Augmentation Mammaplasty (Breast Implant Surgery)

The desired size of breasts for a particular woman is a very individual thing. Because patients will desire a variety of different appearances, it’s very important to convey to the surgeon what you are trying to achieve in your breast augmentation surgery.

Some patients desire a very natural look, whereas other patients want a more-than-natural look. Other patients may desire to have a very full upper part of the breast to give them a very “buxom” look.The general goal of breast augmentation is to provide harmony and symmetry to a patient’s body while avoiding an obviously augmented appearance.

Some patients, however, may desire that look, which is something that should be discussed with the surgeon.

There are technical factors which govern the appropriate size of the breast implants used during augmentation mammaplasty. Factors which go into deciding the appropriate size of prostheses for a particular patient include the height of the patient, the width of the patient’s chest wall, the prominence of the ribs, and the amount of breast tissue the patient has to start off with. Another factor that comes into account is how much loose skin the patient has, which is greatly governed by whether the patient has had children in the past or not.

There is no right answer to what is the proper breast size. Technical considerations and personal preferences concerning the patient’s breast size usually guide the augmentation decision.

Careful consideration of each patient’s particular circumstances and desires is very important to achieve a result that is pleasing to both you and the surgeon. Dr Perkins can help you make these important decisions during a breast augmentation consultation. Please contact our plastic surgery practice to schedule an appointment.

Breast augmentation surgery is performed under a general anaesthetic and generally takes 1.5 – 2 hours.  It is usually performed as a day procedure.

During the surgery, the implant is usually placed behind the breast tissue. However, the prosthesis may for various reasons also be placed behind the pectoralis muscle, which lies directly beneath the breast tissue (subpectoral position). Alternatively, the prosthesis may be placed on top of the pectoralis muscle (subglandular position). Subfascial breast augmentation involves placing the implant below the fascia, or the thick fibrous layer on top of the muscle.

There are pros and cons to all of these approaches depending on the particular circumstance of the patient. If the patient is extremely thin, the prosthesis must be placed underneath the pectoralis muscle to allow the muscle to hold the upper pole of the breast implant. This is the case if there is not enough breast tissue to adequately hide the upper pole of the prosthesis and stop it from being evident after breast augmentation surgery. There is also a thought that there may be a slightly lower incidence of capsular contraction when placing the prosthesis underneath the muscle. In this position, though, the muscle only partially covers the prosthesis as usually the inferior fibres of the pectoralis muscle have to be released to allow the prosthesis to come forward into the breast tissue.

Placing the prosthesis under the glandular tissue during breast augmentation is certainly less painful than in a subpectoral position. It does allow the breast to move more easily after augmentation as the pectoralis muscle is not pinning the implant down. This approach does, however, require enough tissue to cover the prosthesis, and placing the prosthesis in a subfascial plane does provide more tissue to hide the upper pole of the prosthesis.

In the situation where there is a mild to moderate degree of ptosis (loose skin) which must be filled out, the prosthesis will usually do this to a greater degree if placed in a subglandular position.

Ultimately, each breast augmentation patient at our practice must be assessed individually, and the appropriateness of placing in front or behind the muscle again depends on a variety of variables, including the size of the breast implant used as well as the amount of available breast envelope that will cover the actual prosthesis. Careful assessment of each individual is very important to achieve the desired effect.

• Upon completion of the surgery patients are placed in a  bandage.  The bandage is generally removed two days post-operatively when the patient is then placed in a crop top.
• Once recovered and ready for discharge, post-operative instructions covering wound care, medications and follow up appointments will be given.
• It is essential that a responsible adult collect the patient and stay with them for the first 24 hours following the surgery.
• Bruising and swelling are normal following the surgery and will subside over the first few weeks.  A degree of discomfort, particularly when moving or coughing, can be expected for the few first days after the surgery.
• Patients will be able to carry out most normal non-strenuous activities around the house in 2 – 4 days, and many patients will return to work if they have a desk job after 1 or 2 weeks. Patients are usually able to drive a car a week or so after their surgery.
• It is important that patients avoid strenuous upper body activities for about 5 – 6 weeks following breast augmentation surgery. At this time, patients will begin wearing a bra to fit their new size.
• In the majority of cases, patients must work their way back to their normal activity level, but in most circumstances it is a matter of being sensible in what activities one undertakes.

Even with the highest standards of practice, all surgical procedures carry a level of risk and the potential for complications. In addition, every individual will have a different risk profile depending on their general health, age and the complexity of the procedure.

During the consultation Dr Perkins will explain the possible complications and risks of the specific procedure to provide the necessary information to enable patients to weigh up the benefits, risks and limitations of the surgery.  The following are some of the risks associated with this procedure.

• Specific risks include capsular contracture, rupture of implant, rejection of implant, asymmetry, changes or loss in sensation of the nipple, later changes in breast shape, rotation or change in position of the implant, rippling appearance, possible link to autoimmune disorders. Breast-implant-associated anaplastic large cell lymphoma (BIA-ALCL) and breast-implant-associated SCC (BIA-SCC) are rare.
• General risks involved in any surgery include post-operative infection, excessive bleeding, pain/discomfort, haematoma (blood collection), seroma (fluid collection), scarring, adverse reaction to anaesthetic, unsatisfactory scarring. Read more about general risks and complications of surgery.

Augmentation mammaplasty surgery is classified as cosmetic and therefore no Medicare or private health fund rebates apply for the medical or day surgery fees.

An estimate of costs will be provided following the consultation with Dr Perkins.