Breast Augmentation & Breast Implant Surgery

Breast enlargement, augmentation mammoplasty or ‘a boob job’ are some of the terms used to describe breast augmentation, a procedure to enhance the size and shape of the breast using implants surgically inserted behind each breast.

Breasts represent different things to different people; the joys of motherhood and the ability to nurture your baby, expressing your sexuality and how you feel about your body, or your femininity and the power of womanhood.  But if you are unhappy about the appearance of your breasts, it can have a profound effect on your self-esteem, or in extreme cases can result in depression and anxiety.

This guide addresses some of the questions you might have about whether breast augmentation is the right procedure for you.

Overview Of Breast Augmentation

Breast augmentation involves placing an implant behind each breast. The implant is a fluid- or gel-filled sac that is designed to feel like normal breast tissue. The sac itself is made from surgical-grade silicon, and the filling can be either saline (salt water) or silicone gel.

Usually, the implants are inserted through a cut the surgeon makes under the fold of the breast (where your breast meets the upper abdomen)to hide any scars that may remain after the cut has healed. In some cases the surgeon may insert the implant through a cut in the armpit, or the outer edge of the dark skin around the nipple. The surgeon creates a pocket for the implant to sit, inserts the implant and closes the cut with stitches.

The implants can be placed directly under the breast tissue (subglandular), or under the muscle of the chest wall (submuscular). Where the implants are placed depends on how thick the breast tissue is and how well it will cover the implant without the implant being visible.

Your surgeon will advise you on the best placement option and where the cut will be made, based on what is the most suitable option for you.

Why Consider Breast Augmentation?

Breast implants can improve women’s self-confidence and self-esteem, reduce depression and increase overall satisfaction with their bodies. There are many reasons why a women chooses to have breast augmentation. The most common reasons include:

• to feel more feminine or to improve the way their clothes fit
• to improve body proportions and make their shape more balanced
• to provide symmetry to uneven or lopsided breasts
• to restore volume after pregnancy and breastfeeding or significant weight loss
• reconstruction after mastectomy

Breast augmentation can be a) a primary augmentation to alter the size, form and feel of the breasts; b) revision surgery to correct or alter the outcome of a previous breast augmentation; c) or reconstruction to replace breast tissue lost due to trauma, damage or disease (eg a mastectomy after breast cancer).

Breast Implants

The choice of implant depends on the size of your chest wall, how much breast tissue you already have, its position in the chest wall and how you want the implant to look. Your surgeon will guide you and show you before and after pictures from previous clients to help you make your decision.  Once your individual anatomy has been taken into account, there are four issues to be considered: Size, Texture, Shape and Filler.

1. Size – the right size is important because if it is too small, you may be disappointed with the results, but too big and you may feel embarrassed and self conscious. Breasts that are too large can sometimes cause back and neck pain.
2. Texture – the coating of the implant envelope may be rough (textured), smooth or coated with a polyurethane foam. Sometimes the smooth implants can turn after they are placed. The textured surface helps the implant to stay in place, because it forms more of a connection with the tissue around it, but the coating is thicker and can sometimes be felt through the skin. Implants with a polyurethane foam coating form a more natural bond with the tissue surrounding the implant and are thought to reduce the risk of capsular contraction.
3. Shape and profile – implants can be either round or teardrop (or anatomic). Round implants provide fullness evenly around the entire breast, while teardrop implants are more like natural breasts, being fuller at the bottom. The profile, which refers to how far the implant projects outwards, can be low, medium or high.
4. Filling – the two most common types of implants are either:

• Saline: a silicone envelope filled with varying amounts of sterile salt water. In the unlikely event that the envelope breaks and the saline leaks out, it will be absorbed and removed from the body naturally in urine.
• Silicone: a silicone envelope filled with silicone gel that feels more like natural breast tissue than saline. If the implant leaks or breaks, most of the gel will stay within the envelope, but some may find its way into the capsule that forms around the implant, or into the breast tissue itself.

Typical Results and Expectations

Some of the normal temporary side-effects that you will experience after you breast augmentation include:

• bruising around your breasts, which should fade over the next 7-10 days
• chest pain from the muscles being required to stretch to accommodate your new shape
• no strength in your arms, or difficulty in moving your arms, which can last for 2-3 days after surgery
• pain in your arms and back can occur because you are sleeping in a different position and your posture will be different. Try slow gentle stretches to help reduce the discomfort
• itching around where the stiches are is part of the healing process.

Most women are really satisfied with the shape and size of their new breasts, and report being happier with their body image and have greater self-esteem. They feel more feminine and attractive and report that the quality of their lives has improved. However, it is important to have realistic expectation about your surgery. The final results from your surgery can take several months for the swelling to subside and the scars to fade.

Listen to the advice of your surgeon when deciding on size and placement of the implant. They will use their experience to guide you in the choice of implant that will give you the result that you are looking for. Most surgeons will let you ‘test out’ implants by putting them inside a bra so you can get an idea of how they will look.

Recovery Time

You breasts will be a bit bruised and sore for the first 3-5 days after your surgery, but will improve in the 5-10 days post-surgery. Some surgeons will recommend that you take 2 weeks off work after your augmentation surgery to give your body time to heal. You should be able to go back to your normal routine between 1 – 2  weeks after breast augmentation surgery.

Your breasts will still feel sore and sensitive to touch for about 3 to 4 weeks and so limit physical contact until they are less sensitive. You can go back to the gym or your normal exercise routine within 6-8 weeks, but try to avoid situations where you breasts may get knocked or hit for the first 6 weeks. The scars should fade over several months, but may take over a year to fade completely.

Costs of Breast Augmentation

The total cost for breast augmentation includes the surgeon, the anaesthetist, the hospital stay/theatre fees, the implants and the compression garments. Individually these fees vary between states and from surgeon to surgeon, but a ball park figure is between $10,000 and $15,000. Since everyone has different requirements, it is better that a surgeon assesses you first before they provide a quote. It is also a really good idea to get more than one quote before making a choice.

Medicare does not normally cover the cost of breast augmentation because it is considered a cosmetic procedure. Medicare will cover some costs if the procedure is for a reconstruction after a mastectomy or trauma. Some private health insurance providers cover breast augmentation, but it depends on the provider and the level of cover you have. Check with your insurance fund before you decide to have surgery so that you know exactly what the procedure will cost you.

Am I A Candidate For Breast Augmentation?

The decision to undergo breast augmentation is deeply personal, whether it is for reconstructive or cosmetic reasons. Breast augmentation is not a complex procedure but all surgery carries risk and the best person to discuss your requirements and expectations with is an experienced and qualified surgeon.

The best candidates for breast augmentation are those who may be unhappy or self-conscious about the size or shape of their breasts, but are otherwise healthy and well-adjusted and don’t expect the surgery to transform their lives.

Breast augmentation may not be an option for you if you have any health conditions that makes the surgery or an anaesthetic too risky. If you have diabetes, poor heart or lung function, if your blood does not clot normally, or are allergic to the anaesthetic, then surgery of any kind is risky.

Choosing A Surgeon

Doctor showing breasts implants to female patient.[/caption]

Ideally, you should choose a surgeon who you feel comfortable with and has lots of experience in performing breast augmentation or reconstruction. In Australia, any medical doctor or specialist can perform cosmetic procedures without the specialist training required of plastic surgeons.  As a result, the industry’s reputation has suffered because consumers aren’t getting the quality they should expect. Look for doctors who are trained surgeons – they will have ‘FRACS’ after their name, and may use the title ‘Mr’, instead of ‘Dr’. If the surgeon you visit doesn’t have their qualifications on display, ask to see them.

Choose a surgeon who is a member of a professional association, such as the Australian Society of Plastic Surgeons (ASPS), the Australasian College of Cosmetic Surgery (ACCS), or the Australasian Society of Aesthetic Plastic Surgery (ASAPS). To be member of these groups, surgeons will have completed a minimum number of years training and must work under strict ethical guidelines. Breast Augmentation Melbourne or Breast Augmentation Brisbane.

What To Think About Before, During and After Surgery

How to prepare for a consultation

Think about what your expectations from the surgery are. Ask to see the results from previous patients. In Australia, doctors aren’t allowed to use ‘before and after’ photos in their advertising, but they can provide them to you in a consultation.

What are your concerns about the procedure? Are you worried about complications or side-effects of the surgery, or how much scarring there might be? The surgeon should provide you with this information as part of the consultation, but if you have particular concerns, the surgeon can give you the answers you need.

You could also ask question about the surgeon’s qualifications and experience, how often they perform breast augmentation, where the surgery will be performed and what the costs include, so that you know if there will be any additional costs.

An important part of the consultation is the decision on which implant will give you the look that you like best. Issues to consider include:

• The size, shape and profile will determine the overall shape of the breast and what sort of cleavage you will have.
• Whether you choose saline or silicone filling may determine how the breast feels after the implant is in place.
• The position (under the muscle or on top) will depend on the type of implant you’ve chosen as well as the amount of breast tissue you have. If you are slim and don’t have much breast tissue you may be advised to have the implant under the muscle so the implant isn’t as visible.
• Where the surgeon makes the cut may affect how visible to scar is. If you scar easily, the locations with the smallest and least visible cut is best

Before your surgery

Your surgeon will give you a list of instructions to follow before your breast augmentation. If you are a smoker, consider quitting, or giving up temporarily, at least 30 days before your surgery.

Some medications also increase the risk of complications, so speak to your surgeon and GP about which medications are safe to use. It is really important to tell your surgeon everything you take, even if it isn’t classed as a medicine, before your surgery.

It is a good idea to prepare for your return home after surgery. Set up an area with everything you will need in easy reach so you don’t have to raise your arms. You may need extra pillows to prop yourself up while you sleep, as you need to sleep in an upright position for about a week after surgery.

What to expect on the day

Breast augmentation is done under a general anaesthetic, which will put you to sleep, and performed either in a hospital or approved day-surgery clinic. The procedure takes about 1 hour and you will probably be allowed to go home a few hours after you have woken up and recovered from the effects of the anaesthetic.

When you wake up your breasts will be tightly bandaged and you will be wearing a compression garment to support your new breasts while they heal. You won’t be able to drive because you will feel a bit tired and light-headed after the anaesthetic, so arrange for someone to drive you home.

What you can do after surgery and recovery

Your surgeon will provide you with some detailed instruction on how to care for yourself in first few days after the surgery. You should follow them carefully to get the best results from the procedure. Panadol is usually all that is needed for pain medication, but talk to your surgeon if you think you will need something stronger.

You will have to wear the compression garment to support your chest for 4 weeks after surgery. Try it on before your surgery to make sure it’s comfortable, because you will have to wear it continually, even while you sleep. You may require a drainage tube to allow fluid and blood to drain out of the cut.

If it is possible, arrange for someone to stay with you for the first 24 hours after your surgery, or at least have someone you can call in case of emergency.

There are some things you can do to help speed your recovery:

1. Use an ice pack on the chest to reduce swelling
2. Don’t remove your bandages until you have been given the all-clear by the surgeon; this will minimise the risk of infection
3. Use the cream provided by your surgeon to help with swelling and redness
4. Protect your nipples with a nursing pad because they will be really sensitive.

Call your surgeon immediately if you develop a temperature, you are bleeding enough to soak through the bandages, you experience pain that cant be controlled by medication or your breasts are red. These are signs of infection and need medical attention.

What Are The Risks and Potential Complications?

All surgery carries some risks or potential for complications, such as infection, excessive bleeding, blood clots in the heart or lung, poor wound healing or scarring, and reactions to the anaesthetic. These risks can be minimised if you are in good general health, with no pre-existing medical conditions, and you follow your surgeon’s pre- and post-operative instructions.

Some of the complications that have occurred following breast augmentation include:

• loss of nipple sensation because the nerves have been cut or stretched around the nipple area
• capsular contracture, which occurs when the body forms scar tissue around the implant. The scar tissue can shrink, compressing the implant and making the breast feel unnaturally firm. In extreme cases, the implants may have to be removed before they rupture
• unnatural wrinkling or folding of the breast, or being able to see the breast implant under the skin
• asymmetry – where the breasts don’t look even – may require additional surgery to fix.

The best way to reduce the risk of complications is to choose an experienced surgeon who has performed lots of breast augmentation procedures.

Alternatives to general anaesthetic

‘Twilight sedation’ is where a local anaesthetic is used (so you won’t feel any pain) in combination with a sedative that puts you in a ‘dream-like’ state. You wont remember anything about the procedure but you will be able to breathe without assistance. Some surgeons prefer this method to general anaesthesia because it has a shorter recovery time and because there are risks associated with general anaesthesia. It is also cheaper, but keep in mind that cheap is not always best. Twilight sedation is not unsafe, but you won’t be as comfortable during the procedure as you would with a general anaesthetic. Twilight sedation isn’t recommended if your implant is being inserted under the muscle of the chest wall.

Medical Tourism

An increasing number of Australian women are choosing to go overseas to have breast augmentation surgery. The main reasons are the lower costs and shorter waiting times than having the surgery performed in Australia by an accredited plastic or cosmetic surgeon. Others like the idea of combining a holiday with a new look, or because they like the anonymity of having the surgery where you won’t run into someone you know while you are recovering from your procedure. While tempting, keep in mind that the recovery time after your surgery is just as important as the surgery itself. If you develop an infection, or the stitches aren’t healing properly, or if you are unhappy with your results, it is difficult to get these issues resolved if your doctor is in another country.

Frequently Asked Questions

“Will I still be able to breastfeed after breast augmentation surgery?”

Everyone’s experience is different, but there is no reason why you shouldn’t be able to breastfeed after an augmentation procedure. However, if the nipple loses some sensitivity after the procedure it might affect the let-down reflex that draws milk from the tissue into the nipple. Loss of nipple sensitivity is usually temporary.

“How long do breast implants last?”

The average lifespan of a breast implant is between 10 and 20 years. It is obvious when a saline implant needs replacing because the saline leaks out and your breast will look deflated. Silicone implants require an MRI scan to determine if the implant should be replaced.

“Can breast implants ‘burst’ or leak?”  (Can I skydive with breast implants?)

Breast implants are very strong and have been tested against bursting in a variety of conditions. Once you have healed completely from your breast augmentation, you should be able to do anything you want – skydive, scuba dive, surfing etc. The one sport that isn’t recommended is boxing because of the blows directly to the chest. Breast implants, like any medical device, are not designed to last forever. As they age, they can leak or rupture, and will need to be replaced.

What is capsule contraction?

When an implant is inserted into the breast tissue, the body’s natural reaction is to grow more tissue around the implant. This is called a capsule. Sometimes the new tissue around the implant shrinks, causing capsule contraction. Capsule contraction puts excess pressure on the implant, and makes the breasts feel firm or tight and uncomfortable. Surgery may be needed remove some of the capsule tissue, or to replace the implant.

Will silicone implants give me cancer?

There is no evidence that breast implants will increase your risk of breast cancer, autoimmune disease and any other illness. Breast implants can, however, make detection of any breast tumours difficult because they interfere with mammograms and you will not be able to feel lumps in your breast as well as in normal breast tissue with no implant.

What happens if I decide I don’t want the implants anymore?

Some women decide that they don’t like the feel of the implants and want them removed. Your breasts wont return to the way they were before your surgery and you may have wrinkles or folds, sagging and loss of breast tissue. You may require a breast lift to address some of these issues.

What is a breast lift?

A breast lift, also known as mastopexy, removes excess skin around the breast to increase firmness, improve the shape and remove ‘droop’. The nipple and areola are repositioned to the centre of the breast. A breast lift is sometimes needed in addition to breast augmentation to improve the overall result of the breast enlargement.

Conclusion

Breast augmentation is one of the most common cosmetic procedures performed in Australia. It is quite low risk, but the satisfaction rate is high, with most women reporting that they love the size and shape of their new breasts, and they felt more attractive and less self-conscious. However, it’s a big decision, and you should only make the decision once you have considered all the information available to you, like this guide. Your choice of surgeon is really important. The best way to ensure you are happy the results of your breast augmentation is to choose an experienced, qualified surgeon who will help you find the look that feels right for you.

Next Steps

If you have been thinking about changing the shape or size of your breasts, the next step is to book a consultation with a qualified surgeon, who can talk you through the procedure and discuss your expectations.