Breast Augmentation is a cosmetic surgery procedure designed to increase the size, shape and volume in breasts using Breast Implants. The breast is made up of fatty, glandular and fibrous tissues. Within it are blood vessels, milk ducts, fat, glands and sensory nerves. A layer of fat surrounds the breast to give it a soft consistency and contour. Beneath the breast is the Pectoralis Major, a large muscle close to the chest wall that assists in arm movement. Women’s breasts vary greatly in both size and shape. The size and shape of breasts are determined by the amount of breast tissue and fat present in them. Size is also affected by factors such as age, past pregnancies, genetics and skin elasticity. Even breasts on the same body may vary, making one breast slightly different from the other. Such variations in size and shape are common for natural breasts and occur in most women. By inserting an implant behind each breast, cosmetic surgeons are able to increase a woman’s bust line by one or more bra cup sizes.

Patients may choose to undergo Breast Augmentation to:

• Enhance the body contour. This is for women who desire fuller breasts and feel their breast size may be too small
• Restore breast volume due to weight loss or following pregnancy
• Achieve better symmetry when breasts are moderately disproportionate in size and/or shape
• Improve the shape of breasts that are sagging or have lost firmness, often used with a breast lift procedure
• Provide breast contour when they has been removed or disfigured to treat breast cancer
• Breast reconstruction to improve breast appearance where a breast has been disfigured due to trauma or an abnormality

The most popular form of Breast Augmentation is breast implants; which come in many shapes and sizes. Implants also have differing inner and outer materials (such as silicone implants and saline implants). Together, you and your doctor will select the options that are best suited for you and most likely to achieve the results you desire. In this section, we will discuss some of the most important differences between various types of breast implants. All breast implants have an outer pliable envelope enclosing a soft-solid (silicone gel) substance. The implant shapes are generally round, oval or contoured. The surface of the implants has traditionally been smooth to the touch, but now there is another option, a textured Surface. The Silicone-filled implants stay as one solid membrane, meaning that in the rare event of a rapture, the implants will stay in once piece rather than leaking through the body as the old styles used to. This makes replacing an implant quick and simple.

Tear Drop ‘Anatomical’ shaped or Round shaped breast implants are the two main shapes of breast implants. At Cosmos Clinic, we believe that the shape of your breasts after breast implants will be determined by the natural shape of your existing breasts and the size and placement of the implants, NOT by the shape of the implant. We do prefer the use of round implants for the following reasons:

• Round breast implants feel softer than tear drop implants.
• If a round breast implant were to rotate, the shape of your breast will not change. However, if a tear drop implant rotates or migrates over time, your breasts may become asymmetrical.
• Round implants tend to take on a natural shape when implanted, as they form a tear drop shape when a woman is standing.

That being said, you can discuss your options with Dr Choy, to choose which shape you would like.

The following steps are taken to perform a Breast Enlargement with implants:

• Your final choice of implants is discussed with the surgeon at your initial consultation;
• The breast enlargement is performed under a general anaesthetic where you will not feel or remember the cosmetic procedure.
• The breast is numbed with a numbing solution
• A cut is made either under the breast in the crease, under the armpit or through the nipple.  This is the incision site, and the place where we insert the implant. At Cosmos Clinic, we make an incision under the breast because it results in greater symmetry and makes the breast sit more naturally
• The surgeon will then create a pocket either above or below the muscle in which the breast enlargement implant will sit. This is done with a diathermy (a probe that cuts through tissue while stopping the bleeding)
• The implant is placed into a antiseptic solution before being inserted into the pocket
• The surgeon will manipulate the implant to ensure that it sits right. He/she may need to take out the implant and put it back in again to ensure the most natural looking results
• The area is closed with dissolvable sutures
• The procedure will take 1-2 hours
• A support bra is worn for 6 weeks

The body’s natural response to any foreign object is to reject it. The degree of this rejection response is partly dependent on the biocompatability of the materials that make up the foreign object. The more biocompatible a material is, the less the body will reject it. Scientists are continuously researching new materials that are biocompatible to the body. At present, the most common biocompatible material utilized in breast augmentation implants is silicone. This material is used in many medical implants such as pacemakers and joint replacements, as well as consumer products like antacids and preservatives (see Potential Risks and Complications). The body will form scar tissue, made from collagen, around the surface of the implant – this is called the capsule. Capsule formation is a normal reaction to any implant. In some women, the collagen capsule can contract, causing a condition known as capsular contracture. This results in a firmer or hardened breast, which may cause discomfort or pain. However, the textured surface of the implant is designed to disrupt the body’s collagen interaction with the implant surface and the resulting capsule formation.

Usually breast augmentation implants are surgically inserted utilising one of three traditional incisions:

• the inframammary incision
• the periareolar incision
• transaxillary incision

All of these incisions allow the implant to be placed either submuscular (below the chest muscle) or subglandular (between the chest muscle and your breast tissue). No one incision and placement is right for every woman. Therefore, by knowing your options and discussing them with your doctor, together you can decide upon the best combination for you. The inframammary incision is made in the skin fold below the breast, and the breast implant is inserted through this incision. The breast tissue is minimally disturbed, and the remaining incision scar is concealed within the fold of skin under the breast. The periareolar incision is made along the edge of the colored area around the nipple, and the breast implant is inserted through this incision. The incision scar is well camouflaged in this area. The transaxillary incision is made in the armpit and the implant is inserted through this incision. An additional option that patients with ptotic or sagging breasts may elect to have during the breast implant surgery is a mastopexy (breast lift). There are many important factors that may have an effect on your particular procedure, your recovery and your results. They should be well understood and carefully discussed with your doctor. Some of these factors are:

• Your overall health;
• Your chest structure and overall body shape relative to the breast augmentation you desire;
• Your healing capabilities (which can be affected by smoking, alcohol and various medications);
• Prior breast surgeries; and
• Bleeding tendencies.

There is no definitive answer on how long breast implants last, basically they last until there is a problem, with most follow up surgeries carried out to correct movement of implants or replace implants due to changing breast shape (sagging with age). On average, tear drop implants tend to last approximately 15 years, with round implants lasting approximately ten years. Keep in mind you will need follow up surgeries eventually.

Most of our patients describe the post surgery feeling as pressure rather than pain, similar to having done a heavy chest workout at the gym. The duration of this discomfort will depend on the size of implant and may also vary among patients, younger women with tighter chest skin may feel discomfort for longer than older women with looser chest skin. Some discomfort is expected after surgery, and patients usually take painkillers for 3-4 days post surgery.

Your breast implant procedure takes approximately 1.5 hours. In most cases, you can go home on the same day, after about 2 hours of recovery time.

You will experience the most discomfort during the first 24 – 48 hours after your surgery and your breasts will remain swollen and tender for up to two weeks. Although every woman’s recovery time is different, you should be able to resume many of your regular activities after one week and will need to wait at least one month before resuming any strenuous physical activity. You will be given a compression bra to wear for six weeks and instructions on how to perform breast massage to reduce the risk of capsular contracture. Should any problems occur after surgery, contact your doctor immediately. This is especially important if your temperature is elevated, or one of your breasts is noticeably more swollen and tender to touch, painful, red or inflamed. Most of our breast augmentation patients are back at work after 3-7 days, this may vary from patient to patient, and will take longer if you are a smoker. You will have to wear a garment for 6 weeks, this can be easily hidden under clothing.

You will not be able to claim any costs from Medicare. You may be able to claim some costs of the surgery from private health cover.

There is no medical evidence that breast implants will have any effect on breastfeeding. If you are planning on becoming pregnant or breastfeeding post surgery, please discuss this during your consultation.

There are inherent risks and complications with breast augmentation as there are with any surgery. You should be aware of the potential risks and discuss any concerns you may have with your doctor before your implant surgery is performed. Most common risks

• Capsular contracture: the scar tissue or capsule that normally forms around the implant may tighten and squeeze the implant. This is called capsular contracture. Over several months to years, some women have changes in breast shape, hardness or pain as a result of this contraction. If these conditions are severe, more surgery may be needed to correct or remove the implants. Newer textured implants have reduced the risk of this problem occurring.
• Making breast cancer harder to find: the implant could interfere with finding breast cancer during mammography. It can “hide” suspicious-looking patches of tissue in the breast, making it difficult to interpret results. The implant may also make it difficult to perform a mammography. Since the breast is squeezed during mammography, it is possible for an implant to rupture. It is essential that every woman who has a breast implant tell her mammography technologist before the procedure. The technologist can use special techniques to minimise the possibility of rupture and to get the best possible views of the breast tissue.
• Calcium deposits in the tissue around the implant: when calcium deposits, which are not harmful, occur, they can be seen on mammograms. These deposits must be identified as different from the calcium that is often a sign of breast cancer. Occasionally, it is necessary to surgically remove and examine a small amount of tissue to see whether or not it is cancer. This can usually be performed without removing the implant.
• Additional surgery: women should understand there is chance they will need to have additional surgery at some point to replace or remove the breast augmentation implant when and if it wears out. Also, problems such as deflation, capsular contracture, infection, shifting, and calcium deposits can require removal of the implants. Many women decide to have the implants replaced, but some women do not.
• Infection can occur with any surgery: the frequency of infection with implant surgery is not known and is uncommon. Most infections resulting from surgery appear within a few days to weeks after the operation. However, infection is possible at any time after surgery. Infections with foreign bodies present (such as implants) are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the implant may have to be removed. After the infection is treated, a new breast implant can usually be put in.
• Haematoma: a haematoma is a collection of blood inside the body (in this case, around the implant or around the incision). Swelling, pain and bruising may result. The chance of getting a haematoma are about 0.5% to 3% and if it does occur, it will usually be soon after surgery (it can also occur at any time after injury to the breast). Small haematomas are absorbed by the body, but large ones may have to be drained surgically for proper healing.
• Delayed wound healing: In rare instances, the implant stretches the skin abnormally, depriving it of blood supply and allowing the implant to push out through the skin. This complication usually requires additional surgery.
• Changes in feeling in the nipple and breast: feeling in the nipple and breast can increase or decrease after breast augmentation surgery. Changes in feeling can be temporary or permanent.
• Shifting of the implant: sometimes an implant may shift from its initial placement, giving the breasts an unnatural look. Further surgery will be required to correct this problem. It may become possible to feel the implant through the skin. Other problems with appearance include incorrect implant size, visible scars, and uneven appearance.
• Breast-feeding and children: questions have been raised about whether or not breast implants present safety concerns for nursing infants. Breast implants do not interfere with lactation while children are often exposed to silicone in medications, food and drinks. There is no evidence to suggest that babies develop any health problems from mothers who have breast implants.

While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.

Dr. Choy operates out of Sydney & Coffs Harbour. Please contact Cosmos Clinic for more details.