Reconstructive Surgery

As a Specialist Plastic and Reconstructive Surgeon Dr O’Mahony has expertise in treating a broad range of medical and surgical conditions.

Her reconstructive skills are applied to many forms of plastic surgery. In particular she is an expert in facial skin cancer removal, breast and body surgery and congenital conditions such as cleft lip and palate and ear deformities.

Follow the links to read more about the Reconstructive procedures Dr O’Mahony performs.

Abdominoplasty (Tummy Tuck)

Abdominoplasty is a reconstructive surgical procedure undertaken to repair the separation of the abdominal muscles and remove the loose skin associated with pregnancy, or to remove large residual folds skin around the lower abdomen as a result of massive weight loss.

For some women following pregnancy, diet and exercise alone will make little difference to the abdominal muscles and skin that have been overstretched by a growing baby. The abdominal muscle separation that results from some pregnancies can lead to back pain or other discomfort due to loss of core stability, and persistent loose skin and a rounded belly that some onlookers even mistake for another pregnancy can be very disheartening or distressing for women.
How does pregnancy affect the abdominal muscles?

Pregnancy stretches all of the abdominal wall layers, but in particular results in the separation of the rectus abdominus (commonly known as the six pack) muscles that run up and down the centre of the abdomen. This separation is known as a ‘divarication’. With time and targeted exercises this muscle separation can be reduced, but in many women, particularly those with large or multiple pregnancies, the stretch has been so significant that the divarication cannot be corrected without surgery.

Who is suitable for abdominoplasty?

Women in otherwise good health with a divarication, or separation, of the rectus abdominus muscles and/or significant skin excess maybe suitable for abdominoplasty surgery.

If the surgery is following pregnancy women should have completed their family and their youngest child should be over 12 months old.

Abdominoplasty is not a weight loss procedure. The best results, and the lowest rates of complications occur in women who are in a healthy weight range.

Will my health fund cover the surgery?

Unfortunately as of January 2016, Medicare no longer recognises Abdominoplasty surgery to repair the muscle separation and skin excess after pregnancy as a reconstructive procedure. As result none of the procedure, including the hospital stay, can be claimed from your health fund.

Abdominoplasty after large weight loss is still recognised by Medicare in certain circumstances. Dr O’Mahony can advise you of your eligibility after examining you. You would then need to confirm with your own health fund if the relevant Medicare item numbers are included on your policy.

If you are considering Abdominoplasty Surgery and would like to consult with Dr O’Mahony please contact the office for an appointment on 3831 6983.

Dr O’Mahony’s office will provide a written quote for surgery following your consultation, and where appropriate can supply paperwork for you to present to your Health Fund explaining the clinical need for surgery to assist in your discussions with them.

Questions?
​If you would like more information or arrange a consultation with Dr. O’Mahony, please contact us for an appointment.

Body Contouring

The term ‘Body Contouring’ describes a variety of procedures to improve the aesthetics of certain areas of the body.

Body contouring procedures include Abdominoplasty (tummy tuck), breast lift (mastopexy) after pregnancy and breast feeding, or surgery to remove stretched skin and soft tissue after large weight loss.

If you are considering Abdominoplasty Surgery and would like to consult with Dr. O’Mahony please contact the office for an appointment on 3831 6983.

Dr. O’Mahony’s office will provide a written quote for surgery following your consultation, and where appropriate can supply paperwork for you to present to your Health Fund explaining the clinical need for surgery to assist in your discussions with them.

If you have any questions about this procedure, please do not hesitate to contact Dr. O’Mahony for an appointment.

Breast Reconstruction

Breast Reconstruction after Mastectomy can be performed using a variety of techniques, using a woman’s own tissue or using prosthetic breast implants.

The type of technique available to each patient is dependent on multiple factors, these include patient preference, previous surgery, radiotherapy, body habitus and other health issues.

If you are considering breast reconstruction Dr O’Mahony can discuss with you which options are available, taking into account your specific circumstances.

Dr O’Mahony understands that you have breast cancer or have been advised to consider a mastectomy to reduce your risk of breast cancer, it is a very difficult and confronting time. The amount of information to digest and the decisions to be made regarding cancer surgery, reconstruction and any future treatments can seem overwhelming. The information below may be a helpful guide.

Timing of Breast Reconstruction

The timing of Breast Reconstruction is dependent on a number of factors such as the type of reconstruction planned, the need for further cancer treatment such as radiotherapy, smoking, body habitus and a woman’s general health status.

Many women who are considering mastectomy will be understandably anxious to have their breasts reconstructed as soon as possible. In many cases an immediate reconstruction will be possible and successful, however Dr O’Mahony will advise some women to delay reconstruction for a number of months, for the reasons such as those mentioned above. Whilst this may seem disappointing at first, in all cases it is important to look for the end result to be as successful as it can be, with the risks of surgeries minimised as much as possible.

Prophylactic Breast Reconstruction

Some healthy women who have a high risk of breast cancer due to the BRCA1, 2 or other genes may elect to undergo mastectomy to manage this risk. The recent media attention given to high profile figures, such as Angelina Jolie, who have chosen this path has increased community awareness of prophylactic breast reconstruction.

Women who are considering prophylactic treatment should first visit a Breast Cancer Surgeon to discuss their individual risks and the relative benefits of mastectomy, and secondly a Plastic & Reconstructive Surgeon such as Dr O’Mahony to discuss what options are available to them for breast reconstruction.

Breast Reconstruction using your own tissue

Using your own tissue to reconstruct a breast has many benefits, and avoids the need for prosthetic material.  However, the procedures are very complex, with more lengthy surgical and recovery time.

The most common procedures are the TRAM Flap (Transverse Rectus Abdominis Muscle) or DIEP (Deep Inferior Epigastric Perforator) Flap. These procedures are quite similar and both use skin and fat from the abdomen to reconstruct the breast. The TRAM flap also takes some abdominal muscle, whereas the DIEP flap spares all muscle but is only suitable for patients with a specific pattern of blood vessels supplying the skin of the abdomen. In both flaps the tissue is transplanted from the abdomen to the chest, and rejoined to the body by microsurgically joining it to blood vessels in the chest behind the ribs.

In general this procedure is suitable for patients who have sufficient lower abdominal fat to make a breast, have had no major abdominal surgery in the past, are non-smokers and are in good overall health.

On average the hospital stay is 1 week, with up to six weeks recovery at home and up to 3 months before you would feel back to your normal self.

Breast Reconstruction using implants

Implant based reconstruction has the benefit of being a shorter and less physically invasive surgery, although it is usually undertaken in 2 stages, taking the final result longer to achieve.

The first stage of surgery involves placing a deflated, or empty silicon prosthesis called an ‘Expander’ behind the pectoral muscle in the chest. Two weeks following surgery Dr O’Mahony starts to inflate this expander by injecting fluid through the skin directly into the expander. Expansions are simple to undertake in the office, and performed weekly until there is sufficient volume of skin and muscle created to fit a formal prosthesis and make a breast of the desired size. A new form of expander that uses air rather than fluid to expand the prosthesis may be available to suitable patients and Dr O’Mahony can explain the relative benefits of both styles to you. Once the skin has settled from the expansions a second operation is undertaken to replace the expander with a formal breast shaped silicon prosthesis.

In general this procedure is suitable for slim patients with insufficient tissue of their own to make a breast. It is also suitable for those who do not wish to undergo such a lengthy and involved reconstruction as a TRAM/DIEP flap or do not wish to have scars elsewhere on their body.  It is not suitable for smokers or those who have undergone radiotherapy to the breast.

Both procedures require a hospital stay of up to 1 week, but you could return to work 2-3 weeks after the first and 2 weeks after the second procedure. The overall time taken to complete the reconstruction with the 2 procedures and the expansions is at least 3-4 months.

Breast Reconstruction using a combination of tissue and implants

In patients who have had radiotherapy to the breast, implant reconstruction alone can carry a risk of postoperative complications of up to 50%. This is due to changes in the skin, chest and breast tissue caused by radiotherapy, including a reduced blood supply and fibrosis, or stiffness of the tissue.

In patients who are unsuitable for or wish to avoid a TRAM/DIEP flap and would otherwise choose implant based reconstruction, a healthy muscle must first be moved into the chest in order to protect the implant. In these ladies the Latissimus Dorsi (LD) muscle flap is transferred from the back, through the armpit and into the chest to line the space for the expander and implant with healthy tissue. In most cases Dr O’Mahony will still use the 2-stage expander and implant approach in ladies who have an LD flap.

This procedure is usually reserved for those who have had radiotherapy, and do not need their LD muscle to be preserved (rock climbers or wheelchair users cannot usually spare their LD muscle). In some rarer cases women have sufficient fat over the LD muscle to make a breast without the need for an implant, and in those women this procedure can also be used as an alternative to the abdominal flaps.

The LD plus expander surgery requires two hospital stays of up to 1 week for both the first and the second stages. The overall recovery and time off work is approximately 4-6 weeks for the first procedure and 2 weeks for the second.

Nipple and Areola Reconstruction

In some circumstances the breast cancer surgeons spare the nipple and areola, but this is a decision taken between the patient and the Breast Cancer Surgeon who can best advise on the relative risks of this approach.

If removed, the nipple and areola are not reconstructed at the same time as the breast. If a woman wishes to proceed with nipple reconstruction it can be undertaken using the local breast skin 6 or more weeks after the breast reconstruction, usually as day surgery under local anaesthetic. Recovery from nipple reconstruction is very straightforward, although a bulky dressing protecting the new nipple for a few weeks can be tricky to camouflage in some clothing.

The pigmented areola can be tattooed around the new nipple anytime from 6 weeks after its creation. This is only requires anaesthetic cream and the tattoo is performed in Dr O’Mahony’s office.

Questions?
​If you would like more information or arrange a consultation with Dr. O’Mahony, please contact us for an appointment.

 

Breast Reduction

Why consider Breast Reduction Surgery?

Breast Reduction is undertaken in large breasted women for whom the weight and size of their breasts causes significant discomfort.

Common problems resulting from large breasts include painful neck, back and shoulders, indentation from bra straps, rashes and fungal infections under the breast in warm weather, along with difficulties in fitting bras and clothing, inability to exercise comfortably, and social discomfort. For these reasons women who make the decision to undergo breast reduction find that the procedure can make a huge difference to their life.

What is involved in the Surgery?

The surgery involves removing breast tissue to reduce the overall size and weight of the breast, and repositioning the nipple further up on the breast to give a more natural and youthful appearance. Whilst there are visible scars left on the breast skin, many women feel the scars settle well and are worth the benefits that the breast reduction has provided them. The scars are placed around the pigmented areola, and vertically downward from here to the fold under the breast, whilst another is placed in that fold. The long- term appearance of the scars depends very much on a woman’s individual biology but if you are considering this surgery Dr O’Mahony can show you some examples of post operative results to help you visualize the likely scars.

Breast reduction is undertaken under general anaesthetic in hospital, with one overnight stay. The recovery would usually necessitate 2-3 weeks off work.

Who is suitable for Surgery?

Large breasted women who are in good health and who suffer with problems such as those described above may be suitable candidates for surgery. Dr O’Mahony will not undertake Breast Reduction Surgery on smokers, or obese patients, as the risk of complications is too high to proceed safely. She would encourage women to be as close as possible to an optimum weight before surgery, however Dr O’Mahony does understand that large heavy breasts can severely limit the ability of ladies to exercise comfortably and effectively, which can limit their ability to lose weight. 

Will my Health Fund recognise this procedure?

Breast Reduction is considered a medically necessary procedure, rather than entirely cosmetic and therefore Medicare and Health Funds will cover some of the costs of surgery, although few will rebate the entire cost of surgery. Dr O’Mahony’s office can send you a detailed quote after your consultation if you wish to consider surgery.

Questions?
​If you would like more information or arrange a consultation with Dr. O’Mahony, please contact us for an appointment.

 

Skin Cancer Surgery

Queensland has the highest incidence of Skin Cancer in the world due to our climate, geographical location and the Celtic heritage of many Queenslanders. As a Plastic and Reconstructive Surgeon, Dr O’Mahony is a specialist in the surgical treatment of Skin Cancers, particularly when the face is involved, or when some form of reconstruction is required.

There are a number of types of Skin Cancers, most of which are best treated by surgical excision. The most common are

  • Basal Cell Carcinoma
  • Squamous Cell Carcinoma
  • Melanoma

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common form of skin cancer. There are a number of types of BCC, but the majority require surgical excision and reconstruction as necessary. If left untreated BCC can spread within the local tissues but is not expected to spread to other parts of the body.

Squamous Cell Carcinoma

Squamous Cell Carcinoma (SCC) is the second most common form of skin cancer. There is a spectrum of SCC, ranging from the non-invasive, pre-cancerous lesion known as ‘in situ’ or intraepidermal SCC which has not invaded into the deeper layers of skin, to invasive SCC of varying degrees of severity.

Invasive SCC requires surgical treatment, whereas in certain specific circumstances non-invasive SCC can be satisfactorily treated with non-surgical methods such as creams. Non-surgical treatments are usually undertaken by a Dermatologist.

SCCs can occasionally take a more aggressive course, travelling to local lymph nodes and elsewhere in the body. In these cases more extensive surgery and / or radiotherapy may be required to adequately treat the SCC.

Melanoma

Melanoma is less common than BCC or SCC but it is still the fourth most common Cancer in Australia. Like many Cancers, if identified and treated at an early stage, survival from Melanoma is very high. However, if a Melanoma is more advanced, or spreads elsewhere in the body, it can be very difficult to eliminate and may not be curable.

The only treatment for primary Melanoma is surgical excision with adequate margins. If you or your Doctor suspects you may have a Melanoma, it is important that it is treated appropriately. The first step involves accurate tissue diagnosis of the lesion. This involves a biopsy, aiming to remove the whole lesion for analysis. In cases where the whole lesion is too large to be removed and stitched closed directly then a partial biopsy can be undertaken of the most suspicious area. The tissue diagnosis determines the extent of the surgery that will be required to properly treat the Melanoma. The second step involves wide local excision of any remaining lesion, scar, and a margin of surrounding normal tissue, with reconstruction as required. Occasionally analysis of the lymph nodes draining the area is also required.

It is important that patients who have been treated for Melanoma undergo regular follow up to ensure no recurrence of the lesion. This should be undertaken 3-6 monthly for 5 years and 12 monthly thereafter.

Further information

More information on Melanoma can be found at:

More information on Skin Cancers and sun protection can be found at:

Questions?
​If you would like more information or arrange a consultation with Dr. O’Mahony, please contact us for an appointment.

Gynaecomastia

Gynaecomastia or enlarged male breasts can be a distressing problem that Dr O’Mahony corrects with surgery.

What Causes Gynaecomastia?

Enlargement of the male breast may result from a reduction in the levels of the male hormone testosterone compared with the level of the hormone oestrogen. This results in growth of breast tissue. In many cases of gynaecomastia is caused simply by the natural hormone fluctuations that are seen in infancy, puberty or old age.

Other causes for gynaecomastia include:

  • Significant hormone imbalance due to a medical abnormality in hormone production and balance
  • Liver or kidney failure
  • Medications
  • Alcohol
  • Illicit drug
  • Anabolic Steroids

How is Gynaecomastia Assessed and Treated?

Established gynaecomastia in adolescents or older men is treated with surgery. Surgery is not undertaken on infants for gynaecomastia. Prior to any surgery Dr O’Mahony would require investigation into the cause of the abnormal breast growth, usually with a history, physical examination and blood tests.

If you or your child has abnormal breast growth it is most useful to have your local doctor undertake the investigations or refer you to a paediatrician or endocrinologist for investigation into the cause of the problem before your appointment with her so she can proceed with advising you on treatment options when she meets with you.

Surgery for Gynaecomastia

The surgical technique for correction of gynaecomastia depends on the size of the breast. Breasts are composed or both fatty tissue and glandular tissue.

Small to moderate breast excess can be treated using a combination of liposuction to remove fatty tissue and contour the chest to a the normal male shape, and surgical removal of glandular breast tissue through a small incision around the areola (the pigmented area around the nipple), which is well camouflaged. This procedure does not remove extra skin from the breast. In young people the skin usually settles well after surgery and no skin removal is required. In a minority of people a second procedure 12 months or more after surgery maybe required to reduce loose skin if it has not tightened up.

Large breast excess is requires removal of fatty and glandular tissue along with excess skin in the first operation. This results in some scars on the chest around the areola, in the crease under the breast and vertically from the areola to the crease.

What is the Recovery after Surgery for Gynaecomastia?

Surgery is usually undertaken under general anaesthetic as a day case. Dr O’Mahony requires you to wear a compressive vest for 6 weeks after surgery , and not engage in any sport during that time. Time off school or work depends on the size of the breasts, one week maybe sufficient in small or medium breasts, usually 2 weeks in large breasts.

Will Medicare/Health Funds Recognise Surgery?

Correction of gynaecomastia is considered reconstructive surgery not cosmetic surgery and hence some rebates are often available from Medicare and or Health funds. Dr O’Mahony’s practice nurse can provide you with a quotation for surgery after your consultation.

If you would like to make an appointment to discuss your individual concerns regarding gynaecomastia with Dr O’Mahony please contact her office.

Ear Surgery

Asymmetry or other abnormalities can occur in one or both ears during development, following Surgery or after trauma. The ear is also a common site for Skin Cancers to develop as they are often exposed to the sun. Dr O’Mahony undertakes Reconstructive and Cosmetic Ear Surgery for a variety of problems.

Prominent ears, or ‘bat ears’ are a relatively common ear problem and surgery to correct them (known as Otoplasty) can be very helpful. To find out more about Otoplasty please follow this link.

If you would like to discuss your particular ear problem with Dr O’Mahony please contact her office to arrange a consultation.

Questions?
​If you would like more information or arrange a consultation with Dr. O’Mahony, please contact us for an appointment.

Congenital Breast Deformity

Congenital breast deformities have a variety of presentations, but the common feature of all conditions is the anxiety, confusion and social embarrassment many young women feel when they develop two very asymmetric or unusual appearing breasts in puberty. This can cause psychological distress during school years, particularly around sports such as swimming and changing rooms, but also in summer climates such as ours where social events often include swimming pool and beach visits and camouflaging the asymmetries in clothing is particularly difficult. For some girls and women development of intimate relationships can be adversely affected due to self consciousness around the appearance of their breasts.

What causes Congenital Breast Deformities?

Congenital breast deformities are usually predetermined in utero, with abnormal development of the immature breast bud on the chest. Because breast tissue does not grow and develop until puberty the abnormality is often not evident until the usual time of breast development when the breasts fail to develop in a normal shape and/or size. It not usually possible to explain why the developmental problem has occurred.

Some chest injuries, burns, surgeries or other treatments to the chest area in childhood such as radiotherapy can also impact on breast bud development and subsequent breast growth. This can result in major breast asymmetry or failure of normal development and require similar procedures to correct them as those resulting from congenital breast deformities.

Will Medicare/Health Funds recognise Congenital Breast Deformities?

Correction of Congenital Breast Deformities is usually considered reconstructive surgery rather than cosmetic surgery and as such Medicare and Heath Fund rebates may apply. The value of the rebates varies between funds and it would be rare for the entire cost of surgery to be covered. Dr O’Mahony’s office nurse will supply a detailed quote for surgery following your consultation and examination. In order to claim rebates for some conditions Dr O’Mahony may need to seek pre approval from Medicare for you before surgery can proceed.This can take up to 8 weeks.

What is the best timing for surgery?

The timing of correction for congenital or acquired breast deformities depends on the individual. Ideally surgery undertaken at completion of breast growth allows for fewer procedures on the breast, however Dr O’Mahony is very aware that significant asymmetries may need correction during puberty, when the asymmetries become to hard to manage before growth is completed. A final procedure may then need to be undertaken at the completion of growth. Dr O’Mahony will work with you to plan the best approach for your individual circumstances. In some situations Dr O’Mahony will ask you to visit a psychologist to help you prior to the surgery. This can be very helpful to assist you working through the changes to your body that breast surgery brings. For some procedures assessment by a psychologist is mandated by the Medical Board (AHPRA) if you are under 18 years of age.

Please follow the links below to read more about some of the more common types of congenital or acquired breast deformity. This list is not exclusive and congenital breast conditions come in many shapes and sizes. If you would like to consult with Dr O’Mahony about your particular breast concerns please contact her.