Breast Augmentation

Also known as augmentation mammaplasty, breast augmentation involves using implants to fulfil your desire for fuller breasts or to restore breast volume lost after weight reduction, pregnancy or breast feeding. This surgery is an option for you if you are dissatisfied with your breast size. Breast augmentation can:

• increase fullness and projection of your breasts
• improve the balance of your figure
• enhance your self-image and self-confidence

Breast augmentation does not correct severely drooping breasts. If you want your breasts to look fuller and to be lifted due to sagging, a breast lift may be required in conjunction with breast augmentation. Breast lifting can often be done at the same time as your augmentation or may require a separate operation. Your plastic surgeon will assist you in making this decision.

Is breast augmentation right for you?

Breast augmentation is a highly individualised procedure and you should do it for yourself, not to fulfil someone else’s desires or to try to fit any sort of ideal image.

Breast augmentation may be a good option for you if:

• you are physically healthy
• you have realistic expectations
• your breasts are fully developed
• you are bothered by the feeling that your breasts are too small
• you are dissatisfied with your breasts losing shape and volume after pregnancy, weight loss, or with aging
• one or both breasts failed to develop normally

Procedural Steps - What happens during breast augmentation surgery?

Anaesthesia
Dr Vrtik performs breast augmentation under general anaesthetic for your comfort.  Medications are administered to induce full anaesthesia and maintain your sleep during the surgical procedure.

The incisions
Incisions are made in inconspicuous areas to minimize visible scarring. Dr Vrtik will discuss which incision options are appropriate for your desired outcome. Incision options include:

Inframammary Incision	Transaxillary Incision	Periareolar Incision

Incisions vary based on the type of implant, degree of enlargement desired, your particular anatomy, and patient-surgeon preference. Dr Vrtik favours the inframammary incision as it allows placement of implant of all sizes, good visualisation and control of pocket/implant position, as well as well-hidden predictable scarring.

Insertion and Placement of the Implant

After the incision is made, a breast implant is inserted into a pocket either:

• under the pectoral muscle (a submuscular placement)
• directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)

The method for inserting and positioning implants depends on the type of implant, degree of enlargement desired, your body type, and your surgeon’s recommendations. For more infomation about the different types of implants, please click here.

Closing the Incisions

Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive or surgical tape to close the skin. Over time the incision lines will fade.

To watch an animated demonstration of breast augmentation, please click here. 

Breast Implants

Breast size and shape are important, so be honest and open about your expectations when talking with your surgeon. Implant type and size will be determined not just on your desired increase in size but more importantly on your breast anatomy, skin elasticity and overall body shape.

To find out more about breast implants, click here.

What size would be recommended for me?

Limitation in breast implant sizes is the width of your chest wall. Implants are made in a variety of sizes but the range of volume available is very much dependent on the width of the implants. In essence, if you would like to go above the maximum volume for your chest wall width, then you have to be prepared to have prominent lateral fullness which may rub and impede your forward arm movement or have some of the breast volume extend into the front part of your armpit. Over-sized implants may also cause stretching and thinning of the overlying breast tissue, leading to palpability and rippling of the implants.
Dr Vrtik is a strong advocate of breast enhancement for your natural body shape, which is to choose a breast size that matches your overall frame. This has several advantages:

• allows you to easily find clothes and bras which fit
• enhances a natural look
• decreases the strain on your upper back, neck and shoulders due to the weight of your implants
• decrease amount of postoperative pain due to over-stretching of your muscles and glands

During your first consultation with Dr Vrtik, you will be asked to wear a ‘sizing bra’ where different size implants are placed into the front pocket of the bra to enhance your natural breasts. We would recommend that you bring a T-shirt or a favourite firm fitting shirt with you for this appointment, so that you can have an idea of the size that you may want.

Other important considerations:

Before choosing breast implants for breast augmentation, you also need to consider:

• breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants.
• pregnancy, weight loss and menopause may influence the appearance of augmented breasts over the course of your lifetime.
• breast implants can affect the accuracy of mammograms, thus affecting detection of breast cancer and other breast diseases.
• breast implants do not usually affect the ability to breast feed.

It’s important to know that your breast implants are not permanent and may require replacement during your lifetime. Your natural breast may also change due to aging, weight fluctuations, hormonal factors and gravity. You should expect to have future visits with your plastic surgeon to discuss changes in your breasts. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast lift or implant exchange to restore a more youthful contour.

It is also essential that you attend follow-up visits, as your implant integrity and health will need to be reviewed regularly. Dr Vrtik recommends yearly reviews for all patients who have had implant surgery. If there are any concerns, you may be asked to have a mammogram, ultrasound or MRI to assess the integrity of your implant or to screen for breast cancer in your natural breast tissue.

Specific risks associated with Breast Augmentation

The decision to have breast augmentation surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.

Dr Vrtik and our staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks or potential complications.

These risks include:

• Unfavourable scarring
• Bleeding (hematoma)
• Infection
• Poor healing of incisions
• Changes in nipple or breast sensation, may be temporary or permanent
• Capsular contracture, which is the formation of firm scar tissue around the implant
• Implant leakage or rupture
• Wrinkling of the skin over the implant
• Anaesthesia risks
• Fluid accumulation
• Blood clots
• Pain, which may persist
• Deep vein thrombosis, cardiac and pulmonary complications
• Possibility of revision surgery

Most of the risks are very uncommon, and some people (with particular health problems or specific breast features), may be at higher risk for specific complications. Dr Vrtik will discuss this with you during your consultation if any of these risks are specifically pertinent to you.

Although breast augmentation can be an effective and satisfying procedure where the benefits significantly outweigh the risks, like everything in the practice of medicine and surgery, it is not an exact science. The degree of surgical success can be altered by how each individual’s body responds to surgery and healing. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure; revision surgery may be necessary.

Be sure to ask questions: It’s very important to ask questions about your procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings and any specific concerns with Dr Vrtik or any of our staff members.

Postoperative Recovery

Dr Vrtik’s breast augmentation patients are all expected to stay in hospital overnight after surgery. This is mainly for your safety:

• to ensure that you have adequately recovered from your general anaesthetic
• effective treatment of post-operative nausea and vomiting with intravenous antiemetics
• effective treatment of pain or discomfort associated with surgery
• help and nursing support in the first 24 hours after your surgery
• monitoring of potential complications such as bleeding or haematoma
• administration of intravenous antibiotic for 24 hours to minimise risk of infection

You will be discharged from the hospital with foam taping on your breasts and chest wall. This will need to stay dry and intact until your first postoperative review at 5 – 7 days. You will need to bring your garment (in your postoperative pack) to this appointment as your dressings will be removed and replaced with your garment. You will be required to wear your garment at all times – in between daily showers – in the first 12 months to give your new breasts support and protection. Instructions will be given to you in regards to wound care, scar and implant massage.

You will likely experience soreness and swelling for the first 2-4 weeks. Exercise and normal activity usually can resume after 6-8 weeks. You will need to wear the garment for at least 12 weeks. You should not wear any under-wire bras for at least 12 weeks.

Results and Expectations

The results of your breast augmentation surgery will be long-lasting. You will find it easier to wear certain styles of clothing and swim wear. Like many women who have had breast augmentation, you may also have a boost in self confidence.

The results of breast augmentation are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. This will allow your augmentation to settle into a more natural shape, which normally occurs at around 3 months. The scars often mature around 6 months, sometimes up to 12 months. Satisfaction with your new image should continue to grow as you recover and realize the fulfilment of your goal for fuller breasts. Your first shopping trip for new lingerie and clothes will be especially enjoyable!

Costs associated with Breast Augmentation

Private health insurance will not cover cosmetic breast augmentation surgery. Some policies may also exclude cover for related complications or another surgery to revise the appearance of your breasts. Please also note that once you have had breast augmentation surgery, your health insurer may also exclude cover for any future breast diseases in patients who have breast implants. You must carefully review your health insurance policy prior to your booking. If you are unsure, contact your insurer and ask for written confirmation.

Our quote for ‘Surgeon’s Fees’ will include your surgery, the surgical assistant fee, your breast implants, your post-augmentation surgical bra, and your routine postoperative visits with dressings if required.

Vocabulary to know

• Areola: Pigmented skin surrounding the nipple.
• Augmentation mammaplasty: Breast enlargement by surgery.
• Breast Augmentation: Also known as augmentation mammaplasty; breast enlargement by surgery.
• Breast Implants: Medical devices placed in your body to enhance an existing breast size or to reconstruct your breast. Breast implants can be filled with either salt water (saline) or silicone (elastic gel).
• Capsular contracture: A complication of breast implant surgery which occurs when scar tissue that normally forms around the implant tightens and squeezes the implant and becomes firm.
• General anaesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
• Haematoma: Blood pooling beneath the skin.
• Inframammary incision: An incision made in the fold under the breast.
• Mammogram: An special x-ray image of the breast to screen for cancer.
• MRI: Magnetic Resonance Imaging; a painless test to view tissue similar to an x-ray.
• Periareolar incision: An incision made at the edge of the areola.
• Saline implants: Breast implants filled with salt water.
• Silicone implants: Breast implants filled with an silicone elastic gel.
• Submammary or subglandular placement: Breast implants placed directly behind the breast tissue, over the pectoral muscle.
• Submuscular or subpectoral placement: Breast implants placed under the pectoral muscle, which is located between the breast tissue and chest wall.
• Sutures: Stitches used by surgeons to hold skin and tissue together.
• Transaxillary incision: An incision made in the underarm area.
• Ultrasound: A diagnostic procedure that projects high frequency sound waves into the body and records the echoes as pictures.

(Some Information & Illustrations are courtesy of the American Society of Plastic Surgeons)