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FAQ's - Breast Augmentation Surgery
Do breast implants feel unnaturally hard?
While breast implants may sometimes not be as supple as natural breasts, most women are very satisfied with the results. Capsular contracture may result in unnatural firmness following augmentation. Capsular contracture is when the body produces excessive scar tissue around the implant. The incidence of capsular contracture in primary breast augmentation is in the order of 2 -3% of cases. It is often of a minor degree which does not require treatment. Significant capsular contracture may require re-operation to remove the capsule.
Can breast implants cause breast cancer and other diseases?
There is no medical evidence to show that women with breast implants have a higher chance of developing breast cancer or autoimmune diseases. There has been a few sporadic cases of a condition called ALCL developing in association with long term breast implants. This is a rare malignant condition of the breast capsule. There does not appear to be a causal relationship with breast implants however.
Will I be able to breastfeed with breast implants?
There is no medical evidence to show that breast implants interfere with breast-feeding, and women with breast implants do not risk exposing their breastfed children to excessive amounts of silicone. The ability to breastfeed successfully varies in all women with or without breast implants.
Can breast implants make it difficult to detect breast cancer?
It is recommended that all women regularly self-examine their breasts for lumps and changes, and have an annual examination by a doctor. Mammography is more difficult to assess for women with breast implants. Patients should inform radiologists of their breast implants prior to having the mammogram.
Is breast augmentation a painful surgery that requires a lot of time off work and physical activity?
Each patient will tolerate pain in a different way, and this is usually taken into account by the anaesthetist and appropriate pain medications are prescribed post operatively.
The length of time it takes to recover from surgery can also differ from patient to patient, although most breast augmentation patients are mobile and able to care for themselves within two days after surgery. Most patients are able to return to work within five to seven days. Patients are encouraged to commence a slow walking routine two days after surgery and are advised to avoid vigorous exercise for two weeks.
Are breast augmentation scars obvious?
Breast implants are inserted through a small incision and these incisions can be made either in the crease under the breast, under the arm, or around the nipple. The surgeon will recommend the most appropriate incision for each patient in order to minimise visible scarring. The best scar is usually the infra-mammary scar in most cases.
Can anyone tell when a woman has had breast implants?
A carefully planned and performed surgical procedure can give most patients a natural appearing result. It is important to choose an experienced surgeon who will not only consider a patient's desires, but take into account the height, weight, and natural breast size and shape. Choosing an appropriate implant and positioning it correctly are the keys to achieving a natural looking result.
Do breast implants make the breasts sag earlier?
Breasts sag due to gravity, weight and the elastin/collagen structure within the skin that breaks down with the aging process. A natural breast of the same size and weight will sag just as fast as an implant. It is important to wear a good quality, supportive and well fitted bra and not assume that breast implants mean that a bra is not necessary. Excessively large implants can result in premature sagging.
Do breast implants need to be replaced regularly?
The lifespan of currently used breast implants is unknown. There is a possibility they may have to be removed or replaced at some stage. However, there is no set period at which time the implants should be replaced. Many implant manufacturers give a life time guarantee on their product.
What should I expect from the breast augmentation consultation?
A personal consultation is the first step for every patient considering breast augmentation. During this meeting, Dr Cooper will assess your physical and emotional health and discuss your specific cosmetic goals for surgery.
You should arrive at the consultation ready to provide complete information about.
- previous surgical procedures
- past and present medical conditions
- medications you are taking, including herbal remedies or nutritional supplements
- the results of mammograms you have had
- any history of breast cancer in your family
As part of the consultation, your breasts will be examined and photographed for your medical record. During this examination, your surgeon will consider the size and shape of your breasts, your chest dimensions, the quality of your skin and the position of your nipples.
Your surgeon may suggest additional cosmetic procedures to improve your results. For example, if your breasts are sagging, your surgeon may suggest that a breast lift procedure be performed in conjunction with your breast augmentation surgery.
How is breast augmentation performed?
The access incision is made in one of three locations: underneath the breast just above the crease, around the lower edge of the areola, or within the armpit. The incision under the breast is usually the preferable one.
Once the incision is made, the surgeon creates a pocket into which the implant is inserted. This pocket is made either directly behind the breast tissue or beneath the pectoral muscle, located below the breast tissue and above the chest wall. This decision is usually predicated by the thickness of the soft tissue of the upper breast and chest wall. There are other factors determining the "above or below muscle" issue which your surgeon will discuss with you. Drains are not routinely used.
Are breast implants safe?
Each year, thousands of women undergo breast augmentation surgery and experience no major complications. However, you must fully understand the risks as well as the benefits of the procedure. One of the most important parts of your consultation is the discussion that you and your surgeon will have about the possible complications of breast augmentation surgery. These include altered nipple sensation, implant malposition, infection, capsular contracture and implant failure.
Capsular contracture or breast firmness is much less of a problem than in the past. If it develops it can be treated by performing a capsulectomy and replacing the implant. Infection is unlikely but can be devastating as it usually means the implant has to be removed. The likelihood of implant failure is hard to quantify but the newer implants do seem to have a longer lifespan. Implants do not have to be automatically replaced after an arbitrary time such as 10 years. Nipple sensation can be affected but the change is usually only temporary.
Be sure to raise any questions or concerns that you may have about the safety of the procedure.
Saline or silicone breast implants?
All commonly used breast implants have an inert silicone covering. This silicone covering may be smooth or textured (rough surfaced). Following the silicone "scare" in the 90's, saline implants became more popular. However, saline implants have waned in popularity over the past decade for various reasons. There are many women who remain anxious about having silicone implants despite there being numerous scientific papers stating that silicone poses no health risk in breast augmentation.
Silicone filled implants are increasingly the preferred option in Australia. They are approved for general use by the Therapeutic Goods Advisory Service (TGA). The older soft silicone implant is still available, but more recently a cohesive gel implant has been introduced. The benefit of the cohesive gel implant is that if the implant covering ruptures, the gel itself is of a cohesive nature and will therefore not disperse.
One of the downsides of silicone implants is that they are pre-filled and therefore require a slightly longer incision to place the implants. The obvious benefit is that they do impart a softer feel to the breast, and certainly the cohesive gel implants give an excellent feel and form to the breast. This is particularly important in women with small breasts.
Another implant currently available in Australia is the polyurethane implant from Brazil.It has a characteristic furry surface. The perceived advantage of this implant having a lower rate of contracture is not born out in long term studies.
What size and shape breast implant is right for me?
Breast implants currently available in Australia come in either round or anatomic (tear drop) shapes. The anatomic implant has more projection at the base and is said to impart a more natural look. This is probably more important in a woman with very small breasts, or in nulliparous women (women who have not had babies). The anatomic implants are more expensive and may occasionally be prone to rotation.
The size of the implant desired vexes many women. Various factors are taken into account by the surgeon when assessing this. These include the breast shape and size (the surgeon will measure certain dimensions of the breast), the amount of upper breast "padding" and the height and body shape of the patient.
Implant sizing charts allow the surgeon to reasonably accurately predict the dimensions of the new breast. The patient can request to view photographs of previous augmentations and this may help in making a decision regarding the desired size. Sizer implants are placed in the bra to give some idea of the projection prior to making a decision. Desire for a larger size is reported as the commonest reason for reoperation in breast augmentation surgery so it is important to get it right.
The surgeon will generally accede to the patient's wishes regarding the desired breast size, but patients should be counseled against requesting too large an implant. Large implants do, as a rule, lead to more problems in the long term.
How will I be cared for on the day of my breast augmentation surgery?
Breast augmentation is performed in a hospital under a general anaesthetic, usually as a day case, unless combined with other, more major procedures. Pain and discomfort are usually minimal and return to normal sedentary activities in two to three days is expected. A new sports bra or crop top is suggested for comfort, and gentle massage of the breasts is recommended in the early post-operative period.
How long will I continue to see my plastic surgeon?
After the initial healing period, you will return to your plastic surgeon's office for a postoperative follow-up visit so that your progress can he evaluated. In the following months, your surgeon will ask you to return for periodic checkups. It's important to return for these checkups so that your surgeon can assess your long-term results and address any questions or concerns you may have
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