"Perfection" is impossible - understanding your options will help you to achieve the best and longest lasting results.
Inform yourself...

Breast augmentation is a cosmetic procedure designed to enhance the size and shape of a women’s breasts. It’s important to understand that a breast augmentation will enhance the physical features you already have and that “perfection” is not possible. Your surgeon should comprehensively go through all aspects of the surgery so you understand your choices and you can make an informed decision regarding your results.

During your comprehensive consultation, Dr Fleming will discuss:

  • Your personalised operative plan
  • Type of implant
  • Whether you need a breast lift
  • Shape of implant
  • Profile of implant
  • Implant size
  • Implant placement
  • Risks involved in the surgery

The key to achieving the best possible result, given the breasts you already have, is to develop an operative plan with a surgeon experienced in breast augmentation. Your surgeon will be able to help you make the right choices and show you realistic results of what you are likely to achieve.

The elements of the operative plan are:

  1. Type of implant
  2. Breast lift of no breast lift
  3. Shape of implant
  4. Profile of implant
  5. Position of implant
  6. Size of implant

To understand how Dr Fleming develops your personalised operative plan, please watch his detailed video here.

There are 3 types of surfaces available for your breast augmentation surgery; smooth, textured or polyurethane foam covered (P-URE) silicone gel implants.

Textured and smooth implants are a second tier implant. If smooth or textured implants are used, nearly one in 5 patients will develop capsular contracture by 10 years after their augmentation. Capsular contracture occurs when the membrane that grows around the implant contracts, compressing it like shrink wrap. The implant hardens and changes shape, which changes the overall aesthetic results and can be painful for the patient.

In contrast, P-URE (from P-oly-URE-thane) foam-covered implants, are unequivocally safe. Companies who produce P-URE foam-covered implants guarantee these implants for 10 years against capsular contracture, rotation, displacement and for life in case of rupture.

Dr Fleming exclusively uses P-URE implants in his surgeries, as there is a decreased risk for capsular contracture and a decreased risk of rotation of the implant resulting in revision surgery.

 

For more information on P-URE foam implants, read an excerpt from the chapter Dr Fleming wrote for the textbook “Biomaterials in Plastic Surgery: Breast Implants” (Woodhead Publishing, Cambridge) here.

Breast implants alone can lift the breasts, but only so much. Some patients have too much sag for this to be a viable option.

Dr Fleming can advise you at your consultation in regards to whether you need a breast lift in addition to your breast augmentation to achieve an optimal result.

A quick guide to check if you need a breast lift is below.

  1. Stand in front of a mirror with your breasts exposed.
  2. Place your hands on the back of your head so your fingers of each hand are touching.
  3. Your breast will lift as you do this and this is a good indication of the amount of lifting you can achieve with implants alone. If you do not think this is high enough you will probably need a breast lift.

There are some exceptions to this, so a consultation and examination is necessary for the final decision.

There are 2 “shapes” of implants; round and anatomical (teardrop). Round implants are round with the same width and height. Their maximum projection is in the middle of the implant. Anatomical implants look more like a teardrop, with the maximum projection slightly below the middle of the implant.

Anatomical implants can often give better final results because the height and the width can be controlled independently. The shape of implant is personal to your body type and your desired outcome, and is best discussed with Dr Fleming during your consultation.

The profile is the distance that the implant projects from the chest. There is no ‘best’ profile, as your body type and your desired outcome determine the profile of your implant. During your consultation, you are able to try different profile implants in a crop top to help you make an informed decision.

Implant placement refers to where the implants are placed in relation to your breast tissue, muscle and skin. There are 3 options:

  • Under the muscle placement refers to an implant that is placed behind the pectoral muscles and the breast tissue
  • Over the muscle placement refers to an implant that is placed in front of the pectoral muscles but behind the breast tissue
  • Dual plane placement refers to a placement where the implants are placed half under, half in front of the pectoral muscles

There are advantages and disadvantages to all placement sites. The best placement site will vary depending on your body type and desired outcome. Dr Fleming offers all types of placements and considers the description of your desired outcome to advise on which placement will be right for you.

Implants are sized by their weight, measured in grams, or by their volume, measured in ml or cc. The right size implant depends on your desired outcome and your existing body type. Sizing can be determined during your consultation by placing a sizing implant in a crop top, however using this method alone can be misleading.

Dr Fleming will discuss which size implant is best for you during your consultation. As well as utilising the method above, photographs of previous patients are used to show the outcomes of different sized implants in patients who were similar in size and shape pre-operation.

Choosing a surgeon can be very confusing and it’s important that you feel comfortable with the doctor you have chosen to perform your procedure. To help you, we have broken down some of the key misconceptions around choosing a surgeon and provided you with a helpful checklist of questions you should be asking during your consultation.

The Australasian College of Cosmetic Surgery (ACCS) is the only organisation in Australia that certifies surgeons for breast implant surgery. For more information on their standards of training and experience needed to obtain this certification visit www.accs.org.au.

The Australian Society of Plastic Surgeons (ASPS) Members are surgeons who offer cosmetic procedures with recognised qualifications granted by the Australian Medical Council (AMC). However, this recognition doesn’t include any assessment by the AMC of training or expertise in cosmetic surgical procedures like breast augmentation.

Surgeons who have the qualification Fellow of the Royal Australasian College of Surgeons (FRACS) aren’t plastic surgeons or Fellows of the ACCS. These are most often specialists in general surgery who now offer cosmetic procedures.

To help you determine whether your surgeon is the right fit for you, we have compiled a check list of questions to ask the practise or your surgeon during your consultation:

  • How many times have you performed cosmetic breast augmentation before? Make sure it is hundreds, if not, thousands of times.
  • How many times have you performed it in the last 6 months?
  • Are you a trainee? Some cut price clinics use trainee surgeons.
  • Are you a Fellow of the ACCS and are you specifically certified by it in breast surgery?
  • If you are a plastic surgeon, do you have any extra training in cosmetic breast augmentation?
  • If you are a Fellow of the Royal Australasian College of Surgeons (FRACS), do you have any extra training in cosmetic breast augmentation?
  • What is your own complication rate?
  • How do you know this? Do you audit your results or are you just working from memory? Not necessarily reliable where complications are concerned.
  • Do you operate in a licensed hospital or licensed day hospital? Licensing is different from accreditation which is a lower standard
  • Will there be a specialist anaesthetist to look after me during the operation? Some surgeons use a nurse to give the sedation drugs while they are operating, a practice not allowed in licensed facilities.
  • Can I see photos of your own work on patients similar to me?
  • Can I speak to previous patients?

Other questions you should ask, not specifically relating to a doctor’s basic competence but important to help you get the best result you can include:

  • How much experience do you have with the P-URE foam covered breast implant which are proved to reduce complications and last longer?
  • How much experience do you have with the rapid recovery technique?

Make sure you are being provided with the information to make your own informed decision and avoid surgeons or clinics where your initial consultation is not with the surgeon. If the surgeon himself is not willing to spend time with you to make sure you get all of the correct information to help you make one of the biggest decisions of your life go elsewhere and find one who will. Your consultation will be with Dr Fleming who performs the surgery. It will either be free of charge or bulk billed if a Medicare rebate applies.

Finally, take your time and do your research when investigating a surgeon, as it is one of the most important decisions you can make.

If you live more than 3 hours from Brisbane, you qualify to have an initial phone consultation with Dr Daniel Fleming.  If you would like to do so please:

1. Watch the pre-consultation video.
2. Email Daniel at [email protected] with your phone number and three photos of your breasts, (from the front and from each side) with your arms by your sides cropping out your head.
3. Please also let Dr Daniel Fleming know what you would like to achieve.  If you have a picture of a desired result, do send that with the email as it can be helpful.
4. If you have not heard back from Daniel after 3 days please call reception on 1800 682 220.

Following your phone consultation, if you decide you wish to proceed with surgery, you will be contacted and booked for a suitable date.  You will then come to Brisbane on a Monday for your sizing consultation. You will have your surgery on the Tuesday and then see Dr Daniel Fleming again on the Wednesday for clearance to return home.

We have been using this process for our out-of-town and overseas patients for many years and it has proved very successful and convenient.

All surgery including cosmetic surgery carries risks. Complications can, and sometimes do, occur. You should not undergo breast augmentation without all the risks being explained to you and ensuring that you understand them.

Below is a summary of the complications that may occur as part of a breast augmentation surgery. This information is not meant to frighten or alarm you, but is instead to help you make an informed decision regarding your surgery.

There are general risks associated with ANY operation, including breast augmentation, including:

  • Infection in the wound with resultant redness, pain and possible discharge. In severe cases, the wound could break open and need to be re-stitched. Usually after a wound infection the scar is not as fine as it otherwise would have been.
  • Possible bleeding in the wound with swelling or bruising and possible blood stained discharge.
  • Secretions may accumulate in the lungs causing a chest infection.
  • Clotting may occur in the deep veins of the leg, arm or pelvis, and rarely the clot may break off and go to the lungs.
  • Circulation problems to the heart or brain or breathing problems may occur and may result in a heart attack or stroke.
  • Death is possible during or after an operation due to severe complications.

The following facts, risks and complications apply specifically to breast augmentation surgery:

  1. Capsular contraction is the most common complication of breast augmentation surgery. It occurs when the tissues, which normally form around the implant, contract and compress the implant like shrink-wrap. If mild, the implant merely feels firmer. In the worst case the implant feels hard, can be painful and can go out of shape. In most cases it is not certain what causes capsular contraction. Although unpleasant, it is not a dangerous condition and it does not affect your health. It is however the most common cause of re-operations. The latest data has shown that the capsular contracture rate with both smooth and textured surfaced implants is 19.1% after 10 years. (Sources: Allergan p.34 and FDA). Further contractures can occur later than this, even after many years. The use of polyurethane foam covered silicone gel implants is known to reduce the rate of capsular contracture to about 1% and this is one of the reasons Dr Fleming recommends them. If you suffer from severe capsular contraction, you will probably want it corrected. This involves removing some or all of the contracted tissue and replacing or changing the implant. The implant will then feel soft again.  Usually it does not reoccur but it can.
  1. Polyurethane foam covered implants have been used since 1968. They reduce the risks of capsular contracture, implant displacement and implant rotation, which is particularly important with tear drop or anatomically shaped implants. About 1% of patients with these implants will develop a temporary rash on the breasts lasting about 1-2 weeks. It does not reoccur. Polyurethane foam covered implants can be removed if necessary.
  1. The incision will result in scar formation. The scars are usually pink to start, and generally fade to become white, soft and supple over the next weeks or months.  Most patients find the scars are ultimately acceptable and not a concern to them. Keloid scars are rare and cause a thickening, inflammatory process in the scar tissue. These are not due to a surgical fault but due to an abnormality of the patient’s healing process. We will give you a special silicone gel tape to wear over the incision. This tape results in less noticeable scars. Full instructions about the tape will be provided.
  1. Antibiotics are given during the operation and you will be prescribed oral antibiotics to take afterwards. This minimises the risk of infection. Nevertheless infections can occur and would be treated by the usual techniques. If severe this may involve being admitted to hospital for intravenous antibiotics and further drainage procedures.  Further surgery may also be required including removal of an infected implant. The infection rate for this breast implant surgery is about 1%. There is a rare type of infection called mycobacterium infection (about 0.25% with all types of implants), which, if it occurs with polyurethane foam covered implants, may require the removal of the capsule as well as the implant to minimize the risk of recurrence.
  1. It is usual to have some temporary numbness under the breasts after breast implants. This is due to some sensory nerves being affected during the preparation of the pockets.  The numbness is usually fully recovered within six to twelve months, however it can be permanent. Rarely, and in the worst case, permanent numbness of both nipples could occur.
  1. Post-operative pain will occur. It varies from quite severe to mild to moderate on the first day. It gradually improves over the next days. This pain is usually well tolerated by patients if they take the painkillers prescribed. Increasing pain unresponsive to painkillers should be brought to the attention of Dr Fleming as this may be an indication that complications are developing.
  1. It is common to have intermittent mild discomfort or occasional sharp pains in the first few weeks after surgery as the swelling resolves and the nerves recover. Some patients experience a temporary increase in sensitivity of the nipples. This can be unpleasant but typically settles down after a few weeks.
  1. Most patients in non-manual jobs take a week off work. Heavy lifting, vigorous upper body exercise or any activity that involves bouncing of the breasts should be avoided for 4 weeks.
  1. Bruising and swelling is usual and varies with each patient from mild to being so severe that a blood clot collects. This is called a haematoma and is a collection of blood around the implant.  It is due to bleeding in the post-operative period and is uncommon in breast implant surgery occurring in about 1% of patients. It typically causes increasing pain and increasing swelling on the affected side.  It normally requires further surgery to drain and remove the clot. Every step should be taken to reduce this risk including the patient stopping treatment with such drugs as Aspirin, anti-inflammatory drugs or other blood thinning agents, including high dose vitamin E tablets or capsules, two weeks prior to surgery. We will provide you with a list of substances to avoid for two weeks before your surgery in your pre-operative instruction sheet. However if you are taking any medications and you are unsure if they affect bleeding, please ask us at least two weeks before your operation.
  1. A seroma is a collection of fluid around the implant, which may need to be drained. This occurs in about 1 or 2% of patients and this can happen years after the surgery.
  1. Rarely, the stitches used to close the incision may be felt through the skin. Dr Fleming uses dissolving, knot free stitches to avoid this.
  1. The edge of the implants may be visible or may be felt through the skin. Visible or palpable rippling or folding of the implant may occur. These problems are more likely with saline implants compared with silicone gel implants and also more likely with textured surfaced implants compared with smooth or foam covered ones, but they can happen with any implant.  Also, thin patients with very little fat and breast tissue of their own have a higher chance of these problems.
  1. It is not possible to achieve “perfect” breasts nor should you expect this.  There will be minor differences between the two sides, as there are in all women with or without implants. For example, most women have breasts that are not exactly the same size as each other and this will still be the case after surgery, even if different sized implants are used on each side. Similarly if your nipples are naturally at different heights, they will remain so. Major differences between the two sides, unless present beforehand, are uncommon and may need further surgery.
  1. Displacement or movement of any implant from its original position may occur. Downward displacement, or “bottoming out’, becomes more common with larger implants.  About 2-3% of smooth and textured implant patients may need further surgery for this reason at some stage. Polyurethane foam covered implants are less likely to bottom out.
  1. If you are having a teardrop shaped implant there is a risk it could rotate causing an abnormal shape of the breast and sometimes pain. Rotation is much less likely with polyurethane foam covered implants.
  1. “Double fold” is a particular type of contour irregularity where the lower edge of the implant and the lower edge of the existing breast are seen as two separate creases. This can occur in any patient where the diameter of the implant is bigger than the diameter of the existing breast. It is uncommon but certain types of breasts are particularly at risk. If you have a particularly increased risk of this complication it will have been discussed at your consultation and an appropriate implant offered to minimise any extra risk. For more information, read a short article here.
  1. Rupture of any implant can occur even without an obvious cause. If a saline implant ruptures it rapidly deflates and needs to be replaced. If a silicone gel implant ruptures in most cases the gel will remain inside the capsule of tissue that everyone naturally forms around their implants. This means the silicone remains sealed off from the breast tissue. This is called intra-capsular leakage. There are usually no symptoms for the patient and the breast looks and feels normal. Patients only know they have this type of leakage because it is noticed when they have a mammogram or ultrasound scan. If this happens to you it is usually recommended the implant be replaced although there is no particular urgency for this to be done. Occasionally the leak is not confined within the capsule and the silicone does come into contact with the breast tissue. This is known as extra-capsular leakage. In some of these patients, the body will form a lump or lumps around small silicone deposits and the patient may feel this rather like a lymph gland. These lumps are not dangerous and only need to be removed if they are bothering the patient but any implant leaking outside the capsule should be replaced. The silicone implants used today contain a thick cohesive gel rather like Turkish Delight. This means it sticks to itself and is less likely to run out into the breast tissue if the implant covering ruptures compared with the liquid gel used previously.  More than15 years experience with these cohesive implants suggests that, although it is still possible for lumps to form in perhaps a few per thousand patients, the problems of old fashioned liquid silicone implants, where large amounts of leaked silicone could cause disfigurement in the breast, have been either eliminated or dramatically reduced.
  1. Silicone in the body does not cause or affect adversely any diseases. Patients with implants can still have mammograms and these are still effective.
  1. Breast implants do not increase the risk of breast cancer but are associated with a rare type of cancer called anaplastic large cell lymphoma. Breast implant associated anaplastic large cell lymphoma (BIA ALCL) is usually found in fluid that can develop around a breast implant after some years. In this form, it is cured by removal of the implants and the capsule or membrane around them. It can be more serious and need chemotherapy with or without radiotherapy, and there are rare cases where it has been fatal. The estimated risk of the mildest form of BIA ALCL is less than 1 in 1000 patients and the risk of the more serious versions is substantially less than this. To put this risk in context, the risk of any woman in Australia of developing breast cancer in her lifetime, including women without implants, is about 1 in 8. To date, there have been no cases of BIA-ALCL reported in patients who have had smooth implants, however such cases could occur in the future. For more information click here.
  1. In general, the bigger the implants, the bigger are the risks, especially the risk of downward displacement. Large, heavy implants are more likely to stretch the skin over time and move downwards. If you have chosen implants larger than 350g you are accepting these extra risks. Polyurethane foam covered implants are less likely to displace downwards than other types of implant of the same size.
  1. If you are having revision surgery for any reason, you should be aware that this increases the risk of complications compared with an initial breast augmentation. Also the results of revision surgery are less predictable and the use of drain tubes for a few days is much more likely.
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