Breast Augmentation

Breast augmentation is a commonly performed surgical procedure that involves the placement of an implant behind the breasts to enhance their size and shape. Breast augmentation is indicated for the following reasons:

✓ small breasts
✓ restoration for sagging (ptosis) of the breasts after pregnancy
✓ asymmetry of breast size
✓ reconstruction of part or all of the breast following surgery

Breast augmentation surgery is best performed using general anaesthesia and it is recommended that you stay overnight following surgery although the procedure may be done as a day case in selected patients.

In your initial consultation, your surgeon will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, your doctor may also recommend a breast lift (mastopexy).

It is important to have realistic expectations about the results and discuss these frankly with your surgeon. Every patient - and every surgeon, as well - has a different view of what is a desirable size and shape for breasts. The aim of surgery is to make your breasts proportionate but it is difficult to guarantee what cup size will result.

Be sure to discuss your expectations frankly with your surgeon who should be equally frank with you, describing your alternatives and the risks and limitations of each. Be sure to tell your surgeon if you smoke.

Your surgeon should also explain the type of anaesthesia to be used, the type of facility where the surgeon will be performed, and the costs involved. Because Health Funds do not consider breast augmentation to be necessary (i.e. purely cosmetic), they do not cover the cost of this procedure. However once the implants are in place any future problems are likely to be classified as medical rather than cosmetic and thus covered to some degree by the Health Fund. 

Breast implants are available in an extensive range of sizes, shapes and types of fill. Most implants have an outer silicon rubber layer and are filled with either silicone gel or saline (salt water). There are round implants and anatomically (tear-drop) shaped implants. Your surgeon will give you more information so you can decide which implant best suits you. Despite some media reports long-term studies have not found any adverse effects from the use of silicone implants (encl).
The method of inserting and positioning your implant will depend on your anatomy, preference and your surgeon's recommendations. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple) or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible. The implant can be placed directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). There is some evidence that putting the implants behind your chest muscle may reduce the potential for capsular contracture. This placement may also interfere less with mammography than if the implant is placed directly behind the breast tissue and also provide extra support of the implant. Placement behind the muscle, however, may be more painful for several days after surgery than placement directly under the breast tissue.

As with all surgery there are general complications inherent from having any surgical procedure & anaesthetic as well as specific complications from the type of procedure itself, including whether or not implants are used. Your surgeon should carefully explain these to you. As with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Less than 5% of women will develop a significant post-operative complication. Prompt treatment of any complication reduces the chance of long-term problems. Depending on your age you should continue with regular mammograms.

The procedure does leave permanent scars, although your bra or bathers will cover them, unless an axillary approach is used. After surgery, your breasts will be wrapped in an elastic bandage over dressings. A small suction drain may be placed in each breast to drain off blood and fluids for the first day. The bandages will be removed the day after surgery before you go home although you'll continue wearing a sports bra/lycra crop top day and night for 4 weeks and then during the day for a further 4 weeks. The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding should not be affected.

Although you will be up and about the day of surgery, your breasts may still ache occasionally for a couple of weeks. Take your prescribed painkillers regularly for 3-5 days, then as required. Most women can return to normal activities/work (if it's not too strenuous) within one week. However you'll have less stamina for several weeks, and should limit your exercise. You'll also need a good sports bra or lycra crop top for support. Do not wear an underwire bra for at least 8 weeks. Avoid swimming or immersing your breasts under water for 4 weeks. Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy. Most scars take three months to reach their full strength and during this period they may become itchy, firm, red and a little raised. The scars will then gradually mature until they become a fine, white line over nine to twelve months, although this is variable according to individual skin types. After 6 weeks when the wound has healed soundly you may massage the scar with moisturising cream or oil twice daily for two to three months. It is not essential to use Vitamin E cream or oil