 muscles might be more sore, so you might have a little bit less control of the wheel when you’re turning it, and you may, depending on the procedures you’ve had, you may need to put a small pillow in front of your seat belt so that it doesn’t actually rub on the breasts themselves, but for the vast majority of patients, within a week, you should be back to driving.
Dr Rohit Kumar: It’s a very common question, actually, and my answer is very straightforward. If you’re an athlete and you went out and you’re playing sports and you tore a muscle, you’d be out of action for six weeks, right, for the vast majority of athletes, and the same applies. You haven’t torn a muscle. You’ve had a surgeon cut them, but the injury is essentially the same, so walking, getting around, doing aerobic exercise, start that a day or two after surgery. That’s not a problem, just in terms of gentle walking or brisk walking and you build up to it. Exercise that actually physical involve the muscles, so involving the pec muscle, so that may mean things like swimming or physically grasping and pulling things or lifting weights, they should wait six weeks, just like any other athlete that might have torn those muscles, and after that, you should slowly build up after that point.
Trish Hammond: Last week, I spoke to a young lady who had a breast augmentation about three years ago, and what’s actually happened now, she’s presented with a bit of a double bubble and her breasts have kind of gone a little bit pointed out towards the side. She was really happy with them at first, and then something happened that they kind of just popped out of their place. Is this common?
Dr Rohit Kumar: It shouldn’t be. It shouldn’t be common. I think there’s a lot of factors and having not seen her, it’s very difficult to comment, but the reality is that a double bubble can be caused by a variety of things, whether the implant’s too big for pocket that’s created, whether the pocket’s too big, whether the positioning above or below the muscles was not appropriate for the size of implant. What’s happened to the breast crease? Have you done anything? Say you’re a body builder and you’ve been using your pecs a lot more than you normally would.
There’s a lot of factors that come into play when you look at the development of a double bubble, so without seeing the individual circumstances, what we can say is that usually a double bubble forms when the implant is too big for the pocket that’s been created, and so you’re actually getting a distortion of shape, or it’s cousin, if you like, the waterfall effect is that if the implant is placed in a position and then the breast falls over the top of that over time, which can also have a double bubble sort of shape over the time as well. Often, it’s an issue in terms of marrying the size of implant with the pocket and the location of the pocket. If you get those three things right and that they’re appropriate for the appropriate patient, then your double bubble risk should be a lot lower than if you’ve got one of those things out of kilter.
Trish Hammond: If someone does get a double bubble, as far as the surgeon [inaudible 00:06:42], is it just bad luck?  What I’m trying to say here is who’s fault was it?
Dr Rohit Kumar: It’s hard to say. It is very, very hard to say. Look, it’s often as I said, sometimes it’s a decision based on the implant. Sometimes, it is surgically related and the type of surgery you’ve done. I certainly see a lot of patients who’ve been operated overseas who are seeing me for double bubbles, and to me, that is obviously and indication of not only surgical misadventure, but it’s also probably that you weren’t guided appropriately to choose the implant that best suited you, and you’ve got for an implant that’s way too big for what would have suited your frame, so often, it’s up to the surgeon to actually help you choose an implant that suits your frame, rather than just go, “Yup, fine, we’ll put the big one in,” because the big ones, and certainly once you go above 400, 420CC, the potential of developing something else tends to get a little bit higher.
If your frame can support it, if your breast dimension support it, then that’s not a problem, but if you’re a young, petite person, and you’re asking for a 500CC implant, then it really is important for the surgeon to discuss with you your higher chance of possibly developing a double bubble, but also maybe guide you away from that, because it’s probably not the most proportional implant. Also, it makes sense to see the type of operating and dissecting you would need to do to cope with that larger implant and if you don’t have the skills to do that, then yes, I think a double bubble is going to be on the cards.
Trish Hammond: What about for the … You see it happen with all the time on all the closed Facebook groups that we have and people say, “Oh my god, look, one’s higher than the other,” and irregular and all that. Can you explain to us a little bit about dropping and fluffing and what that actually means, because people go into a bit of a meltdown when they don’t need to.
Dr Rohit Kumar: You’re right, I’ve heard a few of these terms along the way. I just use the term breast dropping and the reality is that when you actually did the implant right at the very beginning, you set the implants high because you know that they’re going to fall with gravity. You know that you want to position them to where they’re going to go once gravity kicks in, once the pocket stretches and once the muscle stretches out and accommodates the implants, so if you put them exactly where you would expect them to be when you wake up and for the rest of your life, they’ll just go lower than that point and they’ll change, so what you need to do is when you create the pocket, you put them a little bit higher, you set them up so that you know that over the next few weeks to months, they’re going to settle down to their proper location.
Dr Rohit Kumar: When you look at the breast pre-surgery, then during, and then certainly after and after not just a month after, but then six months after, they’re very, very different. Initially after surgery, everything’s stretched, they’ve almost got a bit of a sheen to them, they’re sitting a little bit higher, and as everything starts to accommodate the new implants, all of that will gradually settle in, and so your breasts don’t actually achieve the true shape and form and position for up to six months after surgery.
Trish Hammond: That was my next question. 
Dr Rohit Kumar: That’s right. That’s exactly right. A good six months before you have an idea of exactly what you’re going to look like. Anytime someone looks at their breasts and goes, “Oh, they don’t look right,” or “My left is sitting higher than the right,” or something like that, you can’t actually really make a call, and there’s no rule that says that they both have to fall at the exact some rate, so one may settle down earlier than the other, and it’s just a matter of time and then you see what they’re like at about six months.
Trish Hammond: Another thing I wanted to ask you is, and I know this different for everyone yet again, as well, but what about scarring? I know it’s not very common for people to have the implant incision under the arm anymore in Australia. Is that right?
Dr Rohit Kumar: That’s right, for a variety of reason. I tell my patients, “You don’t fix the engine in your car by coming in from the roof. You actually come in from the garage.”  While you can hide a breast crease incision wearing a bra or bikini, if you’ve got it in your armpit, which is also at a very dirty, contaminated area to go and put your implant through, not only is it difficult to create the pocket, it’s a scar that doesn’t tend to form as well as it does in the breast crease, and you’ve got it in an area that’s going to be significantly more visible. If you wear strapless dress or something out, you’ll see the armpit scars. You won’t see the breast crease scars.
Trish Hammond: Now, for those women that have had a breast augmentation, having a bit of a panic thing: “Oh my god, they’re not okay,” the best course of advice is to of course contact your surgeon and make that your first port of call.
Dr Rohit Kumar: First port of call: contact your surgeon, see what they say, see what it’s like, give it time, let them all settle in and if you’re still not happy, if you’re not happy with the answers, if you’re not happy at six months as to what they are, then, by all means, get a second opinion.
Trish Hammond: Say, for example, if someone isn’t happy and