Breast Augumentation
Why would I consider breast augumentation?
Breast enlargement is an operation by which the breasts are enlarged with the use of prostheses to make the size, shape and proportions of the breast more normal. It is known technically as breast augmentation and augmentation mammoplasty.
Who benefits?
You would consider breast enlargement if you feel your breast size and shape is out of proportion with the rest of your body. You may feel that you are not balanced, which can result in great concern. Although an anatomical site, breasts are symbolic of femininity and sensuality throughout the ages.
This operation can be extremely satisfying and successful for a woman with disproportionately small breasts. As your surgeon, I would evaluate your motivation, as a patient, to ensure that your expectations of this surgery are realistic.
For example, if you have little or no breast, but feel that you should be of a larger and more normal size - for no other reason than your own fulfillment - you would be an appropriate candidate for breast enlargement.
Breast enlargement is not only performed as a purely cosmetic procedure. It also falls under the realm of Plastic and Reconstructive surgery in the treatment of some syndromes that result in the breast being smaller, usually on one side. e.g. Poland's Syndrome is a congenital syndrome in which the breast and sometimes muscles on one side of the body do not develop normally. This results in a very small breast or no breast at all on the affected side. In rare situations, this can affect both breasts.
Breast enlargement performed to make a patient huge or ridiculous is a rare occurrence - unfortunately, it does sometimes occur and results in a negative stigmata being associated with the operation.
How is it done?
I typically perform breast augmentation surgery as day surgery.
The surgery is performed under general anaesthetic. If the muscle needs to be released, I prefer to do this with the muscle relaxed and with gentle electro-cautery.
My methods of breast enlargement are performed under vision, with no tearing or ripping of tissues, so drains are only used in 10% of my primary breast augmentations (patients who have not had a breast augmentation prior) via an inframammary incision.
Is one method of breast enlargement best?
The answer to this question is simply no.
It is not logical to suggest that one method of breast enlargement fits all patients. Every patient is individual and different, therefore, the type of incision, type of implant and placement of the implant needs to be individualized.
Every woman that presents for breast enlargement has her own body, her own anatomy and her own ideas of how she should be.
If you present to a surgeon regarding breast enlargement and you are only offered one type of incision, one type of implant and one type of implant placement - this may suggest that this is the method of breast enlargement that they are comfortable with, rather than necessarily what best suits your needs.
Is silicone dangerous?
Silicone breast implants were first used in the 1960's. Litigation and controversy surrounded the issue during the 80's and 90's - this was most public and evident in the U.S.A. Since that time scientific studies have not supported the claim that silicone implants are associated with diseases.
This is summarised by the findings of an expert panel in the class action trial in the U.S.A about silicone filled breast implants. This panel examined submissions by the plaintiff, defendant and also any scientific information available to them.
They concluded that silicone breast implants were not associated with any diseases related to toxicology (poisoning), immunology (immune system) or rheumatology. Epidemiological studies also did not support any association between silicone and any definite connective tissue disease or auto-immune or rheumatic conditions.
The report did indicate that free silicone in the body was subject to a local tissue reaction typical of any foreign body in the body, i.e. scar tissue formation. A summary of this report can be examined at the USA’s Federal Judicial Center web site www.fjc.gov/BREIMLIT/SCIENCE/summary.htm.
What incisions are used?
The three most common incisions used are the inframammary, periareolar and the axillary / armpit:
- Inframammary incision | an incision 40 mm in length in the inframammary fold - where the breast joins the chest wall.
- Periareolar incision | an incision that goes in a semi-circle around the lower half of the junction of the areolar and skin of the breast.
- Armpit incision (40 mm) | an incision in the apex of the armpit, which then allows endoscopic dissection and placement of the implant.
Endoscopic surgery often involves the use of small cameras and special instruments and is technically more demanding of the surgeon.
Each of these incisions has advantages and disadvantages depending on an individual patient's anatomy and the type of prosthesis to be used. The best type of incision to be used for any patient is an integral part of the discussion and decision making that occurs between the surgeon and the patient.
What type of implants are available?
There are basically three things differentiating implants:
Filling
In Australia both normal saline (i.e. water filled) and silicone filled implants are available:
- Saline
Advantages: should a leak occur, then it is simply saline that escapes into the body and it will be absorbed accordingly.
Disadvantages: they do leak and have a life expectancy of 7 to 10 years. They are firmer and have the highest risk of rippling. - Silicone
Advantages: the implant is softer-feeling, closer to the texture of normal breast tissue. Modern silicone implants are of aTurkish Delight
consistency and are not runny. They arecohesive gel
implants and, even if cut in half, the silicone does not run.
Disadvantages: Other than the general risks of the operation, nil specific
Shape
The shape of implant used can either be round, asymmetric (left and right) or anatomical (tear drop shaped):
- Round implants are, as the name implies, circular. If you have a reasonable amount of breast tissue already or thicker chest wall tissue, then round implants are my preference. Given their uniform shape, round implants do not carry with them the risk of mal-rotation that, although uncommon, can be associated with non-round implants.
- Anatomical implants are pear-shaped. They are shaped to closely mimic the shape of the breast. If you have a thin chest wall, my preference is for anatomical implants, as I am able to achieve a more natural look compared with round implants (which tend to look more obvious in this situation).
- Asymmetric implants are wider at the side and therefore tend to push the breast and nipple more centrally. If you have a thinner chest wall and either a wide chest, or laterally placed nipples; then an asymmetric implant will give a more natural appearance.
Texture
An implant can either be smooth on the outer surface or textured.
- Smooth
- Textured implants have a rough surface designed to decrease problems related to capsule formation around the implant.
The most appropriate type of implant for you, with respect to shape, surface and filler; depends on you, your anatomy and the type of incision to be used - this forms an integral part of the discussion between you and your surgeon.
Where does the implant go?
The chest wall consists of the breast, the muscle layer (pectoralis major) and then the rib cage.
The vast majority of breast implants are placed either fully or partially behind the muscle layer.
However, the implant can go into either one of two spaces:
- Sub-muscular | the most common site of placement because a woman presenting for breast augmentation often has very thin tissues of the chest wall. Therefore, in order to protect and camouflage the implant, it needs to be placed deep to the muscle.
- Sub-fasaial (pre-pectoral | if you have a specific body structure, ie female body builder, or if you are undergoing this procedure to correct a specific type of breast tissue deformity, then the implant can also be placed immediately deep to the breast tissue.
What can I expect?
You are typically admitted on the day of surgery fasted from the night before. The surgery is usually day surgery.
Specific advantages and disadvantages of each type of approach and scar should be discussed with your surgeon. Antibiotics are given during the operation and take home antibiotics are also given to reduce the risk of infection.
How long does it take to recover?
Recovery with a sub-mammary / sub-breast implant placement can be measured in days and is shorter than when the muscle needs to be released.
If the implant is released, and it is placed deep to the muscle, recovery is several days to a week.
What complications can occur?
Although every endeavour is made to avoid complications, sometimes they do occur and it does not necessarily imply an error has occured. Complications do not necessarily imply an error has occurred, they can be related to the anaesthetic or the surgery.
Surgical complications can include examples such as: bleeding and bruising, swelling and infection. All incisions result in a scar that usually fades and is not easily seen.
Changes in sensation of the breast and nipple can occur.
Capsule formation occurs as the body's response to the implant. It is only if the capsule becomes particularly thick and constricted that this becomes a capsular contracture. Capsular contracture can result over time, with the implant becoming harder and smaller, and may be a reason for repeat surgery. For textured implants the risk of a bad capsule is 1.7 % (Bronz 1999).
Malrotation of an implant can occur in non-round implants. In my experience this is an uncommon event but is the reason shaped implants are used only when they offer an advantage to the specific patient.
Determining whether you are symmetrical to begin with is an important part of the initial assessment by your surgeon. If you are not symmetrical to begin with, and most women are not, then subtle differences are likely to persist after.
Although this list indicates some examples of complications, surgery should not be undertaken until this has been discussed fully with the surgeon.
What other procedures are often performed at the same time?
Generally, breast augmentation is performed as a solo technique.
Sometimes, if there is a significant degree of droopiness to the breasts, your surgeon may indicate that a breast lift should be performed simultaneously. This not my preference, as one part of the operation is designed to make the breast tighter and better shaped while the other part of the operation is designed to enlarge the breast. When done together there is a significant risk of scars stretching.
If both procedures are required, I prefer to do the procedures at different times. Whether the breast enlargement or breast lift is performed at the first stage will depend upon which procedure is most likely to lead to satisfaction and, hopefully, not need to lead on to the second stage operation.
What does it cost and will private insurance help?
Exact costing is highly variable, as it depends on your history and circumstances, the hospital used and specifics of the procedure.
Some private health insurance companies in Australia will assist with bed and theatre fees even on purely cosmetic procedures.
If a procedure can be given an item number then rebates may apply. This may be applicable to you if you have significantly different sized breasts.
A cost guide can be requested from my office on +61 8 9485 1333, some of the individual cost factors can be estimated with more information. Alternatively, we can be emailed at info@cosmetic-surgery.com.au
Where can I get more information?
If you have specific questions, or wish more information on specific procedures, please don"t hesitate to contact my office for a complimentary appointment with my nurse / patient liaison officer.
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