The number of breast enlargement operations is on the increase, and the demand for natural-looking breasts is even more apparent. As a plastic surgeon specializing in Breast Augmentation and Breast Lifting procedures, I have been privileged to treat a large number of patients every year in my Sydney clinics. Therefore, I have drawn from this wide experience and applied this to perfect the formula for successful and attractive breast augmentation.

A well-augmented breast has a natural fullness, with gentle sloping off the chest wall. There should be natural cleavage without webbing between the breasts and only a certain amount of perkiness.

There are three main telltale signs of unnatural breast augmentation:

1. Breast implant margin: This should be soft and imperceptible, as obvious implant edge visibility, especially in the midline, will resemble the 'Tori Spelling' or ‘Posh Spice’ look.

2. Breast implant size : An implant that is too large for a small frame is usually an obvious giveaway that a patient has had a breast augmentation. The best example of this would be 'Pamela Anderson' breasts. Women wanting to go from an ‘A’ cup to a full ‘D’ cup need to understand this point.

3. Perkiness: An augmented breast that is too perky will tend to look fake, as a small amount of droop is natural. When the patient lies on their back the breast implants should roll to the side like natural breast tissue and not sit up like rigid peaks.

Before undergoing surgery, it is beneficial for the patient to review photographic examples of the breasts they would like, and to convey their wants to the surgeon so there is a clear, visual understanding of the desired result.

There are six main clinical parameters for breast implants on initial consultation:

1. Patient's body build and height

2. Natural breast size, shape and symmetry

3. Nipple position in relation to the breast

4. The quality of breast skin

5. Chest wall shape and dimension,

6. Patient's desire for new cup size and shape.

After establishing the crucial parameters in the clinical examination, the process of tailor-making the 'right' breast augmentation begins.
I believe there are six key considerations for a surgeon when customising a breast augmentation to gain a natural-looking result:

1. Incision placement

There are three choices about where to make the skin incisions for breast enlargement. They can be in the breast fold (inframammary), around the nipple (periareolar) or underneath the arm (transaxillary). These incisions can all produce scarring. Although patients may voice some initial concerns about the location of their scars, they are ultimately far more concerned with the final shape and size of their breasts.

Generally, a great majority of patients in my practice opt for the inframammary incision (breast fold). I also find this incision has the least amount of interference with breast feeding and nipple sensation, and it generally heals very well.

2. Breast implant shape

The choice of implant shape varies from round to teardrop. The round implant comes in both low- and high-profile varieties. The shape variation is in the width and projection of the implant for any given size. The spectrum of breast implants available to the surgeon can therefore provide great versatility in achieving a more natural look.

The majority of patients in my practice elect to have round-shaped implants. Since I prefer placing the implant in a submuscular pocket in most patients, implant edge visibility in the upper pole of the breast can be avoided. The round implant tends to be ideal for those patients with good-shaped natural breasts who desire a straightforward enlargement.

Use of the teardrop (anatomical) shape depends on the patient's desire, as well as her breast shape. In general, there are two groups of women who benefit from teardrop-shaped breast implants. It can be the ideal choice for women who have droopy or tuberous breasts. Mild elevation of the nipple in relation to the breast mound can be achieved without the need for extra scars on the actual breast (unlike a breast lift scars). In these cases, the implants will be inserted in a subglandular (subfascial) pocket (under the breast tissue). In severe cases of droopiness, breast lift must be performed to restore aesthetic shape.

Secondly, some patients specifically want less fullness in the upper quadrant. Teardrop breast implants certainly offer less fullness in these particular situations. It should be noted, however, that this request tends to be very personal, as most women are seeking breast augmentations in order to obtain upper pole fullness. Please note that Teardrop or Anatomical implants do have a slight tendency to rotate. The figure quoted for the rotation is about 5%. Unfortunately, this problem can only be corrected by secondary surgery.

3. Breast implant fill

I use both the cohesive silicone-gel and saline-filled breast implants. The new generation silicone-gel breast implant is very safe and generally feels and looks more like a natural breast. The gel is always my first preference.

Most breast augmentation operations in Australia are performed with silicone-gel breast implants. In December 2006, the Food and drug Administration (FDA) approved the use of gel implants in the US market. The decision was based on a great amount of scientific research into safety of silicone-gel implants.

The gel usually comes in low and high cohesiveness (soft or firm) and you should ask your plastic surgeon for different samples at the time of the consultation.

4. Breast implant size

Breast implant size is one of the most important decisions in a breast augmentation procedure. Because of this, a good surgeon will take several approaches to help the patient make the best decision based on their anatomy, personal preferences and the appearance they wish to achieve. In general, attractive breast augmentation can be in proportion or slightly out of proportion to the woman’s overall body shape.

In a recent survey, over 80 percent of patients undergoing breast augmentation stated an average to full C-cup was their desired postoperative goal. D-cup was the second most popular request. Small C-cup is the third commonest followed by full-D and Double D cups.

Final breast implant size is a complex function of preexisting breast volume, chest wall diameter and implant dimensions.
For this consideration, I always begin by showing the patient numerous photos of actual patients who have had breast augmentation. By finding someone who has a similar preoperative appearance and evaluating their results with the size of implant they chose, the patient can get an idea of her own final result and increase or decrease the implant size according to her wishes.

I will also measure the patient's breast and chest shape, paying particular attention to the base and projection of the breasts. This gives me an idea of what size breast implant will help achieve the patient's desired size postoperatively.

As breast implant size increases, so does the diameter of the breast implant. In most cases, there is a breast implant that will be an ideal match for the diameter of the patient's natural breast, and I find this is a good starting point for discussion.
Choosing a breast implant smaller than the patient's natural breast shape will not provide the proper cleavage and shape following the procedure. Similarly, choosing a breast implant too large for the patient's natural chest shape is more likely to give an unnatural appearance.

Unfortunately, breast implants do not come in cup sizes. Rather, they are categorised by the volume of gel that they are designed to hold. There are several reasons for this. First, the final cup size will be partially determined by the preoperative breast size, and every patient is different in this regard. Second, a C-cup from one bra manufacturer is not necessarily the same as a C-cup from another manufacturer.

Although every woman is built differently and bras are not manufactured to a set standard, it can be expected that a B-cup implant size is approximately 200g (cc) or C-cup is 330cc in a woman of average height and average build. That number will ordinarily be higher if the woman is tall or has broad shoulders. Similarly, if the patient is shorter than average or has a narrower chest, that number can be expected to be slightly lower. Although a desire for a certain cup size is helpful in guiding the patient in the selection of the proper breast implants, I find it is more helpful to focus on the shape and appearance she wishes to achieve.

5. Breast implant position

The next consideration is where to place the breast implant - on top of or behind the muscle. In general, I prefer to place breast implants behind the muscle so they are partially covered. I find the muscle allows a smooth takeoff from the chest wall. If put directly on top of the muscle the breasts can look like rounded balls on the chest, which is another definite giveaway. It is also my opinion that placing the implant under the muscle will, in the long run will have impact on breast droopiness.

In women with mild droopy (ptotic) breasts, I use a dual-pocket technique of dissecting both on top of and underneath the pectoral muscle, but inserting the breast implant behind the muscle. In cases of moderate droopy breasts where the patient does not wish to undergo a breast lift procedure, I will consider full placement of implant on top of the muscle.

6. Smooth vs textured Implants

This issue is controversial. This is because, generally speaking, textured or rough surface implants are said to reduce the rate of capsular hardening or contracture, but they also are known to create more wrinkling issues down the track, especially in thin patients I see in my Sydney practice. This wrinkling is normally felt in the lower edge of the breast where the implant is closest to the skin surface.

Smooth implants may give a smoother look and feel in many cases, particularly in thinner patients, but the downside is that the patient needs to massage the implants for at least one year to help prevent capsular hardening.

There are many different combinations of the above breast implant considerations. To attain a natural-looking breast augmentation, the surgeon must be skilled in deciding the best options for each individual patient as well as carrying out the surgery.

What kind of anaesthetic is used?

A general anaesthetic is used when the breast implant is placed under the pectoral muscle. Dr Tavakoli works with a skilful group of anaesthetists that perform both general and "twilight-sedation" anaesthesia. Dr Tavakoli only operates at fully accredited operating facilities where administration of both types of anaesthesia are permitted.

Some surgeons perform breast augmentation surgery in their consulting rooms under so called "twilight-sedation" without having the appropriate license for full general anaesthetic. Beware of clever marketing ploys that promote the use of sedation for breast augmentation surgery. Simply ask your surgeon if the choice of different anaesthesia is available to you.

In addition to general anaesthesia, Dr Tavakoli uses plenty of local anaesthetic around the surgical site in order to make the immediate recovery period very comfortable.

AFTER BREAST AUGMENTATION SURGERY

What happens after breast augmentation surgery?

Your breasts will be somewhat swollen and bruised postoperatively. This usually settles in about two to three weeks. Sometimes swelling may be slightly different between the two sides. This is normal and settles with time. However if a great difference develops between the two sides then you must contact us for advice.

Following a Breast Augmentation, the breasts may appear to be placed quite high up. This is also normal. During the first two months postoperatively the breast implants will gradually lower and settle from the effects of gravity into a more natural position. Do not be alarmed if one side settles quicker than the other, as this sometimes occurs.

Following the operation you will have a light dressing in place which will need to be kept dry until your follow-up appointment. At this time the wound inspected and lightly cleaned. There are no stitches to remove, as these are internal and dissolvable. Always remember to read and follow the postoperative instructions that will be given to you.

What are my limitations in activity post-operatively?

You should plan to avoid activities which require much raising of the arms above the level of the head for 10 days after surgery. With great care, you can drive about 7 days after surgery. Patients can usually return to work in a few days unless their occupation requires particularly strenuous movements and lifting. In such cases, 2-3 weeks should be allowed.

• Walking can commence within days,
• Light jogging within 2 weeks,
• Gym and Pilates after 4 weeks and upper body weights 6 weeks.

Pregnancy: Should you become pregnant following your operation then your existing breast tissue will be subjected to the normal hormonal influences of this period and therefore your breast will enlarge and the skin will stretch accordingly. Likewise, once the pregnancy and any associated breast feeding ceases, your own breast tissue will then shrink down. It is impossible to predict to what degree these changes will occur; however, the breast implant volume will remain the same throughout these.

Palpation of the breast implants may occur in thinner women following breast augmentation. In these situations the breast implants are more likely to be felt at the lower part of the breast near the fold. Again this has no medical implications, although women who do not bear this in mind may suddenly become worried about feeling a "lump" in their breast. In any instance of uncertainty it is always best to contact your surgeon to have this examined.

Surgical risks may include: infection, bleeding, asymmetry, scarring, and capsular contracture. The latter is unpredictable and can affect the patient any time during the life of the implant.

Capsular Contracture (Hardening)?

This is the most serious complication of breast implants. A capsule or capsule formation is a layer of scar tissue that normally forms around any artificial material placed in the body. It is important to realize that this is the natural response of the body to foreign material. Most times this capsule is so soft that it is virtually undetectable and therefore does not affect the breast implant in any way. Capsular contracture or hardening occurs when this layer of scar tissue shrinks around the breast implant, squeezing it so that it starts to feel firm, or in some cases, quite hard. Most capsular contractures experienced today stem from the smooth shell silicone breast implants placed some years ago. The capsule contracture rate in the past was 30-35% (in the 1980's implants).

With the onset of textured shell breast implants, the problem of capsular contracture has been significantly reduced, now being between 5%.

The cause of capsular contracture is not totally clear, but seems to be multifactorial. It is important to realize that there are degrees of contracture and that the majority of women, who do develop this hardening, develop it only to a mild extent. In the minority however, it may be severe enough to be bothersome, even painful and may cause distortion of the breast. The condition may occur in one or both breasts and to a different degree either side.

It may develop any time, even years later although it is most likely to happen in the first 3 years after surgery. Unfortunately at this time there is no effective way to prevent capsular contracture if it is going to occur. However as mentioned previously, encapsulation is no longer the problem that it was. Having mentioned all the above, it is important to note that capsular contracture is not in itself a health risk other than its possible interference with mammography.

Are the prostheses safe? Can they cause cancer?

In Australia and Europe current sales figures show a distribution of 90% silicone, 10% saline. As modern silicone gel implants have been available since 1963, surgeons therefore have over 35 years of experience with these types of breast implants. This is more than any other type in use. Evolution has brought changes and improvements over the years with the introduction of textured surface envelopes made of newer formulations designed to minimize the "bleed" or diffusion of what is usually tiny amounts of the silicone oil fraction of the gel contents.

Importantly the standard silicone gel by most accounts, arguably "feels" the most natural of all breast implants. This is probably as a result of the inherent smoothness of the silicone gel content.

 

Send message to doctor to get more information about your treatment.