Breast Augmentation Mammoplasty

Silicone or saline?

Breast implants are filled with either silicone or saline. There are pros and cons to each choice. Both implant types are coated on the outside with silicone, but the fillings are different.

Silicone implants are filled with a semi-solid gel. Because the implant material is a solid, there is very little risk of leakage. Saline implants are filled with medical grade saline. Should these implants rupture and leak, the saline solution is absorbed into the body.

Silicone is said to feel more natural, but some women prefer saline because it’s similar to the fluids found in the body. Silicone maintains its shape much better than saline. If a saline implant loses its shape, it can cause the skin around it to ripple, making the implant obvious.

Smooth or textured?

All implants have a silicone coating on the outside. You can choose whether this outer shell is textured or smooth. A textured implant has a slightly rough surface, is thicker than the surface of a smooth implant and can be more easily felt through the skin. Smooth implants are made with a shiny polished surface, which is a lot thinner than that of a textured implant.

The reason for the two different implant surfaces is to prevent the implant from rotating. Sometimes smooth-surfaced implants, especially round ones, can turn after they are placed. Theoretically, the textured implants ‘stick’ to the muscle or tissue and don’t move.

Whether you choose textured or smooth should be discussed with your surgeon.

How big?

Size is a major decision for you. An implant that is too large for your frame will make you look top heavy and unnatural. Too small an implant may be barely noticeable. Often surgeons provide their patients with a stocking filled with rice equal to the suggested implant size. Inserted in a bra, this stocking can let you try on new breasts before having the procedure.

What shape?

The two main implant shapes are either circular (round) or oval (teardrop or anatomic). Teardrop implants mimic the natural shape of the breast, with greater fullness towards the bottom. Round implants are perfectly round hemispheres with the entire material of the implant distributed evenly. Both of these implants have a flat base.

Which profile?

You can also choose low, medium or high profile implants. For any given size a low profile implant will have a greater diameter and lower projection than a high profile implant. The medium implant will be somewhere in between. The choice of which profile type is best for you is based on your current chest-wall shape and size, as well as your choice of implant size.

Implant shape and profile is something that can be discussed in more detail with your surgeon. It’s also a good idea to have a look at before and after photographs to get an idea of what these different shapes can look like after surgery.

Under or over the muscle?

The breast implant can be placed either under the pectoral muscle or over it. There are pros and cons to each choice. Your decision will depend on the type of implant you’ve chosen as well as the amount of breast tissue you have. Women who are slim and have a small amount of breast tissue are sometimes advised to have the implant placed under the muscle so it isn’t visible after surgery.

There is no difference in pain or recovery time between implants placed under or over the muscle. Both options should be discussed with your surgeon.

Incision location?

The surgeon can make the incision to insert implants in four different places. The choice usually comes down to personal preference, but one important factor must be considered carefully: scarring. If you are a person who scars easily, the smallest and least visible location is best.

The four incision locations are around the bottom of the areola, where dark and light skin tissue meet (periareolar); in the armpit crease (transaxillary), ensuring absolutely no scarring on the breast itself; in the crease at the very base of the breast where it meets the chest (inframammary); and through the navel (transumbilical or TUBA), in which an incision is made in the belly button and an endoscope is used to push the implants up to the chest area. This scar is almost undetectable. At present, the most common place for the incision is in the armpit crease.

After you and your surgeon have decided on implant type, texture, size, shape, profile and incision location, you are ready to book in for the procedure. The operation will take approximately 1–2 hours and is performed in a hospital or approved clinic under anaesthesia. When you wake up in the post-operative recovery room, your new breasts will be tightly bandaged, and you may feel a bit woozy.

Most breast augmentations are performed on an outpatient basis, which means you will probably be sent home a couple of hours after you’ve recovered from the effects of anaesthesia. Do not drive yourself home.

There are things you can do leading up to any kind of surgery to improve the experience. There are also a few things specific to the breast augmentation procedure you can do before your surgery:

• Put everything you will need (food, clean clothes) in easy reach and below chest level, so you don’t have to raise your arms to get at them.
• Your surgeon may advise you to wear a tight-fitting top or compression garment to support your chest for about a week following surgery. Your surgeon may provide this garment. If not, buy one before surgery.

There are a number of things you can do following any surgery.

Specific things to do after your breast augmentation procedure:

• Your surgeon may have given other instructions, such as icing the chest area to reduce inflammation and swelling. Follow this instruction. A bag of frozen peas makes an excellent ice pack.
• Even though you desperately want to look at your new breasts, resist the urge and keep your bandages on until you next see your surgeon. You don’t want to get an infection by exposing the wound area.

Bruising around your breasts should resolve in around 7 days. At first they may feel hard and a little high but will soften and settle into position over time. Chest pain should diminish as your muscles stretch. You may also experience some pain in your arms and back. This, too, will diminish over time. Itching is common after surgery. It will resolve as you heal. Your scars may take a full year to fully diminish or disappear. Follow your surgeon’s instructions on scar-healing treatments.

You should expect to be back to most normal activities in about a week after a breast augmentation procedure.

As with any surgical procedure, there are risks involved in breast augmentation. You should be fully aware of these before you consider surgery.

The best way to reduce risk is to find a fully qualified surgeon with formal training in breast augmentation who has performed the procedure many times.

Make sure you familiarise yourself with the list of complications that could arise as a result of any surgery.

Specific complications that may occur after breast augmentation surgery:

• Loss of nipple sensation as a result of cut or stretched nerves in and around the nipple area, especially if the incision is made on or near the areola. This risk is fairly low, but is worth being aware of.
• Capsular contracture can occur as a result of the body’s natural response to foreign materials. When a foreign object (i.e. a breast implant) is inserted, the body forms a lining around it and is programmed to shrink this lining the same way it does with scar tissue. As this happens the implants are squeezed and tightened within their cavity, which can cause them to feel hard. Sometimes the breast implants will need to be removed altogether as a result of extreme capsular contracture.
•  In severe cases of capsular contracture implants can sometimes rupture or shift.  Trauma to the breast area and injuries sustained from surgical instruments can also cause rupturing or shifting.
• Breast implants can wear out, and a rupture could occur after a long period of time.
• The implant can ripple against the tissue or muscle after it has settled into place. Textured implants are more likely than smooth ones to cause this problem, as the implant can ‘stick’ to the muscle of the breast tissue wall.
• Implants can sometimes interfere with the detection of suspicious lumps and lesions in the breast. Tell your radiologist about the implants before a mammogram, so that he or she can push the implant away from the breast tissue and gain a better view.

The first breast augmentations were performed in the late 1960s. Since then many improvements have been made in both the technique of inserting implants and the implants themselves. Nevertheless, breast implants, like any other device, have a limited life span. It is impossible to know exactly how long an implant will last, but they usually last between 10 and 20 years.

It is obvious when a saline implant needs replacing, because the saline starts to leak once the outer shell has broken and the breast looks deflated. It is more difficult to tell when silicone implants need replacing, and for this reason it is advisable to have occasional MRI scans to establish if there have been any ruptures. Generally though, silicone implants have a history of lasting longer than saline.

Some women decide after having breast augmentation that they don’t like the feel or size of their implants. Breast implants can be removed whenever you choose. Occasionally, women who have large implants removed will have a degree of chest wall deformity and tissue loss. Sagging may also occur after the removal of implants.

Breast augmentation has no effect on breastfeeding. The milk glands in the breast tissue determine how much milk a mother will produce, and implants don’t interfere with the function of milk glands.

Surgeon, anaesthetist and hospital costs will vary, but the procedure usually costs somewhere between $10,000 and $15,000 (AUD). Some private health insurers in Australia will help with hospital bed and theatre fees. Having a doctor’s referral will enable you to claim the cost.

You should expect the costs to be higher if you are having combined procedures at the same time.

Read our article What Does Breast Augmentation Cost in Australia for more detailed information on all costs associated with breast augmentation.

This information is correct as of 2013.