Breast Implant in Brief

Breast implants is a kind of plastic surgery which add volume to existing breast tissue to create a fuller chest. Implant options include silicone or saline, rounded or shaped, and textured or smooth, all of which come in a variety of sizes.

  Breast augmentation, often combined with a breast lift, is a highly individualized procedure, which you should do for yourself, not to fulfill anyone else’s desires or to fit a certain type of ideal image. It is the most commonly performed cosmetic surgical procedure in the Australia and only authorized Plastic Surgeons experts have perfect techniques for the ultimate results.

Am I a candidate for breast augmentation?

If you aren’t satisfied with the shape, size or contour of your breasts, you may wish to consider breast augmentation. Also known as augmentation mammoplasty, the procedure involves using implants to enlarge the breasts. You can consult plastic surgeon consultants first.

Breast augmentation may also help after pregnancy or weight loss if you are unhappy with the size or droopiness of your breasts. Implants can also correct asymmetry or unevenness in breast size caused by developmental problems or breast cancer surgery performed in the opposite breast.

One or more of the following feelings or conditions may indicate that you are a good candidate for breast augmentation:

• You are worried by the feeling that your breasts are too small
• Clothes that fit well around your hips are often too large at the bustline
• You feel self-conscious wearing a swimsuit or form-fitting top
• Your breasts have become smaller and lost their firmness after childbirth
• Weight loss has changed the size and shape of your breasts
• One of your breasts is noticeably smaller than the other

How do I prepare for breast augmentation?

If you are a smoker, you will be asked to stop smoking well in advance of surgery. You should avoid aspirin and certain anti-inflammatory drugs that can cause increased bleeding for a period of time before surgery. Your plastic surgeon will provide you with additional preoperative instructions.

Breast enlargement is performed with either saline or silicone implants that are placed either under the chest muscle (sub pectoral) or over the chest muscle (sub glandular).

Plastic surgeons evaluate individual factors and personal preferences to determine your appropriate breast size, the location of incisions and whether the implants will be placed on top of or underneath the chest muscle.

How is breast augmentation performed?

Usually performed under general anesthesia, incisions are made in inconspicuous areas of the breast to minimize visible scarring. There are a variety of incisions used to perform the procedure:

• In the lower crease of the breast (inframammary incision)
• Around the lower portion of the areola, or dark-colored skin around the nipple (periareolar incision)
• In the armpit (transaxillary incision)
• Under the breast fold (sub-mammary incision)

Through these incisions, the plastic surgeon creates a pocket to place the implant. To maximize the accuracy of future mammograms, implants are generally placed under the muscle (subpectorally).

Some breast enlargements can be performed in a minimally invasive manner using endoscopes and small incisions made in the armpit, with the major benefit being less scarring for the patient. The procedure, which takes about two hours, is typically performed on an outpatient basis.

Are there different options for breast augmentation?

Breast implants are made up of a silicone shell filled with either saline (a salt water solution) or silicone gel. Silicone gel has a thick, sticky fluid consistency that closely mimics human fat, offering a more ‘natural’ look and feel if capsule contracture (shrinking and tightening of the scar tissue around a breast implant) does not occur. Saline implants have the disadvantage of sometimes feeling like a water balloon to touch, especially in patients with thin, soft tissue.

What is involved in recovery?

Breast enlargement surgery is usually performed as an outpatient procedure. If this is the case, be certain to plan for someone to drive you home after surgery and stay with you at least the first night following surgery.

You will be given medication to take at home. Stiffness and soreness in the chest for the first two to five days is normal. These side effects, along with some swelling and bruising will subside over two to three weeks. Any surgical dressings will be removed within several days and you may be instructed to wear a support bra.

Physical activity is limited for the first several weeks, with most patients able to return to work and their normal activities within two to three weeks. Each year, thousands of women undergo successful breast augmentation surgery. Yet, all surgical procedures involve some risk

Is breast augmentation safe?

Both saline-filled and silicone gel-filled breast implants present potential risks, including:

• Implant rupture
• Need for additional breast surgery
• Breast pain

• Scar tissue that hardens around and distorts the breast implant (capsular contracture)

• Potential for decreased nipple or breast sensation
• Infection

Breast Lift: Procedures

Patients must stop smoking for at least 2 months before and after the operation. Time off work from this procedure is usually 10-14 days for recovery and healing to take place. Smoking increases chances of bleeding, infection and long term scarring.

What happens to the circulation and sensation of my nipple? 

Generally, the nipple-areolar complex (brown part of the breast) is carried on some breast tissue to keep it alive. This usually preserves the nipple sensation and keeps it viable.

How long is the patient hospitalized? 

A Mastopexy can be performed as a day procedure under general anaesthetic, or may require 1-2 nights in hospital depending on the patient and accompanying procedures.

What kind of anaesthesia is used? 
A general anaesthetic is used on all Mastopexies.

What can I expect postoperatively? 

Discomfort, swelling, and discolouration of the breasts are to be expected for several weeks. Usually, our patients return to almost normal activity within 10 days. The scars at the incision lines typically become reddish, raised, and firm a few weeks after surgery, but after many months become pale and soft. After 12-24 months, the scars are relatively inconspicuous. The nipples and some areas of the skin may be numb or sensitive after surgery. Sensation frequently returns within a few weeks or months but may be diminished or overly sensitive.

Will the breasts start to sag again? 

Gravity continues to have its effect, and there is a tendency for the skin of the breast to stretch over a long period of time. Women vary a great deal in this respect. In general, the smaller the breasts, the less tendency for sagging to recur. If the breasts sag further, minor revisions may be needed to reverse the process. 

What are my limitations in activity post-operatively? 

You should plan to avoid activities which require much raising of the arms above the level of the head, heavy lifting and activation of the pectoralis muscles. With great care, you can drive about 7 days after surgery. Patients can usually return to work in 10 days unless their occupation requires particularly strenuous movements and lifting. In such cases, 2-3 weeks should be allowed.

Light walking can commence within 7 days
Lower body exercises can commence within 6 weeks
Light jogging and physical activity can recommence at 3 months post-op

Surgical risks & Complications may include: infection, bleeding, asymmetry, keloid scarring, and nerve damage. Damage to the blood supply of the nipple-areolar complex, although uncommon, can occur.

Breast Lift (Mastopexy)

What is a Breast lift surgery / Mastopexy?

Breast lift or Mastopexy is designed to improve the shape and position of the breasts without reducing their size. It is a term used for breasts which sag but are not necessarily too large. Sagging of the breasts may occur with normal development for some women or as part of aging. Pregnancy, breast-feeding, and weight loss are other conditions which increase breast ptosis (sagging). Some patients will have a better shape to their breast if an implant is used at the time of mastopexy.

It is becoming increasingly obvious to the savvy plastic surgeon given the spectrum of breast shapes and conditions that simply using breast implants alone will not always produce aesthetically acceptable results. In assessing breast geometry and design, the plastic surgeon must consider 4 crucial parameters:

Breast Shape
Breast Size
Nipple-areolar Position
Skin elasticity & Stretch marks

Breast lift surgery or Mastopexy is therefore designed to return breast shape to a more youthful appearance in 3 ways:

1. Move the position of nipple-areola complex,
2. Remove excess breast skin,
3. Reshape the breast tissue

Although mastopexy does not change the amount of breast tissue a woman has, it can change the shape dramatically. This in turn can affect the overall breast size and projection. However, there are many cases where breast lifting needs to be combined with a breast implant to produce a desirable breast size.

Breast Reduction

Breasts come in all shapes and sizes and not all women are happy with the shape or size of what they were given. Just as some women are disappointed with having to live with small breasts that do little to fill out a dress, there are women that have large breasts that can be felt as a burden to have to carry around.

Women with very large breasts often suffer from back problems as the weight adds extra strain to the upper back and this is one of the most common reasons why women decide to have a breast reduction. The other reason is that of appearance, as women with large breasts  often desire something smaller and in proportion to the rest of their body.

Nipple & Areolar surgery

Nipple correction surgery addresses the problems associated with enlarged, asymmetrical, protruding or inverted nipples.

If you suffer from any of these problems, you may have both functional and cosmetic concerns.

Nipple correction surgery may be performed as an isolated procedure or in combination with other breast surgeries. In most cases surgery involves minimal scarring.

Areolar issues general involve being too large. This is typically associated with  breast sagginess that requires surgery to perform a breast lift or conditions such as tuberous breasts that requires reconstructive surgery including reducing areolar size.

    1. Inverted Nipples

There are different degrees or grades of nipple inversion possible. The nipples can be inverted intermittently or constantly and can vary from being simply flat to a slit like depression. For women, this can at times mean difficulty with breastfeeding. The surgery required to correct inverted nipples depends on the severity of the problem. Any scars are very small and concealed within the nipple areola region.

Mild Inversion – The nipples are intermittently inverted but can evert in response to temperature or stimulation. With mild inversion the potential to breastfeed is generally not affected following corrective surgery.

Moderate Inversion – The nipples are constantly inverted and if they do evert, return almost immediately. The potential to breastfeed following corrective surgery can be reduced as surgery often affects the milk ducts.

Severe Inversion – The nipples are severely inverted and by no means evert. Breastfeeding is typically not possible following reconstructive surgery as milk ducts are in most cases divided to achieve the correction.

    2. Enlarged Nipples

Women may have nipples that become long, dark or sometimes wide in girth. This can be a result of prolonged breastfeeding or part of the normal development of the breast. With nipple correction surgery, nipples can be reduced in length and/or girth. After undergoing nipple correction surgery you can expect your nipples to project normally, proportionate to the size of your breasts.

Length – To adjust length, a circumferential excision of skin around the nipple is removed. The deeper structures including milk ducts and nerves are left intact. The nipple is then sutured to its shorter, predetermined length.

Girth – To adjust the girth, a wedge incision is made on the underside of the nipple and the nipple is then “taken in”.

    3. Enlarged Areolars

The pigmented area around the nipples is also known as the areola. In some people, the circumference of the areola can be very large. Although there are no functional concerns, people may seek surgical intervention for aesthetic purposes.

The required amount of pigmented area is removed by one of 3 methods – An incision can be made around the outside of the areola; around the base of the nipple; or in severe cases, a lollipop incision is required.

Breast: Incisions

Incisions are carefully placed, and with the aim being to hide them, in the creases under the breast or placed in the skin around the nipple. Typically most women find that they or their partners don't notice the small scars made under the breasts. The scars from implants heal well and should ultimately be a fine, white, barely visible line.

Normally most of plastic surgeons aim for minimal scarring. Typical scars range from approximately 2 - 3cm in length for saline implants and 4.5 - 6cm in length for silicone implants. The length of scarring for silicone implants does vary according to the size of the implant.

Breast: Implant position

All potential clients having breast augmentation surgery will have to consider the question, should I place the implant below or above the muscle?

Implant placement depends on the amount of breast tissue available to hide the implant to ensure it cannot be seen or felt. Generally those with minimal breast tissue benefit from sub-muscular (sitting under the muscle) placement to provide more cover above the actual implant thereby preventing visible rippling of the implant. It seems that behind the muscle placement is superior from a mammogram and ultrasound imaging point of view. Sub-muscular placement also can reduce the risk of capsular contracture.

In general, it is preferable to place breast implants behind the muscle so that they are partially covered. This usually gives a more natural shape. When placed above the muscle, the appearance and shape of the breast can appear more rounded and appear unnatural, although this is becoming more popular with woman who prefer the 'beach ball' look.

Speak to your consultant about the best option for you and your lifestyle.

Breast Implants: Commonly Asked Questions

Is breast enhancement the right procedure for me?

Breast Enhancement is a highly individualised procedure and you should do it for yourself, not to fulfill someone else's desires.

Breast Enhancement may be a good option for you if:
You are physically healthy.
You have realistic expectations.
Your breasts are fully developed.
You feel your breasts are too small.
You are dissatisfied with your breasts losing shape and volume after pregnancy, weight loss, or with aging.
Your breasts vary in size or shape.
One or both breasts failed to develop normally.

What will they look like after surgery?
Your breasts will be bigger, rounder, and project further forward. Under the muscle implants look more natural than above muscle implants; this is because there is tissue over the implant which will give them a more natural feel too.

Will I get stretch marks?
It depends on the size of the implant and how stretchy your skin is.  It is a possibility to have stretch marks when your breast implant size is quite large compared to your original sizing.

Is there a minimum or a maximum size I can get?
The size is proportionate to your body size, the laxity of your skin and the tension of your muscle.

How big is the scar?
Generally less then 3cm, the implant is inserted in the crease of the breast, this is a much smaller scar then other types of implant.

How much 'downtime' is there?
Most people need 5-7 days off work; this can vary according to each individual's pain tolerance.  If your work involves physical activity or lifting, you may need more rest.

How soon after can I exercise?
Walking 7-10 days, more vigorous exercise can be introduced slowly after 3-6 weeks.

Do I have to get them replaced every 10- 15 years?
NO, the saline implants that professionals use have a lifetime warranty. They have been designed to withstand extreme force. Should something happen to the implant during your lifetime, the company will replace the implant free of charge.

What happens if they leak?
You will notice straight away if a saline implant leaks. Saline implants are completely safe and there is no danger to you as it is only salty water which can be absorbed by the body. We choose saline because of its safety.  A gel or silicone implant would leak very slowly into the body cavity and you wouldn't notice straight away.

What type of implant do you use?
We preferentially use saline implants, this is because the scar is smaller, you will have a choice of variable size for each implant and you can correct left to right variations. There is no difference visually or to touch.

Will I still be able to breastfeed?
As the implant is placed under the pectoral muscles, it does not affect the mammary glands therefore allowing you to still be able to breast feed in the future.

Will breast enlargement/breast augmentation lead to cancer?
Breast enlargement or breast augmentation does not cause cancer. You can also still detect cancer. It has been said that women with implants touch their breast more, therefore early detection is better.

Silicone VS Saline Implants

Summary of advantages and disadvantages of Silicone & Saline Implants

Saline Advantages
-Scarring is smaller, even with larger size implants.
-Rupture is revealed immediately.
-Less pain for recovery.
-Cost less than Silicone implants.
-Saline breast implants are available to women age 18 and older for breast augmentation, or women of any age for breast reconstruction.
-Leaking saline solution will be absorbed by your body without posing any health risks.

Saline Disadvantages
-Sometimes the feeling of saline movement can be experienced.
-If a saline breast implant ruptures, the implant will deflate — causing the affected breast to change in size and shape.
-Complication of infection inside the implant during filling.
-Some people can experience change in temperature of the breast implant depending on the season.

Silicone Advantages
-Leakage of silicone gel is not so common.
-There is no sound phenomenon by moving.
-Less movement of content.
-Gel feels more like breast tissue.
-A ruptured silicone breast implant may eventually cause breast pain or changes in the contour or shape of the breast.

Silicone Disadvantages
-It is more difficult to diagnose a rupture.
-The price can be up to 50% higher.
-Silicone implants can form inflammatory granulomas by leakage of gel and even the nodes can be affected.
-The scar is bigger, especially with larger size implants.