Key facts about breast augmentation
- Breast enlargement does not correct sagging breasts. If you have sagging breasts you may need to have a breast lift (mastopexy). This surgical procedure involves removing excess skin and shifting the nipple position.
- Breast implants will not affect your ability to breastfeed.
- The two types of materials used in breast implants in Australia are saline and silicone.
- If you want breast augmentation to boost your confidence, there are alternatives to breast implant surgery, including counselling, therapy or wearing padded bras.
- Breast implants are not guaranteed to last a lifetime. Future surgeries may be required to replace one or both implants.
- You will normally achieve a good breast augmentation result with well-shaped breasts and a relatively natural texture if your preoperative breast has non-stretched, elastic skin, is well shaped and has a reasonable amount of breast tissue present.
- If your preoperative breast has a non-ideal shape, has stretched or lax skin, has very little breast tissue or you are extremely thin, it is not always possible to achieve a natural or an ideal result. Although good results can still be achieved, it is important to note that in patients with pre-existing shape or volume problems, poor results may occur despite the best efforts of the surgeon.
- Being realistic about your own anatomy and situation is essential to achieving satisfaction with your breast augmentation outcome. Not all patients can achieve the exact breast enhancement result they most desire.
What is breast implant surgery?
Breast implant surgery, also known as augmentation mammoplasty, breast enlargement or colloquially, a 'boob job', is a surgical operation where implants are inserted beneath the breasts to enlarge them.
Who is breast augmentation surgery for?
Women who opt for the breast enhancement usually want to:
- Restore or replace volume and aesthetic appeal after weight loss, pregnancy, breast feeding, general ageing and health related issues such as breast cancer
- Increase the size of the breasts and achieve a more proportionate shape and symmetrical look
- Lift sagging or drooping breasts caused by volume loss, genetics, loss of skin elasticity or general ageing
- Reconstruct a breast after a mastectomy or injury
- Reduce breast size because the size or weight has caused posture and other health related issues
- Remove and replace breast implants
- Correct previous breast surgery
Who is breast augmentation surgery not suitable for?
Breast implant surgery is not suitable for women with untreated breast cancer or pre-malignant breast disorders, active infection anywhere in the body, or who are currently pregnant or nursing.
People with a weakened immune system (currently receiving chemotherapy or drugs to suppress the immune system), conditions that interfere with blood clotting or wound healing, or have reduced blood supply to the breast tissue from prior surgery or radiation therapy treatments may be at greater risk for complications and poor surgical outcome.
How is breast implant surgery performed?
Breast augmentation and enlargement is achieved by inserting a breast implant either behind the breast tissue, or partially or completely under the chest muscles. Incisions are made to keep scars as inconspicuous as possible, usually under the breast, around the lower part of the areola, or in the armpit.
When breast implants are inserted during the breast reconstruction process, tissue expanders are used to stretch healthy skin in order to provide coverage for a breast implant. Breast implants are manufactured in a variety of shapes, sizes, and with either smooth or textured surfaces.
The method of implant selection and size, along with surgical approach for inserting and positioning breast implants will depend on your preferences, your anatomy and your surgeon's recommendation. The shape and size of your breasts prior to surgery will influence both the recommended treatment and the final results. It is important to note that if your breasts are not the same size or shape before surgery, it is unlikely that they will be completely symmetrical afterwards.
What kind of breast implant should you choose?
To help reshape or fill-out your breast area, breast implants come in many different shapes and sizes. The type of breast implant will depend on whether you want to have slightly a fuller breast cup size (from an A or B cup size to a C or D cup size), more noticeable breast cleavage or a fuller side breast.
You can choose silicone gel filled or saline breast implants that are round or anatomical, smooth or textured. The implant used will also depend on what type of profile you are wanting in terms of cleavage and projection.
The silicone used to fill the breast implant can be in the form of a gel (cohesive silicone) or liquid. Saline and liquid silicone implants will give you a softer and more natural feeling breast.
Cohesive silicone implants will give you a firmer feel and come in more shapes, including those that look more like a natural breast. Cohesive silicon implants are often recommended to women who are having a breast reconstruction.
Textured liquid implants with a simple round shape will often give similar results as shaped cohesive-gel implants.
Polyurethane-coated implants give a firmer consistency. Some breast augmentation patients choose these as they can reduce the risk of scar tissue thickening and tightening around the implant.
To give you a result that is proportionate for your physique and looks good, your Breast Surgeon will customise the breast augmentation surgery.
Is Silicone safe?
Silicon (without the ‘e’) is one of the most common natural elements. It becomes silicone when it combines with oxygen, hydrogen and carbon. Silicone has brought major benefits to industries, such as food production and personal-care products and can be made into many forms.
Because Silicone does not dissolve in water or react easily to changes in temperature or to substances in your body, it is useful for healthcare products. Silicone is also used in tubes used to give people medication, in facial implants and to make heart-valve replacements.
Many scientific studies have been carried out to discover if silicone breast implants are safe. There has been no evidence to suggest that women with silicone breast implants have a higher risk of developing autoimmune diseases such as breast cancer and arthritis. A reported link between having an implant and a rare type of cancer called anaplastic large-cell lymphoma has emerged, but the increase in risk is small.
Your breast implant plane and position
Breast implants can be placed “under or over the muscle”. It is very important before your breast augmentation surgery to understand what this means. You also need to be aware of the pros and cons of your decision about which plane your implants are placed in.
Implants are placed either under the muscle (subpectoral or dual plane) or on top of the muscle and under the breast (subfascial or sub-mammary). Both have their advantages and disadvantages.
The normal breast is actually a skin structure, so it lies within the body fat under your skin. Under the fat layer is your pectoral muscle that is covered by a thin strong layer called the pectoral fascia. This fascia allows the muscle to move or glide under it while your pectoral muscle lies on the ribs.
- The pectoral muscle only lies under the upper half of your 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.
What are the advantages and disadvantages of “Under the Muscle” and “Over the Muscle” breast augmentation?
Over the muscle:
The advantage of the “over the muscle” (subglandular or subfascial) plane is that pectoral muscle activity or strength does not negatively influence the position or movement of the implant.
Although pain tolerance varies very widely, the breast augmentation operation is generally less painful for the patient. In most cases, placing an implant above the muscle works perfectly well and achieves excellent implant results and patient satisfaction.
In patients with wide spaced breasts, or “pigeon chest” (pectus carinatum to use the medical term), the breast implant has to go above the muscle to achieve the look the patient is seeking.
The disadvantages of placing an implant over the muscle are all about the possible visibility of the upper pole of the implant leading to a “fake look”. In certain types of patients, this can occur particularly if they are:
- Have very small breasts with little natural breast tissue,
- Very thin,
- Have very soft breast tissue with some droopiness
- Have a loss of firmness of the natural breast tissue or skin
These patients will achieve much better results with an “under the muscle” approach.
A poor result of the “above the muscle” plane is generally due a fake look, or negative implant effects such as visible rippling or implant visibility. Over the years, the “under the muscle” approach has often been promoted as having a lower risk of capsular contracture. Whether this is true or not, capsular contracture occurring in an implant “above the muscle” looks worse than a capsular contracture in an implant “under the muscle”.
Under the muscle:
The advantage of the under the muscle approach is that it can cover and disguise the upper part of the implant better. There is no doubt that this creates a better look in certain types of breast and chest shapes.
The disadvantages of the “under the muscle” approach mostly relate to the forces the pectoral muscle places on the implant, which sits partially under it. Many patients with “under the muscle” implants experience some movement or flattening of their breasts when they use their pectoral muscle.
In some cases, 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. This effect is not dangerous, but is often unsightly and distressing for the patient.
Women who are thin and exercise a lot, and especially those who use chest weights and have strong pectoral muscles, are caught in a dilemma. An implant under the muscle in these patients is at higher risk of displacement, muscle tension bands and movement or compression complications. An implant above the muscle is less risky for implant movement, but may cause a “fake look”.
Your Breast Surgeon will take you through these choices, so after the pros and cons have been considered, you can decide on the best implant plane for your desired outcome.
What are the consequences of choosing to have breast augmentation surgery?
All surgical procedures carry risk and consequences. It is important to know that breast augmentation surgery can leave scars. Breast implants will all eventually rupture and need to be replaced or removed.
Breast enhancement scars
After your breast enhancement, you will have a small scar that is usually under your breast (in the fold) through which the breast implant is inserted. There are occasionally other positions for the scar that are suitable, such as the nipple or armpit areas.
These breast scars will generally fade over time, but never disappear completely. Some scars can take up to 2 years to fully mature?
Breast implant rupture
Breast implant rupture occurs because of repetitive folding, flexing and pressure on the implant wall during normal activities of living. Although ruptures can occur earlier or later, the average expected life of an implant is around 20 years. A breast implant rupture could conceivably occur as early as 5 - 10 years after implantation, or as long as 30 years.
Early implant rupture is uncommon but can happen because of an injury, during mammography or most commonly from no known cause.
Rupture of a silicone breast implant is most often not detected by the patient (a silent rupture). Sometimes the patient may feel that something has changed or the breast is firmer than usual.
Further surgery over life
Most women who undergo breast implant surgery have a further operation at some point in their life because of their breast implant. This surgery is needed to remove, revise or replace the breast implants.
Your body changes a great deal over your life, and there are many reasons why women choose to have further breast implant surgery, or require it because of a long term implant failure.
What you can do to help make the breast implant surgery a success
If you smoke, it’s recommend that stopping smoking several weeks or more before the operation may reduce your risk of developing complications and will improve your long-term health.
You have a higher risk of developing complications if you are overweight. Try to maintain a healthy weight.
Regular exercise will help to prepare you for the breast implant operation, help you to recover and improve your long-term health. Before you start exercising, ask your GP for advice.
To reduce your risk of infection in a surgical wound it is recommended that:
- In the week before the operation, do not wax or shave the area where a cut is likely to be made.
- Have a bath or shower either the day before or on the day of the operation.
- Keep warm around the time of the operation. If you feel cold, let the healthcare team know.
Post surgery breast augmentation care
After your breast augmentation surgery, to limit any pain and nausea immediately following the procedure you will be given medication.
Usually no drain tubes are needed after the breast implant surgery. You will have skin tape on the wound with a light compression garment as the only dressing.
Once you are tolerating fluids, an intravenous drip is removed. Breast augmentation surgery is often only a day procedure. If you are prone to post-anaesthetic nausea and vomiting, have travelled a long distance, or would just prefer it, an overnight stay is recommended.
At home take medication for pain as directed and you must rest. One to two weeks off for office work is sufficient. If physical labour is required at work, two to four weeks off work may be recommend.
Once you are comfortable, can react quickly if necessary, and are not taking strong painkillers, you may resume driving. In most patients, this usually takes between three and six days. Full exercise can be resumed six weeks after surgery. If your Breast Surgeon advises, light exercise can commence earlier.
Alternatives to breast implant surgery
If you are unsure about having breast augmentation surgery, there are alternatives. Wearing padded bras or bra inserts can make your breasts look larger with a better shape.
Some surgeons may recommend injecting your own fat into your breasts. However, this technique can cause infection, and may result in hard lumps and problems with the shape of your breasts.
Injecting synthetic material (such as hyaluronic acid) into your breasts has a temporary effect, lasting for about a year. This treatment can cause infection that may need surgery and result in unsightly scarring.
Important to know
So you can make an informed decision, your elected Surgeon will discuss the possible risks associated with breast implant surgery. Although the majority of patients do not experience these complications, it's important to understand how they can be managed in the event that they occur.