Tue 14th Jun 2022
Breast Augmentation also referred to as Bilateral Augmentation Mammoplasty (BAM) or Breast Implants, is a cosmetic surgery that involves using silicone implants to enhance the shape and volume of the breasts. Breast Augmentation is the most common cosmetic surgery in Sydney, Australia and worldwide. This procedure is also often requested after pregnancy or significant weight loss to address breast volume, shape and symmetry.
If you are thinking about Breast Augmentation, you probably have many burning questions. Here are answers to the most common questions about the procedure.
Our fee for Breast Augmentation starts at is $13,270. This all-inclusive price covers the plastic surgeon’s fee, the Anaesthetist’s fee, all hospital and theatre fees, the cost of your implants and your post-operative care. Additional costs may apply depending on the complexity of the procedure.
Medicare does not cover elective surgical procedures completed purely for cosmetic purposes. Breast Augmentation is primarily a cosmetic procedure, but it rare cases it may be medically necessary, and in such cases, you may be eligible for a Medicare rebate.
Silicone implants are silicone pockets filled with a thick silicone gel that mimics the look and feel of breast tissue. Saline implants have silicone shells filled with a sterilised saltwater solution. Saline implants are more likely to show rippling and may cause slight sloshing when you move. Dr Dona only uses silicone breast implants.
Round implants have a semicircular profile, whilst teardrop implants have a teardrop profile. Teardrop implants, also known as anatomical implants, are shaped to imitate the asymmetric appearance of natural breasts. The implant is thinner at the top and gently slopes down into a fuller, more rounded base; hence, the teardrop shape. There is a common misconception that round implants always result in round unnatural breasts and that teardrop implants always result in more natural-looking breasts – both types of implants can provide a ‘natural’ look.
Many women mistakenly believe that breast implants must be replaced every 10 years. The truth is, there is no expiry date on implants! Although the average life span of a Breast Implant is typically 10–15 years, breast implants only need to be replaced if you have an issue such as implant rupture or capsular contracture or your aesthetic preference has changed. Unfortunately, your body changes over time and breasts are no exception. Weight fluctuations, pregnancy, breastfeeding and natural aging are likely to affect the appearance of your breasts – replacing implants may be required to facilitate addressing these changes.
The implant pocket refers to the placement of an implant in relation to the pectoralis muscle. The pectoralis muscle is the chest muscle that covers the collar bone, outlines the breastbone border and stretches along the ribs near the lower breasts. A breast implant can be placed in three primary pockets. Placing the implant above the pectoralis muscle and underneath the breast mound is called a subglandular or prepectoral placement. Placing the implant underneath the muscle is considered a submuscular or subpectoral placement, which can be further distinguished by placement entirely under the muscle (totally submuscular – rarely performed in breast augmentation cases) or partially under the muscle (dual plane – their are several variations). There are advantages and disadvantages of each pocket location, and after making an assessment, your surgeon will recommend a pocket placement that considers your individual anatomy, lifestyle preferences and desired look.
Although the Breast Augmentation procedure may only take a couple of hours and be done without an overnight stay, recovery will take up to six weeks. It is important to understand that recovery can take time and is different for everyone, but here is what you can expect. After the procedure, you will be sent home with a waterproof dressing, surgical bra, pain medication and antibiotics. Typically, the first week is the most uncomfortable, and you will likely experience some swelling and bruising. After a week, you will return to us for review, when we will change your dressings and check your wounds. Then, with your surgeon’s approval, you may gradually ease into daily activities, such as walking and light office work. The discomfort should be reduced at this point, but labor-intensive jobs and any strenuous physical activity, such as going to the gym, should be avoided. You will see us again at six weeks for another review. Most of your swelling should be gone at six weeks, and you can engage in most activities with caution. Complete healing can take up to six months; your breast will have settled and softened by then. For the first 12 months, your surgeon will examine you at each milestone, examining the incision, breast fold and scar tissue and ensuring that they are healing correctly and that your aesthetic objectives have been achieved.
Most women can breastfeed with implants. Breast implants are not likely to affect a woman’s ability to breastfeed. Whether the implants go under or over the muscle during Breast Augmentation surgery, they do not interfere with the breast ducts or mammary glands from which milk is excreted. Hence, Breast Augmentation does not affect your milk quality or ability to breastfeed.
Although it is possible to breastfeed after a Breast Lift or Reduction, your ability to produce milk may be compromised. A Breast Reduction is more invasive than a Breast Lift as it removes significant amounts of glandular tissue. Many Breast Lift and Breast Reduction surgery patients can breastfeed without any issues, but there is an increased risk from these surgeries that breastfeeding may be affected.
Pregnancy and breastfeeding will not affect the integrity of the implants; however, implants or not, pregnancy and breastfeeding may affect the breasts’ appearance. Your breasts will continue to change throughout your pregnancy, thanks to surging hormones. The breasts swell in preparation for milk production and continue to remain engorged throughout breastfeeding. When the nursing period ends, the breasts typically shrink to their near-original size. The breasts may then appear to be deflated, stretched and ptotic (droop). The skin may also have lost elasticity, and it may struggle to contract completely around your smaller breasts. In this situation, you may wish to have further surgery. However, in some women, there may be little to no difference in breast appearance.
Changes in nipple sensation are very common after Breast Augmentation surgery, including under or overly sensitive nipples. The good news is that neural pathways can heal and re-establish themselves, meaning normal nipple sensation will usually fully return in most patients. This process can take up to a year to complete. Unfortunately, in approximately 10 per cent of patients, nipple sensation may be permanently altered – too much or not enough. It can be difficult to predict which women will have lasting sensation changes after a Breast Augmentation, so it is important to be aware of the risk.
Studies have found no difference in breast cancer severity, aggression or survival rates between women with and without implants. Implants do not affect the ability to detect changes in your breasts, and breast cancer can still be detected early in women with breast implants. While breast implants do not cause breast cancer, a possible association between women with breast implants and anaplastic large-cell lymphoma (ALCL) has been found. ALCL is a type of non-Hodgkin’s lymphoma that is a cancer of the scar tissue capsule. It is very rare and associated with textured, not smooth, implants. Approximately 1 in 86 thousand women are diagnosed with ALCL depending on the type of implants, and the cancer can be treated effectively if it is detected early. We advise patients to continue with monthly breast self-examinations and annual mammograms, just as they did before receiving implants. Look for lumps, distortions or swelling in the breasts and armpits that warrant further investigation. If you find a change in your breast, see your doctor without delay. To find out the latest go to the TGA WEBSITE.
Yes, most women with implants can and should still have their regular mammogram screenings. Mammograms may be less effective for some women with implants because the implant can obscure some of the breast tissue. However, studies suggest that mammograms are still very effective in screening for breast cancer in women with breast implants. We advise you to find a clinic where the radiologists are experienced in performing mammograms on women with implants and interpreting the results; tell the staff that you have implants. Other tests such as ultrasounds or MRI’s may also be required for routine screening.
After surgery, you will be given a surgical compression bra that is not underwired. They are designed to support your breasts comfortably while assisting with swelling, inflammation and healing. You will wear the surgical bras day and night for the first six weeks. After six weeks, you will no longer need to wear the bra at night-time; however, you can continue to wear it overnight if you find it more comfortable. You may also go and buy some new bras. A very supportive sports bra that minimises breast movement is recommended for the first couple of months.
Generally speaking, you should not be bra-less for at least six weeks after breast augmentation—potentially longer, depending on your surgeon’s recommendation. Your breasts need to be thoroughly supported to ensure optimal healing and results. After six weeks, you may occasionally go bra-less for special occasions, but do not make this a habit.
In most patients, the areolas do not dramatically enlarge after breast augmentation. They may stretch slightly because of the larger volume of the breasts, but it is uncommon for them to become substantially bigger. Often, the areolas appear much smaller relative to the larger breasts. Many women want their breasts enlarged and their areolas reduced in the same surgery, but this combination is not advisable. During breast augmentation surgery, the breasts are under much tension. Making the areolas smaller is counterproductive because it becomes a tug of war between the thick breast skin and the weaker areola skin. Inevitably, the areolas naturally stretch back out. It is best to wait until after the breasts have softened and healed, which will be approximately six months after augmentation, and if you are still concerned about the areola size, we can surgically reduce their size.
Although the term ‘scar-less’ Breast Lift (mastopexy) gives the impression that there will be no scarring, all invasive surgery guarantees some scarring. Scars may lessen in intensity and be strategically placed to minimise visibility or cleverly concealed. With a well-planned and well-performed Breast Augmentation, a reasonable lift can sometimes be achieved with a usual Breast Augmentation scar in the lower breast fold – and no scars on the breast mound. This procedure is generally referred to as a scar-less breast lift, although it is technically a just a breast augmentation. In more extreme cases of ptosis (droop), breast lift scars may be unavoidable without compromising results. A breast lift incision typically outlines the areola and traces down from the bottom of the areola to the crease below the breast. This scar naturally resembles a lollipop. In the beginning, the scars will be raised with a reddish-pink appearance. As they heal, the scars will eventually flatten and fade. The scars from a breast lift may not always heal as nicely as we would like.
During implant surgery, your surgeon creates an appropriately sized pocket to hold the implant firmly, ensuring that the implant is secure. Sometimes, the implant moves around the pocket too much. There are two reasons movement may occur. First, an inexperienced surgeon might have created a pocket that is too large for the implant. More likely, however, there is a weakness and a lack of elasticity in the breast tissue. So, even though the pocket was an appropriate size at surgery, the implant continues to affect the envelope by stretching it out. Weakness and a lack of elasticity in the breast tissue can be caused by genetics, pregnancy, breastfeeding and weight fluctuation. Whatever the underlying cause, the implant pocket needs to be surgically corrected to make it smaller. Correction involves operating along the same scar, typically to suture and tighten up the pocket. If the cause of the issue was weak tissue, smaller implants, more supportive bras or implant removal may be advised. Consideration is to be given for a formal internal bra (mesh) in these circumstances.
Breast Implants can shift or become displaced from the original position. Displacement can be caused by capsular contracture, healing and surgical issues, weight fluctuations and trauma to the breast. Larger implants are more likely to be displaced than smaller implants. The implants may migrate to your armpits (lateral displacement), towards the midline of your chest (symmastia) and downwards, which is referred to as ‘bottoming out’. Revision Breast Augmentation surgery may be needed to reposition the implant; surgery usually involves tightening up the pocket around the implant. Wearing an appropriate and supportive bra, being fully compliant with all post-operative guidelines, and attending all post-operative appointments can reduce the likelihood of implant displacement.
Breast Implants are very resilient and do not rupture easily. Although unlikely, implants can rupture due to intense physical trauma to the breast, accidental perforation during a breast biopsy and other exceptional circumstances. Symptoms such as an abrupt loss in breast shape, ongoing breast ache or pain or misshapen and lumpy breasts may indicate a ruptured or collapsed implant. However, most of the times a ruptured implant causes no symptoms and is typically discovered by accident when the patient is having a breast scan for another reason. If your breast implant has ruptured, you will need corrective surgery to remove or replace the breast implant.
Surgery is commonly performed on interstate patients. However, we do have strict guidelines regarding the necessary time you need to remain in Sydney for post-operative care.
If you are fuller figured but in good overall health, you absolutely can undergo Breast Augmentation surgery. Given that there is a much higher complication risk for overweight breast surgery patients, it is important that you discuss your suitability for surgery with your doctor and that you are aware of the potential risks. Nevertheless, if you have a fuller figure, it is possible to have breast augmentation surgery.
After Breast Augmentation, your breast tissue needs time to heal and adjust to the presence of a breast implant before you can fully appreciate the final results. At your six-month postoperative appointment, your surgeon will examine, discuss and critically review your results. Here, you will have the opportunity to enquire about further surgery.
Fat transfer, commonly referred to as fat grafting, involves transferring fat from your troublesome areas via liposuction and injecting the fat into the breast. While Dr Dona does offer fat transfer, it is not often recommended. The issue is that fat grafting is less effective, more unpredictable and less reversible than breast implants. When fat cells are injected into a new location, they are not guaranteed to take. The body breaks down much the fat, and only a small percentage of fat cells receive enough blood supply to survive. It is difficult to predict the size and symmetry of the breasts after a fat transfer, so you may require several follow-up procedures to achieve the desired result. Although many surgeons feel that fat grafting provides the most natural-looking result, in successful procedures it typically increases the breast by a minimal amount.
Capsular contracture occurs when the scar tissue that normally forms around the implant becomes abnormally thick and tight, contracting around the implant. The scar tissue capsule is essential, as it holds the breast implant in place and prevents slippage, but if the scar tissue contracts too tightly, it can cause the breasts to become hard, distorted and even painful. When capsular contracture begins to present visible distortion or causes discomfort, corrective surgery to remove the capsule and replace the implant is necessary.
Textured implants have a rough surface, similar to sandpaper, that can help adhere to the breast tissue. The texture stabilises the implant in position and reduces the risk of capsular contracture. Anatomically shaped implants, also known as teardrop implants, are textured to avoid rotation. Round implants, however, can be textured or smooth. A smooth breast implant shell is as its name suggests, smooth.
Breast Implants are made of silicone. Silicone is considered a biocompatible material that are suitable for living tissue and pose no risk of injury or rejection by the immune system. Silicone is used in numerous medical devices. Silicones are also found in everyday items, such as antiperspirants, shaving creams, shampoos, cooking utensils, soaps, laundry detergents, fabric conditioners and contact lenses, so you have likely already been in contact with silicone. If you have experienced allergy symptoms post-surgery, it is more likely due to the medications or adhesives used during the surgery.
Breast Implant Illness, commonly referred to as BII, is a term that some women and medical professionals use to refer to a wide variety of symptoms that appear to have developed after Breast Augmentation Surgery. In some cases, women who have had their breast implants removed have reported improved symptoms. BII is a very difficult topic, and there is no scientific evidence proving an association between silicone breast implants and chronic illness. However, where does that leave women who are experiencing symptoms? The only treatment that surgeons can offer is to remove the implants, but there is no guarantee that the symptoms will disappear.