Breast augmentation.

Since its introduction in 1963, millions of women have chosen breast implant surgery as a reliable way to produce larger, fuller breasts.

The basics

Since its introduction in 1963, millions of women have chosen breast implant surgery as a reliable way to produce larger, fuller breasts.

What can I expect to achieve?

During consultation, you’ll learn about breast implant surgery and breast implant devices, and their potential to achieve your preferred size and shape. If you are realistic about your own anatomy and situation, you are likely to be satisfied with the outcome.

  • If the breast is well shaped before surgery, with non-stretched and elastic skin, and there is a reasonable amount of breast tissue present, a good result is normally possible, with a well-shaped breast and relatively natural texture.
  • If there are pre-existing problems with breast volume or shape, it is not always possible to achieve a natural or ideal result by implants alone. Good results can still be achieved but they may be adversely affected by stretched or loose skin, where there is very little breast tissue, or if you are very thin. A lift may also be necessary to achieve a good result.

What happens before surgery?

During consultation, I will carefully examine you and recommend the best surgical treatment plan for your individual situation. I will also discuss with you the quality of result the surgery is likely to achieve.

Various strategies can be used to achieve the best possible result – incisions, implant position, implant shapes, and adjustments to the breast tissue envelope. The choice of treatment may not necessarily be your personal preference, or even mine. Instead, I will recommend the type of implant and procedure that will best achieve your goals after carefully assessing breast anatomy, chest wall anatomy and functional requirements, as well as the desired breast size.

What type of incision is used?

The most common type is the infra-mammary incision (under the breast). The periareolar (around the nipple) method has the highest risk of affecting nipple sensation and the highest risk of infection, so I use it less often. It is more often used for areolar surgery, or if a lift is being undertaken as well. An axillary incision (under the armpit) can also be discussed if appropriate, but usually is not ideal if cohesive gel implants are used.

Where are implants placed?

Implants are placed either under the muscle (subpectoral or dual plane) or on top of the muscle and under the breast (subfascial or submammary).

  • The natural breast is actually a skin structure and lies within the body fat under your skin.
  • Under the fat layer is the pectoral muscle, and this is covered by a thin strong layer called the pectoral fascia. The fascia allows the muscle to move or glide under it. The pectoral muscle lies on top of the ribs.

Note that the pectoral muscle only lies under the upper half of the breast. So, an “under the muscle” approach refers to the top part of the implant only, not the part that sits under the lower part of the breast.

How do we decide where implants are positioned?

This is perhaps the most important decision regarding your surgery and the desired outcome. It is particularly important if you are thin or have minimal breast tissue or loose skin, as your implants will potentially be more visible.

Before making a decision, we will take you through all the options in detail, including the advantages and disadvantages of “above the muscle” and “under the muscle” placement. You will probably also wish to do your own research and may develop your own preferences for the position of implant insertion.

The decision will be made together, after a careful physical examination and depending on your current breast shape and physical activity level.

Above the muscle – pros and cons

The advantage of the “above the muscle” (subglandular or subfascial) plane is that pectoral muscle activity or strength does not negatively influence the position or movement of the implant. The operation is generally less painful for the patient and achieves excellent results. In certain patients, especially those with wide spaced breasts, or “pigeon chest” (pectus carinatum), the implant needs to go above the muscle to achieve the best result.

Disadvantages of this method are the potential for implants to be visible, which can give a ‘fake look’, or effects on implant shape such as visible rippling. A ‘fake look’ is more likely in patients who are very thin or have very small breasts with little natural breast tissue, or who have very soft breast tissue with some droopiness and loss of firmness of the breast.

Under the muscle – pros and cons

The advantage of the “under the muscle” approach is that it can cover and disguise the upper part of the implant better. In certain types of breast and chest shapes, this definitely creates a better look. Also, in the unlikely event that capsular contracture occurs (tightening of scar tissue around the implant), the result is more attractive.

The disadvantages of this approach are mostly due to the forces the pectoral muscle places on the implant, which sits partially under it. Most patients with this type of implants experience some movement or flattening of their breasts when they use their pectoral muscle. This can be unsightly, and over time can actually force the implants out of position, either downward (causing a “double bubble” effect), or outward toward the armpit. Though it is not dangerous, it is often unsightly and distressing for the patient.

Women who are thin and exercise a lot, and especially those with strong pectoral muscles, are faced with a difficult decision. An implant above the muscle is less risky for implant movement, but may cause a “fake look”. An implant under the muscle is at higher risk of displacement, muscle tension bands and movement or compression complications.

How do I choose my implants?

This is another important choice when having breast implant surgery. Breast implants have now been well studied and are regarded by the Australian Therapeutic Goods Administration as safe for implantation as medical devices.

Saline implants, which were used in Australia during the period when gel implants were under study, are still available.

However, I usually use cohesive gel implants in my practice, as I believe they are the best, safest and longest lasting implant types available. Also, the gel filling does not leak out in the event of rupture. I only use implants made by large multinational companies, as they are more likely to be around in the longer term than smaller companies.

Breast implants come in many shapes and sizes and choosing the right size is obviously important. Your options are limited by the size of your chest and the shape of your existing breasts, but there will normally be some choice when it comes to size and projection.

To help you make the right decision, I will work with you, following a proven protocol and using a number of different tools including digital imaging.

What happens during surgery?

An incision of around 4-5cm is made to create the pocket that contains the implant. I use the Keller Funnel™ (www.kellerfunnel.com) to deliver the implants through the incision. This reduces handling of the implant, which in turn reduces the risk of contamination and capsular contracture. I rarely use surgical drains, and stitches are dissolving, buried under the skin.

Antibiotics and antiseptics are used as part of the procedure to reduce the risk of infection, along with meticulous sterile techniques in the operating theatre. Local anaesthetic is administered to reduce postoperative discomfort and most patients wake up fairly comfortably.

Minor asymmetry may be visible after the surgery, and this is quite natural, as very few women have perfectly matched breasts to begin with.

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What happens after surgery?

You will be given medication to limit any pain and nausea immediately after the procedure. Usually no drain tubes are needed, and I use skin tape on the wound with a light compression garment as the only dressing.

An intravenous drip is removed once fluids can be tolerated. Breast enlargement is often a day procedure. If you have travelled a long distance, are prone to post-anaesthetic nausea and vomiting, or just prefer it, we recommend an overnight stay.

At home you must rest and take medication for pain as directed. One to two weeks off for office work is sufficient. I recommend two to four weeks off work if any physical labour is required. You may resume driving once you are comfortable, can react quickly if necessary, and are not taking strong painkillers. This usually takes between three and seven days.

Full exercise can be resumed six weeks after surgery. Light exercise can begin earlier. Follow up appointments will be arranged before surgery, and if you have any concerns when at home, just call my office in office hours.

For urgent problems, I can be contacted at any time through the number on my office answering machine. If you feel it is an emergency, which is very rare in breast implant surgery, you should go to the nearest emergency department or call an ambulance, and contact me when there.

Possible complications

Complications of the surgery are possible, though unlikely and revision surgery may be required. Occasionally, implants will need to be removed. Although unusual, nipple sensation may be temporarily altered by breast implant surgery, and, occasionally, permanently altered. Breast feeding is unaffected by breast implant surgery.

Before you commit to having this surgery, it is important that you read the document “Consequences, Risks and Complications of Breast Augmentation Surgery” which we will provide for you.