Breast augmentation remains one of the most commonly performed cosmetic procedures worldwide and year after year, the number of cases performed is increasing.
Familiarity with cosmetic surgical procedures and exposure in social media has led to a rapid increase in the number of cases being performed in Australia and it is now the commonest procedure performed on an annual basis in this country.
Although it is a very common procedure, the key to success is individualising the procedure to each patient’s needs and expectations.
No two patients will be the same and in my practice, no two breast augmentations are going to be the same. The procedure needs to take into account each individuals age, the cup size they are starting from and the cup size they desire, to ensure they achieve the look and feel that they are after.
The process starts at the initial consultation where an assessment is made of the current breast tissue in terms of volume, height of nipple, skin laxity and the dimensions of the patient’s chest.
From here, a patient will need to make a decision as to the type of implant, be it silicone or saline; the shape of the implant, be it round or tear drop shaped; the location of the implant, be it under the muscle or in front of the muscle; as well as the volume of the implant. The patient will also need to consider the incision used to place the implant so that their expectations can achieve the best result for them.
There will be circumstances where a breast augmentation alone may not achieve the best result possible and a breast-lift may need to be combined with the augmentation. This procedure is known as an augmentation mastopexy and again, is a very common procedure particularly in patients who have had multiple children or lost a significant amount of weight.
Breast Incision Location
Options exist for different locations for placement of the incision to allow positioning of the breast implant.
The most commonly used incision is in the fold under the breast, known as an inframammary fold.
Other options to consider are placing the implant via an incision in the armpit, around the nipple or through the umbilicus or tummy button and each of these will have advantages and disadvantages.
The Implant Location Subpectoral/Subglandular
Placement of the implant in a subglandular position will allow for a more natural movement of the implant though there needs to be adequate tissue coverage, particularly in the upper pole, to avoid visibility of the implant. Implants placed in a subglandular appearance can create the ‘bolt-on’ look and for this reason, patients often elect to have the implant placed underneath the pectoralis muscles.
‘Dual plane’ is an implant that is placed underneath the pectoralis muscle with part of the implant placed underneath the breast tissue and is probably the most common location technique for implant placement. In my practice, this is my preferred treatment as it creates a natural breast in terms of appearance and mobility.
Implant Shape – Round Versus Anatomic (tear drop)
A round implant has more fullness in the upper pole and an anatomic implant has a more tear drop shape.
When used in appropriate patients, these implants can create different results and this needs to be discussed with your surgeon.
Patients seeking volume in the upper pole will be well suited with a round implant, whereas patients who have a lack of breast shape and definition will be better suited with an anatomic or tear drop shaped implant.
Saline Versus Silicone Implants
Silicone implants are more commonly used these days than saline implants.
In the past, saline implants were used when silicone implants were being investigated, as they were thought to be associated with a number of disease conditions such as chronic fatigue syndrome.
At this stage, there is no scientific evidence to support any link of a disease to a silicone implant and given this, they have made a widespread return and are the most commonly used implant in Australia.
Breast Implant Volume
Implants come in volumes ranging from 100 cc to 700 cc and different volumes will create different results on different patients’ frames.
During the consultation, we will assess which volume of implant is best suited to you, using an implant sizing system so that you can have an understanding of what to expect from your augmentation.
Who Can Have a Breast Augmentation?
In my practice, breast augmentation really falls into three patient groups:
1. Primary breast augmentation
Primary breast augmentation will be performed in patients who lack the volume they desire in their breast tissue and are looking to achieve a fuller cup size.
2. Post pregnancy/post weight loss breast augmentation
In these patients, due to changes in the shape of the breasts and change in volume following pregnancy, breastfeeding and childbirth or weight loss, they are looking to restore potentially what they previously had.
These patients may also elect to restore more volume than they had previously to achieve the desired cup size.
In these patients, consideration needs to also be given to whether a breast-lift in combination with an augmentation will achieve the best result and in these cases, an augmentation mastopexy or breast-lift with implant will be the treatment of choice.
3. Breast asymmetry/congenital breast disease
Everybody understands that no two breasts are the same in terms of size and shape but in some instances, the differences can be clinically significant.
The patients who experience a marked different in the size and shape of the breasts may have difficulty fitting clothes and swimsuits and are unable to enjoy the things that a lot of women take for granted.
In cases such as this, their medical condition can be corrected with the use of breast implants to restore volume in a smaller breast and potentially combined with a breast-lift or reduction on the larger side to create two breast mounds that are the same size and shape and meet the patients’ desire.
Breast Implants Surgical Procedure
I offer the procedure of breast augmentation in a fully accredited hospital, under a general anaesthetic.
This ensures maximum safety and the best outcome for the patient.
The procedure is often performed as a day surgery procedure and takes approximately one to two hours.
In terms of recovery, patients will need to consider taking the remainder of a week off work to allow tissue to settle and the healing process to start. Following this, they can plan to return to normal activities with a view to returning to sporting activities at approximately six weeks.
Following the procedure, it is very important that patients return for postoperative care. We will instruct them on implant massage, pain relief and scar management to ensure they achieve the best result possible.
During the procedure, techniques will be used to ensure patients achieve the best result possible. Local anaesthetic is used to minimise postoperative pain and nerve blocks are placed at the time of the procedure to ensure patients have a rapid recovery.
Patients can expect discomfort on the first few days after the operation and then a return to light duties following this.
A postoperative compression garment will be provided at the time of the operation and is used to minimise swelling and speed the recovery process.
Adequate postoperative instructions will be provided, as will contact details to ensure if anyone has any queries following their procedure, they can easily and quickly be answered by my office.
Breast augmentation remains one of the most commonly performed procedures in Australia and it certainly has huge benefits in terms of quality of life for a large number of women.
The fact that it is as frequently performed as it is does not mean that it is a straightforward ‘cookie cutter’ procedure and each operation needs to be tailored to an individual.
This process begins at the time of the consultation and is carried through to the surgical procedure itself and through the postoperative period, to ensure my patients achieve the best results possible in the short term and the long term.
The goal of the procedure would be two breast mounds of the same size and shape with intact sensation that allows patients to fulfil all of their expectations.