Breast Augmentation Surgery Sydney

Your Sydney Breast Augmentation Consultation with Dr Dona

For all those who are seeking to schedule a consultation with Dr Dona or have already scheduled an appointment for a Breast Augmentation consultation at our clinic in Sydney Australia, this video will let you know what to expect when you arrive. So hopefully this will make your first visit a little more relaxing.

Breast Augmentation Q & A

In this video, Dr Dona answers many of the common questions the people want to know, and need to know, about breast augmentation surgery.

Breast Augmentation Surgery Explained

There are multiple things a surgeon must assess and consider prior to any breast augmentation surgery. The three key things you need to understand about the surgery are the implant type and style, the incision or scar location, and the pocket or implant placement.

Implants can be different shapes, round or tear drop shaped (otherwise known as anatomical).
The surface of the implants can differ, they can be either textured (rough surface) or smooth.
The profile of the implant is also very important – the profile refers to how far forward the implant projects – they can be either moderate profile, high or extra high (otherwise known as full or extra full).
The consistency of the silicone gel is something else you need to know about. Silicone gel can either be firm or soft.

Incision or scar location is the second key thing you need to understand. Most surgeons, including Dr Dona. place the incision within your lower breast fold. However, some surgeons may place the incision along your lower areolar border whilst others may place it in your armpit. There are pros and cons with each of these approaches, however the lower breast fold incision is the most popular.

Pocket placement is the final thing you need to understand. Pocket placement refers to where the implant is placed with respect to your chest muscles. The implant can go in front of the muscle or under the muscle. However, it is really important to understand that the implant is never completely under the muscle. The lower third or so of the implant is typically below the lower border of that muscle.

Dual plane is the next pocket type and basically it is a variant of the under-muscle approach. In fact, every under-muscle approach is effectively what is called a Dual Plane Type 1. In Dual Plane Type 2 you are getting less of the implant at the bottom part covered by muscle. There are pros and cons in regard to each of these approaches.

Choosing a Breast Implant

To determine the implant that’s right for you, Dr Dona performs a careful physical examination to determine what is technically possible on your frame, and then use that information to determine which implant will match the look you’re after.

One of the key variables of an implant is its width. So, when it comes to determining the implant size for you, the diameter of your breast footprint, or your breast base width, is the maximum implant width you can go. Of course, this is adjusted a little depending on how much cleavage and side boob is wanted.

For example, if someone has a breast base width of 13cm, then technically, this is as wide as we can go with our implant selection. Choosing an implant wider than this is technically not going to be possible for that person’s frame.

The other issue is profile, or how far forward they project. Implants can have a moderate, high (also known as full) or extra high profile (also known as extra full).

The round extra full profiles are generally for those people who are happy to let people know they have augmented breasts.

The moderate profiles are a softer look and generally suited for someone who has nice breast shape but just want a soft/natural enhancement.

The round full profile is somewhere in between, basically someone who wants a little bit of upper pole fullness and projection but doesn’t want to stand out too much from the crowd.

Of course, for any given volume, the projection of one implant brand may be labelled high profile, but for a different brand that same level of projection may in fact be called extra high profile. So, it can get a little confusing!

Also, for those who want extra-large full look, but have limited breast base width, certain brands of implants come with a much narrower diameter for very large volumes.

When it comes to teardrops, these issues with regards to variable widths and profiles are exactly the same. Of course, the shape is very different with the bulk of the volume down the lower half of the implant with a gentler taper at the top half. This helps create a far softer look in those wanting that, without that upper pole fullness. The only additional variable with the teardrop implants is the breast base height because some brands of anatomical implants have heights which differ from their width. That is, they have an oval shaped base and not a round base. So, measuring the breast base height is also important with assessing someone’s frame.

In the end, Dr Dona is an experienced and skilled surgeon who will provide you with all the information required to make an informed decision regarding what Breast Implants will be most suited to your needs.

Breast Footprint – what is it and how does it determine the best implant size for you?

The breast footprint is a term which Dr Dona uses to help explain the chest wall and how he chooses the appropriate implant for your body.

In simple terms, the breast footprint refers to how much of the chest wall your ideal breast should occupy. For many breasts, your actual breast footprint is fine but it is simply lacking in volume. However, in many women the actual breast footprint is not ideal for a number of reasons:

• Breasts may be too narrow or constricted – either at the cleavage, or sideboob or both. This basically means a very narrow breast base.

• Or, the lower breast fold could be too high

A crucial part of your physical assessment is determining your ideal breast footprint. So in surgical planning terms, Dr Dona needs to find an implant that’s going to occupy your breast footprint to provide the ideal breast size and shape for your frame.

One of the limiting factors for choosing an implant is how wide you can go. Ultimately you want an implant extending to your cleavage and also extending to your sideboob. So the diameter of your breast footprint, or breast base width being another term, is one of the limiting factors for your implant selection.
The breast footprint height is another limiting factor, which is important especially when looking at teardrop based implants.

Dr Dona often describes the breast footprint like the boundaries of a property – you want to build to the boundaries rather than having a big property and a small building sitting in the middle of it.

Once the breast footprint dimensions has been determined, we then need to establish the implant style – round or anatomical – and the implant profile – moderate, high or extra high. These are determined based on the look you’re trying to achieve.

When it comes to the implants, whilst the volume, or cc’s, is important, the key is to ensure we find the right implant to suit your body, your frame, your breast footprint and of course, the look you’re after, and whatever volume that will be, will be right for you.

Dual-Plane Breast Augmentation

The chest wall muscle important in breast augmentation is called the pectoralis major muscle, otherwise known as the pec muscle.  This muscle extends from the arm bone near the shoulder and attaches to the chest wall near the midline.  How the implant is placed in relation to this muscle is important in determining the final long-term result.  The implant can be placed in front of the muscle, however most surgeons choose to place the implants under the muscle which is often referred to as a subpectoral placement.  It is important to note that an implant placed under the muscle is never completely covered by muscle, with the lower part of the implant extending below the lower border of the muscle.

A standard subpectoral implant placement is often referred to as a dual plane type 1 technique.  The placement of an implant in a dual plane type 1 follows several steps.  Firstly, an incision is made in or near the lower breast fold.  The lower end of the pec muscle is identified and then detached from the chest wall at the lower end to make room for the implant.  However, as the muscle remains attached to the overlying breast tissue, it does not retract or move too far.  A space or pocket is then created under the pec muscle large enough to accommodate the chosen implant.  Once the pocket is created the implant is then inserted and positioned and the wound is closed.  Depending on the person’s natural anatomy, in the early stages after surgery the lower breast curve, or underboob, can sometimes appear very tight and flat, sometimes even having a slight groove within it.  This groove is referred to as a double bubble.  As the breast softens and the implant settles, this usually goes away.  However, as the muscle remains attached to the breast tissue and close to the lower curve of the breast, and as this muscle contracts, it often pulls the skin in, causing a groove along the lower breast curve.  This is referred to as a dynamic double bubble and is quite common.

Another form of under the muscle implant placement is a dual plane type 2.  In this situation, many of the surgical steps are the same as dual plane type 1.  The incision is made at or near the lower breast fold, the lower end of the pec muscle is identified, but unlike a dual plane type 1, the breast tissue is detached from the pec muscle approximately up to the level of the nipple.  The space under the muscle is then opened and the lower end of the pec muscle is detached from the chest wall.  Because the muscle is now detached from both the chest wall and the breast tissue, this segment of the pec muscle retracts upwards.  With the under-muscle pocket created, the implant is inserted and positioned, and the wound is closed.  The dual plane type 2 implant placement results in the rest of the implant covered by muscle along the lower half of the implant, and this can have the benefit of a fuller, more curvaceous underboob.  It also significantly reduces the potential for a dynamic double bubble as this muscle is no longer close to the skin along the lower curve of the breast.  One of the negative issues of a dual plane type 2 approach is that the detached segment of muscle is no longer functional, so you can expect a slight reduction in pec muscle function.  However, for the majority of people this will not be noticeable.

Chest Wall Shape – how will it affect your augmented cleavage?

The chest wall, comprised of ribs and associated muscles, is vital to how your breast will appear after enhancement.  The reason for this is quite simply that your chest wall is a platform or foundation on which your breasts sit and project from.  An ideal chest wall is flat; however, some are barrel-shaped, this can vary from mild to extreme, or others point inwards.  Also, often these issues with the chest wall are not particularly noticeable when the breasts are small.  They become quite evident with larger breasts, that is, after breast-enhancing surgery.

The results of Breast Enlargement Surgery and, in particular, the potential cleavage, is largely dependent on the person’s pre-existing chest wall shape.  As stated, an ideal chest wall shape is flat.  In this situation, essentially the platform of your breast is flat and pointing in a directly forwards manner.  The axis of the breast is always perpendicular to the chest wall.  The nipples point directly forward along the axis of the breasts.  So, when the breasts are increased in size with implants, the breasts project in a directly forward manner and the nipples remain the same distance apart.

It can be appreciated through this that to improve the cleavage, several aspects of the implants are vital.  Firstly, choosing an appropriately wide implant has a significant impact on cleavage.  The implant must appropriately occupy your breast space width.  Too narrow an implant will result in a wide cleavage gap.  Also, the depth of your cleavage can be altered based on the profile of the implant.  The greater the profile of the implant, the greater the angle that your breast has on your chest wall.

In contrast to a flat chest wall, you can have a barrel-shaped chest wall where the breasts point away from each other. The angle between the breasts is much greater and you have a much shallower cleavage.  Also, because the axis of each breast is perpendicular to the chest platform, they project away from each other as each breast points outwards.  Therefore, with implants the breasts are projected along this axis, so effectively the nipples end up further apart.  With this chest wall shape and the shallow cleavage, it is not possible to achieve the deep cleavage that is possible with a flat chest wall.  This is regardless of the width or profile of the implant.

The final example of a chest wall shape is concave.  In this situation the cleavage area of the chest wall is deep. Essentially the breast platform is collapsed along the midline, and the breasts are pointing towards each other. So, when we perform an enhancement, the breasts are projected forward and ultimately the nipples move closer together.  Furthermore, the cleavage in this situation is typically very deep as the breasts move closer together.

Chest Muscles – will they affect your potential cleavage after augmentation?

The chest wall muscle, or pectoralis muscle, can play a significant role in the cleavage achievable after breast enhancement surgery.  The pec muscles insert along the midline.  However, the point of insertion can vary from directly at the midline or far from the midline.  Also, the skin along the cleavage area can be very tight, and tethered to the chest bone, or very loose and thick.  These factors can also impact on the cleavage after breast implant surgery.  Typically, those women whose skin is very tight and tethered to the midline have pec muscles that are attached some distance from the midline, and those with very loose skin along the midline have their pec muscles attached closer to the midline, but this is not always the case.

When the muscles are attached some distance from the midline, with subpectoral implant placement there is a higher potential for having a wide gap along the cleavage area. In this situation, the surgeon must actively detach the pec muscles from the chest wall to allow for a wider-based implant to achieve a tighter cleavage.  For those women whose midline skin is tight and effectively tethered to the chest wall, there is a limit to how much of an improvement is technically possible.

In contrast, when the muscles are attached very close to or at the midline, it is technically easier to achieve a deeper and closer cleavage. However, the surgeon must be very careful to not be overzealous in detaching the muscles from the chest wall, as this can result in implants sitting too close together with the central skin lifting off the midline, resulting in what is referred to as symmastia, otherwise known as monoboob.

The final matter for consideration is the thickness of the pec muscles and the width of attachment to the chest wall.  A thick pec muscle with a broad attachment to the chest wall can make achieving a tighter cleavage very difficult.  The surgeon must at least partially detach the muscle from the chest wall to allow the implants to sit closer to the midline, and thus achieve a tighter cleavage.

Breast Augmentation Cleavage

The cleavage achieved after surgery is dependent on many things.

These include: ​​

• The quality of pre-existing breast tissue ​​​​
• Pre-existing cleavage skin:
  • Is the skin tight and tethered to chest bone
  • Or is it loose and free
• The chest muscle or pectoralis muscle is an important consideration in cleavage, as its position and shape is very important when implants are placed under the muscle. This is because certain features of the muscle can affect how close the implants will be sitting to the midline.
  • For example, is the muscle attached close or far from midline?
  • Or, is the chest muscle thick or thin. In other words, does it have a broad or thin attachment to chest wall near midline?
• Shape of chest wall can have an important role in the cleavage – is the chest wall flat (which is ideal), is it concave, or barrel shaped.
• Implant ​style – moderate, high or extra high profile. Extra high implants give the best chance of having a deep cleavage.
• Does the implant make the most of the pre-existing breast footprint or desired footprint – in other words, is the implant the appropriate width for the diameter of breast footprint.

Ultimately, surgical skill and experience is vital to assess and work with all these variables to provide the ideal cleavage. However, many times due to the way the person’s natural anatomy is, it is not possible to achieve a tight full cleavage outside of a bra.