Prof. Pennington FRCS (Ed), FRACS is the former senior Plastic Surgeon and Department Head of Plastic Surgery at Sydney’s Royal Prince Alfred Hospital, now Associate Professor of Plastic Surgery at Macquarie University. He is one of Australia’s most experienced Microsurgeons, and practices a wide range of Plastic Surgery and Cosmetic Surgery, sub-specialising in Reconstructive and Cosmetic Surgery of the breast.
Prof. Pennington is a member of the Australian Society of Plastic Surgeons and the International Society of Aesthetic Plastic Surgery. Dr. Pennington has featured on a number of episodes of the well-known Channel Nine series ‘RPA’.
Read Dr. Pennington’s full bio
The microsurgical DIEP flap has now overtaken the older TRAM flap as our preferred method of breast reconstruction, having the lowest failure rate and most natural appearance when compared to implant-based reconstructions. Like the TRAM flap, the blood supply of the DIEP flap is based on small blood vessels that pass through or “perforate” the rectus muscle in the abdomen. Unlike the TRAM flap, these blood vessels are extracted from the muscle by splitting it, rather than removing muscle as happens with the TRAM flap. A number of scientific studies have confirmed that this method weakens the abdominal wall less, particularly when a double or “bilateral” reconstruction is performed.
The recent news story of actress Angelina Jolie having bilateral mastectomies has heightened the interest of women who are genetically at high risk of breast cancer in having bilateral mastectomies and simultaneous reconstruction. Whilst some women will be suited to implant-based reconstructions, those who have suitable abdominal tissue have the option of a more natural reconstruction with their own tissue, thus side-stepping the problems of implant reconstruction. These implant problems include possible hardening in around 20-40% of cases (capsular contracture), implant deterioration and rupture and the rare risk of anaplastic large cell lymphoma.
For the last 4 years Prof Pennington has been using a pre-operative planning technique using a CT angiogram to show, measure and map the small blood vessels of the lower abdominal wall to be used with the DIEP flap. He has recently published a ground-breaking research paper demonstrating that measurements taken from the CT angiogram can be used to give a formula that predicts how much of the tissue will survive, allowing intra-operative “tailoring” of the flap. This significantly improves the results of this operation.
This gives both surgeon and patient a greater degree of confidence that the procedure will be successful. As a result our success rate with the DIEP flap is now approaching 99.5%
For further information on breast reconstruction, please see the dedicated Reconstruction section under Breast on the top menu bar.
Rojina before and after surgery to release contractures of her right shoulder and elbow
In March-April 2012 another team of Plastic Surgeons from Australia and NZ, headed by Prof Pennington, as well as Anaesthetists, nurses and ancillary staff visited Nepal. This was the 9th such program, and this time 39 patients were operated on over a period of two weeks, to relieve severe burn-scar contractures. All procedures were successful and all but three patients had been discharged from the Scheer Memorial Hospital by April 24.
We were also able to review several patients who had had previous surgery, and three of them underwent procedures to further improve their restricting scars. An example is Rojina, an eight-year old girl whose “before and after” photos are above.
This program relies entirely on donations for funding, and those wishing to do so may go to http://www.sah.org.au/healthcare-outreach-donations where you are directed to the donations website. Tax-deductible donations should be made to “Sydney Adventist Hospital Foundation – Project C”. Thank you !
Silicone implants have been the mainstay of breast augmentation surgery for over forty years. The commonest complication of all-silicone implants has been capsular contracture, where the body’s reaction to the implant in around ten percent of patients causes the implants to feel hard, go out of shape or cause discomfort. Coating the outer shell of the silicone-filled implant with polyurethane foam has been known for many years to reduce the incidence of these complications to around one percent, but there had been safety concerns in the past. These are now resolved and polyurethane-coated implants are making a comeback.
A Brazilian company, Silimed, have pioneered the re-introduction of polyurethane-coated implants into the market, and they have recently become available in Australia. Allthough they won’t necessarily replace the standard textured surface silicone implant in all cases, many surgeons are using them to replace silicone implants that may have developed capsular contracture before, to reduce the risk of that happening again. Moreover the reduced risk of contracture makes them more attractive for some patients seeking breast reconstruction after mastectomy, as those patients normally are at a much greater risk of capsular complications.
Another advantage of the Silimed implants is that for now their cost is significantly less than the usual silicone implant range available. Replacement of implants that have developed medical problems or complications attracts a Medicare rebate, and health funds will usually cover hospital costs, further reducing costs in patients who have suffered those problems.
Dr Pennington has commenced using these implants in selected patients, so far with good results, although the follow-up periods have not been long to date.
To enquire about these new implants, please phone 92471066 and request an appointment with Dr Pennington. For general information on breast augmentation, see the “Breast” section on this website.