mind that we have had to put stars over all the nipples, which is sort of a bit annoying in breast surgery because sometimes nipple placement is really the mark of a great surgeon but if we didn’t, it would be banned off Facebook and this might, even as we’re going live, be taken down, so we’ve had to make that concession.

Dr Moncrieff: Anyway.

Amber: So yeah we’ll still go ahead with what we can. So that’s the goals for tonight, we’ll show you at the end, so Jess our practice manager who’s here will show you a bit about the Vectra, it’s certainly one of the favourite tools and in fact I noticed someone commented, I think it might have been one of the ladies that is already commenting here saying that she’s actually got one booked for tomorrow so she’ll get a little bit of a preview of it, nice to be that keen.

But look, a little bit about us, we’ve been in Newcastle, we set up Hunter Plastic Surgery what year?

Dr Moncrieff: 2009.

Amber: Good job, also the year we got married, so it was a busy year that year. So Dr. Moncrieff has actually been up here 10 years and we moved up here from Sydney and in that time, we’ve run a really busy plastic surgery practice but what is your sole focus now?

Dr Moncrieff: I really love doing breast and body work and that’s basically what I concentrate on now, I don’t do anything else and I dedicate my time to being a master in breast surgery and the breast lift process and also in body work and body lifts.

Amber: And by body work, he doesn’t mean tattoos!

Dr Moncrieff: No.

Amber: He means tummy tucks and body lifts and things. So I guess one of the big things, we talk about our five star difference, you know, Dr. Moncrieff is a proper plastic surgeon and I know this group really endorses, you know, the work of plastic surgeons but he doesn’t do a bit of everything you know, the days of doing skin cancers and facial work and all that sort of stuff, we just focus on that and as a result, you’ve done more than 1,000 breast augmentations in the last 10 years, but certainly the pace in the last couple of years has really picked up, so very, very, busy.

All right, so a little bit about who our patients are because I think you know, understanding who breast augmentation is suitable for, who are we talking about?

Dr Moncrieff: Obviously we’re talking about women of all ages, people come in for plastic surgery from 18 up to 70 and you know, we treat women of different shapes and sizes but mainly we treat a lot of mums in our practice. We do a lot of mums from early 20s to mid 40s who may have had two or three children, they may have breast fed and they’ve just lost some volume, especially in the upper part of their breasts, we call it the upper pole and they’ve got some laxity maybe in the bottom of their breast and they just want to restore mainly a bit of the shape back that they had before kids. And so, this is where breast implants become very useful and are very good at correcting these shape changes.

We often see a lot of younger women who have got very thin, athletic bodies, we call them like a surfboard type body and they just want a sort of more natural enhancement not being too big and we do see a lot of that and we are doing more and more of that now. And also, we do a lot of breast augmentation that we are seeing from mass weight loss. So, patients who’ve come in, they’ve lost their weight, they’ve got some laxity and we often do a lift first and then put some implants in, usually six months later.

So there’s all different shapes and sizes we’re presenting for this and you know, there’s always a solution to a lot of the problems and we’ll go through this in a lot of detail with the women trying to get them the best solution.

Amber: I’ll keep looking down to see if we’ve got questions as we go, thanks Ebony, great to see you on here.

Dr Moncrieff: Yep.

Amber: Finance organised, it sounds like you’re on the way to a bit of Moncrieff Magic. So yeah so what we’ll do is we’ll run through some of those hot topics that Trish asked us to address. Hi Lyn, hi Sharon so we’ll get to that Sharon, about some mass weight loss and some obviously a lot of these things are on our website as well.

So all right, so let’s kick off, so the first big thing, one of the questions that Trish had sent through for us to address is the difference between anatomical and tear drop implants. So I’ll just try and position it there so-

Dr Moncrieff: So there’s a tear drop there that Amber’s holding up and I’m holding up a round and then you can see there, so the round is round in every direction so it doesn’t matter where you go, it’s round. Whereas Amber’s tear drop shape is smaller at the bottom and bigger at the top. So if you held it up, the other way, yep, the other way, there, it looks like a raindrop or a tear drop. And you know, these implants are certainly newer to the market than the round which has been in practise and used I guess for 50 years and the anatomical has been used now for 20, 25 years.

But basically the difference is the gel is a lot squishier in these round implants but the gel in these ones is a lot thicker, it’s a lot firmer and it gives, I think, a better shape to women’s breasts using these implants than the squishy soft ones, or the round ones. That’s not to say I don’t use round but a majority of my practise is using shaped implants because I think they give a lot better shape to the breast and then this operation is not just about making them bigger, it’s about shaping them and these implants are good, they do hold, they have more memory, I think in them. So I think, the thicker gel that’s used in these anatomical implants tends to be more long lasting in terms of the shape that it provides.

So, when do I use shaped implants? When do I use these round implants? I’ll just get to the round implants first, because I do less of them but for women who are before kids, they’ve got nice tight skin, they’re small breasted, these round implants are certainly very suitable and they can give you a nice, augmented look, they can provide full cleavage, they can provide lots of volume in the top part of the breast and they can certainly give very nice looking results.

I also use these round implants, so women who have mass weight loss, they might have had a lift and we’ve cut off all the skin that’s lax at the bottom and if they want to go ahead and have a sort of fuller looking breast augmentation, I would use these rounds in that setting.

So but they are really the only two instances where I use them and the majority would be this shaped or the tear drop implant and as I said, these have got this fullness at the bottom and this will help kick out the breast and help shape the lower pole.

Now, this is the thing ladies and gentlemen, if you’re really serious-

Amber: This is only women, this is private group.

Dr Moncrieff: Okay, I thought there might be some men watching, but if you’re really serious about doing this operation well, you need to get the lower pole right, the bottom of the breast right, and this is what these implants do. They really have revolutionised, I think, breast surgery practise because they give so much great shape to the bottom of the breast. Now anyone can make the top of the breast look good by either using a shaped implant or a round implant but it’s at the bottom which is really key in getting a really great shape. And I just don’t think you can get that with a round. Firstly because, you’ve got more volume at the bottom, so you can shape the bottom better but also the gel, it’s super thick and it’s super strong and that’s what gives it the great shape.

So my practise is basically an anatomical practise or a tear drop shape practise but having said that, we will use rounds in certain settings and certainly it comes down to patient preference.

Amber: And we should note that these are actual implants, so this is real implant. This is a 440, that round is a 450. So for the same kind of volume, you can see there one is giving you much more projection outwards. So we will show you some photos later how it still creates cleavage even using the tear drop but in terms of where the weight, particularly if you want that kicking out, which most mums do, then that’s the one. These are Mentor implants-

Dr Moncrieff: So yeah, we only use Mentor implants. I’ve been using them for almost 10 years now, I’ve been very, very happy with the product and Mentor stands behind their product and they’ll give women a 10 year warranty on these implants, that is to say that if they have any problems in the first 10 years, they’ll replace them free of charge. So they really stand behind their product because they’ve got, you know, they’ve got millions of implants used worldwide and they know that they work and they know that they last.

And Mentor implants that are placed 10 years ago, they’re still working very well today and I’m really, I’ve really had to revise very, very few of them and I would expect to tell most women that you should be getting somewhere between 10 and 15 years out of these, possibly longer if you don’t go and have a lot of kids or big weight changes.

So the implants themselves are very, very stable, they are very good and really, they’re some 50 million plus women in the world have got implants and you can’t use them unless they are very, very safe.

Amber: Just a couple of quick questions, I hope that answers Kirsty’s question about how long you can expect to get from a tear drop, so about 10 to 15 years. Brianna is just asking, in relation to a tummy tuck and a breast lift, could it be done as one surgery?

Dr Moncrieff: Yep definitely.

Amber: We do it all the time.

Dr Moncrieff: Yep.

Amber: And would it help avoid the square look? So the tear drop. I think it’s probably, we can sort of talk about it later but the flop, sorry the flop, the drop and fluff concept, and often, you know you see it on this page, people say I’m really worried because it’s got that very square look.

Dr Moncrieff: The results] obviously look different one week or you know, one day, one week, five weeks until that three months. So, they will start a little bit high to begin with but then they’ll drop into the pocket if the pocket is done correctly. And they produce this lovely round shape at the bottom, it’s this thing here that really shapes the bottom and that’s why I like them so much. And I don’t think they produce square looking implants, I think it’s because the gel is so strong, that it really expands up that lower pole, that bottom of the breast and that’s what gives the great shape. So look, I haven’t found that it is shows a square shape but I guess look, it depends on the way they’re done.

Amber: Right so we might get on just quickly, what arms too, because it will be in the same surgery?

Dr Moncrieff: Yes, we do that, we do arms and breasts.

Amber: Obviously with mass weight loss often the surgery is staged so just to make for recovery. What happens to the implants after the 10 years?

Dr Moncrieff: Nothing happens, they’re fine and look, they might be in a woman’s body for 40 years without a problem, it’s just that we know from looking at lots and lots of these patients is that sometimes they can get something called capsular contracture where the shell around the implant goes hard and basically they’ve just looked at, what is the average time for replacing an implant after a woman’s had one and they think, and the scientists at these companies think it’s somewhere between 10 and 15 years, so that’s why we say that because that’s what the data shows.

But, if you’re having no problems with it and you’ve had regular check ups, mammograms, ultrasounds, there’s no reason to move to having them replaced just because someone told you 10 or 15 years.

Amber: Alright so we might move onto Dual Plane. So for those of you that are sort of, we call it Dual Plane but you might call it overs or unders the muscles and then a combination of both. Though we will actually show you an example of this in a minute so breast lift with an aug. So I’ll bring this a little bit closer just so that Dr. Moncrieff can demonstrate.

Dr Moncrieff: So I hope you guys can see this so we are talking about where the implants would be placed. So you probably heard about people talking about, I’ve got mine over the muscle, I’ve got mine under the muscle, so these are very common expressions. And you can see here on this diagram here, it’s called a subglandular position. So the implant’s placed over the muscle. And that’s the implant, the muscle there in red, circled. And the implant is located between the muscle and the skin of the breast, so that’s subglandular or under the breast.

In this instance here, you can see the muscle here in red and that’s the implant placed in the submuscular position. And that’s a very common position, it’s been used very, very widely over the last 35 years and is still very common in practise today. And it gives a nice protection for the implant, it holds the implant in place and it tends to stop them dropping.

Whereas the subglandular position is good because it expands up the breast skin and really shapes the breast nicely but the problem is, over time is the weight of the breast cannot be supported by the implant, so they tend to drop.

So this is where implants can be placed, but where I really like to place them is this, called Dual Plane. So this is Dual Plane and it means that half of the implant, as you can see here, is under the muscle and the remaining half or third or whatever it is, can be placed under the breast. And I think it has the advantages over each of those two placements.

So firstly, the implant is protected and it’s held in place by the muscle at the top here but the lower pole, is where we were saying the shape change has occurred, is better if it is exposed in the breast, so that’s why the bottom half of the implant is sitting under the breast and can really effect the best shape change.

And that is, I think, the key thing about this technique, it is certainly harder to master but I think it gives more longevity to the result and really gives you lovely, natural looking results. Is there any questions?

Amber: So hang on, I’ll just check. Oh, muffled sound, sorry, can somebody just let me know if they can hear it now? All right can we hear it? Okay. I’m just checking if anyone can let us know if they can hear it now, yep, okay. So just, you saw the photos there but what were you saying Dr. Moncrieff in terms of all of that?

Dr Moncrieff: I said, basically I was just saying that Dual Plane is really good because it holds the implant, it’s held by the muscle at the top and that is where the implant’s covered by the muscle in the top half of the breast. And the bottom is where the implant is exposed to the breast so that’s called the Dual Plane because half of the implant is covered by the muscle at the top and the breast at the bottom and it gives, I think, the best longevity in terms of the result because the muscle tends to hold the implant up and it also tends to shape the breast, especially the bottom half we were talking about before and it gives really great shape change to the bottom of the breast.

Amber: All right, so sort of combining those two concepts, so the concept of the tear drop implant and the concept of the Dual Plane. We will now move to scarless lift.

Dr Moncrieff: Yep.

Amber: So we were talking about this last night so people were saying, is it actually possible to have a lift without a scar?

Dr Moncrieff: Well it’s impossible because we can’t do a surgery without a scar making incision but the scarless lift is something that we specialise in because a lot of mums who have lost volume at the top and have got laxity at the bottom, but they want to get away with not just having the lollipop scars that you might be familiar with or the anchor scars and they want to get away with an implant alone and we certainly can do that in certain situations where the nipples are pointing straight ahead, we’ve got some not really big areola or we’ve got some skin between the bottom of the areola and the breast.

In those instances, we can use a Dual Plane placement as we just showed and an anatomical implant to really expand up that lax skin that we are seeing at the bottom of these people’s breasts.

Amber: So what we’ll do, because obviously you can’t hear the audio when I bring it closer, so we’ll just show a couple of pictures and then Dr. Moncrieff will talk to them.

Dr Moncrieff: Yep.

Amber: I think the summary of all that is when we say it’s a scarless lift, what we mean is, it will not have the scars that are normally associated with a lift being the big lolly pop scar around the nipple and down the breast, but of course it will still have what we would consider a normal augmentation scar which is that four and a half centimetres under the breast.

So we’ll show you some examples now and hopefully then, that will sort of make it a little bit clearer. So first of all, we’ll just show you the befores and then we’ll talk you through it.

Dr Moncrieff: So you can see all of that guys hopefully, so you see here, here’s a mum, she’s got two kids I think and she’s got some laxity you can see at the bottom of the breast but the key point here to consider is that the nipples are actually pointing straight ahead.

Amber: I’ll just show you that. So, what you can see there is that the nipples are still pointing straight ahead.

Dr Moncrieff: And so in this instance, we would consider doing, this is a scarless lift, so using the implants alone to shape the breast and to stretch that lower pole, laxia at the bottom of the breast and to stretch it up and this is exactly what we’ve done and I think Amber will show you the afters now.

And you can see now from there guys that the nipple is now placed in the centre of the breast and we’ve basically expanded up using a shaped implant or an anatomical implant on the lower pole of the breast and given that lovely breast shape, and that is called a scarless lift. So there is no scar around the nipple, there’s no vertical scar, there’s no big cut underneath, there’s just a five centimetre cut at the bottom of the breast.

Amber: All right, so there won’t be any sound when we just show you the power point but then we’ll bring it back and continue talking. So can everyone just hear when we are actually talking? Yep, so we will just show you again the results.

Dr Moncrieff: And that’s a typical scarless lift result that we’ve expected to see in the right patient.

Amber: Alright so-

Dr Moncrieff: Here’s another example a scarless lift and we will just show you again that shape changes and the volume that happens from just using an implant alone.

You can see there guys that the lower pole has been driven up by the shaped implant and given her the volume that she wants and without the need of a scar. And a lot of women, rightly so, do not want to have the traditional lift scars on their breast if they can get away with using an appropriate sized implant done in such a way with a Dual Plane placement to give them the look they’re after, especially without scars is a big plus.

Amber: So now we’ll discuss lifts for some patients, definitely and we will show you a good example in a second. A lift is definitely the right operation but for these sort of patients where that nipple’s still in the right sort of position and it’s a reinflation, this is the solution.

Dr Moncrieff: Yep.

Amber: All right.

Dr Moncrieff: So we’re also going to talk about now, do I need a lift and this is a question we get asked a lot, we get sent lots of pictures every week of someone saying, do I need a lift? Can I get away with implants alone? So there are certain situations in a women’s breast where if the nipple is too big or if the nipple is too low on the breast, or they are pointing down, then we actually recommend having a lift.

And the way that I tend to recommend it is having the lift first then waiting for six months and then going back and having the breast implants because we know that scars don’t stretch when you do the implants and the lift separate, because sometimes after doing it together, so in one operation, we find that the scars, especially around the areola and the along the vertical fold can stretch.

So now, we have taken to doing them in two operations in appropriate patients and I think you can see the results will speak for themselves.

Amber: I’ll show you in a sec, because obviously the volume will go again, but what you’ll see is the before, you will then see post the lift, so then that was allowed to settle for several months before the implant was placed in and that was really to get those lovely fine white scars that you see in this patient at the end, as opposed to many of those patients, including when I see on this page, that have had it done in one hit and the pressure of that implant has just been too great and the scars have really stretched out.

So it is possible to have it done in many cases, in one, but in lots of cases we say no, stage it. Yes it is more expensive but if you want those thin little white scars rather than those big sort of angry red ones, this might be something to look at.

So I will show you the pictures and then Dr. Moncrieff can talk.

Dr Moncrieff: Okay guys so you can see the before picture was a lady who had breast fed two kids and it was difficult for her to get the volume she wanted so I said, because the areolas are very big and that they are at the bottom of the breast, that she needed to have a lift first and that’s what you can see in the second photo, you can see the lift scars, they are around the areola and down and then we’ve gone on to do the breast implants, six months after that surgery and then you can basically barely see the vertical scars or the scars around the nipple, even though it’s hard to see with the stars on them that Facebook made us do, you can still, it’s very hard to see the lift scars. And that is the advantage of sometimes doing it in two operations.

Amber: I’ll just show you that one more time, just so that’s sort of, now that it’s been explained a little bit more. All right.

Dr Moncrieff: So yeah so, and that’s I think that’s definitely the way to go and certain people should certainly consider that if they are one of those women if it’s not suitable to do it just as an implant alone.

Amber: Right, so we’ve now got tuberous breasts, so what are the things that indicate a tuberous breast? Is it just a small breast?

Dr Moncrieff: Yeah so this is a really good question and one we get asked a lot of, it’s not just small, underdeveloped breasts, it’s actually a fact that the tuberous breast condition is basically an anomaly, so something that people are born with and basically what happens is, the breast doesn’t develop fully and normally.

So basically during puberty, the breast doesn’t reach it’s final shape and size and people are left with breasts that can be very widely spaced apart, they can have this puffy nipple or puffy areola which we see commonly. We can see this triangular shape, or it’s sometimes called cone breast and often the breast fold is very, very high.

And that combination of features of the breast can indicate that this is a tuberous breast and you know, we probably see it in five percent of all women presenting for breast augmentation so it’s not uncommon and if you’ve got some of those features, it could very well be you.

So how do we treat it? We often treat it with breast augmentation, we often treat it with fat grafting and there’s a myriad of techniques we could use to basically inflate the breast up using an implant and basically dilute the breast. We are using implants to basically cause shape change, because we know that they can and we might have combined it with a scar around the nipple to narrow the areola down because the areolas is often very big in these women.

And you know, it’s a difficult condition to treat and sometimes we do it in two operations where we will do a lift first and then put an implant in six months later but it just depends on how severe the condition is really, to guide us what to do.

Amber: I might show you again, the before and the after photos and then Dr. Moncrieff will talk about it and then we will just show you sort of like a close up of it. So just keep in mind, so this lady was in her 40s, was a mum but hadn’t been able to breastfeed, the tuberous breasts really made that quite difficult so we will just show you her photos. Straight through to the afters there.

Dr Moncrieff: So yeah so you can see in the befores, you had very widely spaced breasts, you could see there was puffy areola, the breasts looked quite triangular or cone shaped and the fold was quite high, particularly on the left. But I think what struck me also is how widely spaced apart they are but in that instance, we used a cohesive gel, like a shaped implant that was quite a good size, it’s a 440, made by Mentor and the idea is then, and we’ve put that implant in that position under the breast so it’s actually not under the muscle or Dual Plane, it’s under the breast and then we used fat grafting to disguise it to narrow the cleavage in order to achieve that result.

And I think you can see it’s quite a significant transformation in this lady who has always been embarrassed about her breasts, now she feels like she has a normal pair of breasts that sits normally on her chest wall.

Amber: All right, so I’ll just show her finals of before and afters again close up. Thanks for the nice comment there.

Dr Moncrieff: Yep.

Amber: So I guess the important thing to know there is normally you are a big fan of Dual Plane.

Dr Moncrieff: Yep.

Amber: It wasn’t appropriate in this case.

Dr Moncrieff: No. So yeah we try to Dual Plane as much as possible and the reason we do that is because the muscle holds the implant in place, it stops it from falling but in some instances, you actually want the implant hard up against the skin of the breast so it can shape the breast and give the breast the best shape. In that instance, in severe tuberous breasts, we will put them under the breast.

Amber: Okay and also you talk about tuberous breasts, it’s not just a small breast, so we see, even in larger patients, there is still that characteristic shape.

Dr Moncrieff: Yep, that sort of triangular sort of cone shape looking breast, big puffy areola, it’s not just a small breast and you know, we do quite a lot in this practise, we only do breast and body so by default, I guess we do a lot of it and you know, it’s often a combination of treatments that we will use to get the best breast shape.

Amber: So we’ve dealt with a lot of those sort of more challenging cases, so the scarless lift and then the staged aug and lift, tuberous, how about a relatively nice easy one?

Dr Moncrieff: Yeah I think it’s always good to get back to the bread and butter which we all certainly enjoy because it means that this is going to be hopefully a pretty standard straight forward case. So we are going to talk about the patient who comes in who is thin, who has got a very nice body, but just doesn’t have much volume in her breast and wants a better breast shape, so we might show you a picture of that now.

Amber: Alright so this is this patient before.

Dr Moncrieff: So as you can see, I said thin body, you know, not much in the way of breast tissue, probably an A cup and she wants just a bit more volume, she’s quite sporty and athletic and just feels she’d like to be a bit more womanly and just with a few more curves.

Amber: Alright, these are the afters.

Dr Moncrieff: So I don’t know if you could see the screen but there’s a question I’ve put to the group there, so guys, what do you think those implants are? Are they round or are they anatomical?

Amber: So if you can just comment below, so we might even just go back and we will just show you. So we’ll show you as you do your guesses, but comment below, do you think these are round or anatomical implants? Not sure if anyone’s responding there. But I think-

Dr Moncrieff: Yeah.

Amber: Jay thinks round, Tania thinks round, Leah thinks round.

Dr Moncrieff: They’re good, they’re very good comments. Beck, yes, good, Taylor anatomical, Sharon anatomical, Carly round. So I think there’re more rounds than anatomicals and this just goes to show people, that you can’t ever tell and when you guess, 50 percent of the time I think you’ll probably be wrong and they are actually anatomical.

So what it goes to show guys is that you can style any type of breast you want if you know how and you can get an anatomical to look round and you can get around to look anatomical but that is harder, that is much harder. But definitely that’s why I like them because you can use them in so many situations and you can create totally different breast shapes and profiles for people who think they’ve got an idea in their mind that they definitely want round, but, you know what, I can do it by using a shaped or anatomical implant.

Amber: But you still get the benefit of that anatomical because you are still getting that-

Dr Moncrieff: Longevity, the thick gel, you are getting the Dual Plane, so the thing is guys, you know, I don’t tend to Dual Plane a round implant, because the benefits come in the fact that implant is asymmetrically manufactured so you have got more gel at the bottom and when the muscle squeezes down on the implant, it squeezes the gel into the bottom of the breast.

Amber: We might just show that one again, for those of you that had guessed round, this is probably why. So most people sort of see that nice full looking cleavage and what do they think?

Dr Moncrieff: Oh yeah it’s definitely a round implant and that’s the thing, if you know how to use this technique of an operation, you can create anything and that’s what I think really good breast augmentation surgery is about, it’s about shaping breasts, not just stuffing an implant into a pocket and going, that’s good enough. And that’s what we really try to do here at Hunter Plastic Surgery is really shape the breast well and I consider myself a breast shaper, not a breast stuffer.

Amber: Yeah so look, sometimes we do get phone calls from people that have gone and seen cosmetic surgeons, so anyone that’s a GP can call themselves a cosmetic surgeon and they say, ‘oh, I’ve been told not to have the teardrop or the anatomical because it might rotate’. How many have you had rotate Dr. Moncrieff?

Dr Moncrieff: Look I’ve had one of my own, but I’ve seen a lot of other people but the trick to getting them right is when you make the pocket just big enough for the implant to get in, because it is bigger at the bottom than the top, that’s how they are made. But if the implant can barely get into the pocket, it’s like a hand going into a glove, they just don’t, there’s no room for them to move and they just don’t move.

So I think that’s a theoretical consideration, a lot of surgeons will say, no, no have round, have round, because it’s easier for them. It’s only easier for them to, don’t worry about and set and forget and go well if it’s round, it doesn’t matter, it doesn’t change the shape.

But the advantages around anatomical, I think, far outweigh the technical considerations of making a tight pocket.

Amber: The thing is, lots of people will say round because they don’t want to spend the time or they don’t have necessarily the knowledge and in saying that, there are lots of surgeons that still do rounds and there are lots of our colleagues that still do rounds for lot of different reasons but if it’s simply just because the surgeon wants to be able to operate that bit sooner, then that’s not a good reason, you should be asking that question.

Dr Moncrieff: Yep.

Amber: All right so, we’ll get onto fees, so I always say in our practice, it’s not Dr. Moncrieff’s job to talk about fees, you know, he’s now supposed to learn every Medicare item number and what rebate it gets from what health fund and things so usually in our practise, you’ll meet Jess, so she’s the one that you’ll meet doing the Vectra simulation but Jess will talk to you about fees. But the important thing about our fees, they are all on the website, so if you go on our website, there’s all the permutations, so whether you’re insured or uninsured, obviously certain procedures do carry an item number but also it’s a total fee, so it’s a total out-of-pocket fee.

So that’s the surgeon, the anaesthetist, the hospital, the garment, the aftercare, everything. So that’s one fee, it just makes it really easy. I know some other practises get you to go off and try and get a quote for an anaesthetist and the hospital, oh God, what a nightmare, so that’s not what we do, we just make it easy for you.

So in terms of cost, so a breast augmentation with an anatomical implant is a day case at one of our properly accredited hospitals up here, we don’t do it basically in the rooms, that’s just over $11,000, so $11,100, about $600 less for rounds because a round is a cheaper implant.

A cosmetic breast lift, so you saw the lady that had it in two stages, if she’s stopped in that middle stage, and some people do don’t they?

Dr Moncrieff: Yes.

Amber: They have the lift and they say, this has solved my problem.

Dr Moncrieff: They don’t need the implant and a lot of patients go on to say, no I’m happy, I thought I wanted implants but I’m happy just to leave it.

Amber: So if it’s a cosmetic lift, and that really just means that you are just doing it for cosmetic reasons, there’s not a medical need which would have otherwise got an item number, that’s $16,000 so obviously that reflects all the same things, the hospital, the surgeon et cetera.

A lift plus implants, so this varies from $19,000 to $25,000, depending on whether it’s done in one stage or two stages. Again, for some of those smaller, less complex lifts with augs, it can be done in one stage but certainly in our practice, we see a lot of people that really would get a better result with two and you know, sometimes they do argue the toss and they say someone else that they know will do it for less and do it in one, good luck, we are not that practise, so that’s okay.

A breast reduction, so for those of you that might just be joining us because you’re interested in a breast reduction, if you’ve got insurance that’s $10,500 and as I say, all the fees are on our website.

A consult with Dr. Moncrieff is $250, a Vectra, which we will show you in a second, is $50 but if you do decide to go ahead, for a consult, you don’t have to but then that $50 just comes off your fee, doesn’t it?

Dr Moncrieff: Yeah.

Amber: So we encourage lots of people to do that, they just find it an easy way to have a look at what’s really possible and see lots of our before and afters and just sort of get our vibe.

Dr Moncrieff: Yep, and just meet …

Amber: Maybe we’re a bit conservative.

Dr Moncrieff: Maybe a bit bland.

Amber: We’re not bland, just a bit careful.

All right, so if you want more information, I’ll just show you this for a second, it’s basically just saying follow us on social media at the Hunter Plastic Surgery Facebook or Instagram page on Instagram it’s really good because you can type in Moncrieff Magic and see lots of real patient results like we’re just going to show you that.

Dr Moncrieff: Whet your appetite.

Amber: Yeah so lots of patients are happy to share their own experience, you know, we’ve got lots of reviews, not allowed to talk about reviews but you know, if you are on a search engine, and you were to look it up, but obviously on #MoncrieffMagic, if you type in that hashtag, lots of people will share their results and you can see what are realistic outcomes. I did see a lady actually just posted, just before we went on saying should she bring in pictures for us? What do you think? Do you like it?

Dr Moncrieff: Yeah great, bring in pictures, tell us what you like, tell us what you don’t like because that helps us, helps me anyway to see what type of implant, size of implant, the pocket, all those things to get the result you are after.

Amber: Yeah and just keep in mind though, that it’s got to be like for like, so you know if you’re someone like me, so in my mid forties, having had three children, the realistic outcome is going to be different from a girl in her twenties who has never had children.

Dr Moncrieff: Yes.

Amber: So just sort of understanding that you know, you will definitely try your best so someone like me could be you know, a supermodel but-

Dr Moncrieff: What do you say to that?

Amber: Yeah, yeah, yeah. Anyway we won’t get into domestic disputes. And then of course the website, that just shows the website, it’s definitely worth having a look at.

All right so the Vectra, so we’ll go through now and we’ll show you what happens in that room with Jess. So as you say, $50 and that comes off the consult with Dr Moncrieff if you want, a lot of people really love it, it’s fantastic for the breast augmentation, fantastic for smaller breast lifts and reductions. If however the nipple is really, really low, sometimes that can be a bit of a challenge for the simulator to really assess where that would go.

Dr Moncrieff: Yep.

Amber: In its simulation but look, there’s still lots of good things about coming in for a Vectra even if, on the day, we can’t get you a fabulous one, if you’re in that category of those sort of really, with lots of laxity kind of breast reductions and lifts but with no further ado, we will take you through.

So now you can come on the road through Hunter Plastic Surgery and I’ll just show you while we’re out here, this is our reception area and we have a little patient education and meeting room there and then we will take you through here. So we’ll just go past a couple of our treatment rooms so we do things like fat freezing in here and we have a couple of similar rooms that we do post ops.

But this is the room with the Vectra so you can meet our beautiful practise manager Jess.

Jess: Hello, hi everyone. Thanks for tuning in and welcome to our photo room and our Vectra room. So all the magic happens in here so we take all our before and after photos in here but we also have our amazing Vectra machine to help with our simulations.

So what happens in the Vectra appointments, so we come in and we get you in a robe and we get you to do your bra off and the machine just takes a photo and just scans so you don’t have to put your breasts in the machine as some people thought, it’s not a mammogram. So it then takes a photo and uploads to the computer and we can play around with different sizing.

So for Facebook, we have some lovely ladies in..

Amber: We might get you to talk here so we don’t lose the sound.

Jess: Okay. For Facebook, the lovely lady is in a bikini, but I’ll point to it now and you can see the difference, so she’s quite big, this is a reduction example, and you can see that they are lifted and a lot of the weight taken out, so I’ll just point to that now for you. So before and then after, much smaller, lifted, perkier, looking a lot better.

And then obviously of course, breast augmentation so again, this woman that I’m showing you the example of is in a bra but we can try different sizes, there’s not just one size we can try. We can go moderate and a little bit bigger, just to play around with the sizes. So this is an example, so small, moderate and a little bit larger.

So yeah, the Vectra simulation, we find it very reassuring for patients because if they’ve already seen Dr Moncrieff and they’re worried about sizing and things, this gives them a little bit of an example to see, you know, the sizing isn’t too big on their body or just showing with different lifts and reductions, what you can get out of it before committing to surgery. It’s definitely a great tool and if you’re interested, please come and see us.

Amber: All right everyone, so yeah just important to note with the Vectra that, obviously we’re not the only ones that have it, lots of plastic surgeons have it so it’s definitely worth, if you’re looking at having a breast aug, actually asking if they have the Vectra or there’s a few other systems, like there is Chrysalis and things so they are all quite good in just helping you understand what’s realistic and possible and again, just remember that when you do it, you’ll actually see on your own body, without the bikini on so we’ve only had to do that for Facebook tonight, but you actually get to see the full thing.

So excellent, well thanks Jess and thanks Dr Moncrieff.

Dr Moncrieff: Thank you everyone, thanks for listening, it was really good and hopefully it’s informative and I hope you’ve learnt something.

Amber: But yeah, go and check us out on our website or our Facebook and Instagram page. If you’d like more information, send us an email, you can send it on the website really easily tonight if you’d like, and we will get back to you tomorrow. But look, thank you very much for spending some of your Wednesday night with us.

Dr Moncrieff: Thanks guys.

Amber: And thank you so much to Trish for giving us the opportunity to show you a little bit about what we do. Thanks guys.

Dr Nicholas Moncrieff Interview
Dr Nicholas Moncrieff