BREAST IMPLANTS

There is significant scientific information to support the safety of silicone for breast augmentation and many other body implants. The newer types of silicone gel are cohesive (meaning that the implant holds together even without its shell) and are not liquid like the first generation of implants.

In the unlikely event of shell failure, there would most likely be no noticeable or significant issues with the feel or appearance of your breasts or general health. Saline implants contain a type of salty water that causes no reaction if they leak. The problem with this type of implant is that if they do leak, they rapidly deflate and need to be replaced at another operation. The rate of deflation or leakage is higher than silicone-containing implants. They do not feel as natural as silicone and are also more prone to “rippling” – a problem that can be seen or felt at the sides of the implant.

Silicone implants are a soft gel manufactured into a range of shapes. They can be round or anatomical (teardrop/asymmetrical) in shape and are made in a wide range of sizes which vary in how far they protrude from the chest wall (projection).

With saline implants, there is a much smaller selection. All types of implants can develop a problem called “capsular contracture”. This is when the ordinarily soft membrane that forms around an implant hardens, making the breast feel firmer and sometimes distorting the shape of the breast. It is unknown exactly why this occurs in some patients and not in others.

It depends on the shape of your breast, the amount or thickness of tissue that you have at the upper part of the breast, and how physically active you are.

In general, it is best to place an implant on top of the muscle if there is sufficient breast tissue to cover the implant at the upper part of the breast. Patients who don’t have much tissue in the upper part of the breast will most likely get the best result by having their implant placed under the muscle so that the implant has more tissue covering it and looks more natural.

In thin patients, where the ribs at the top of the breast are visible, placing an implant behind the muscle will provide more tissue to cover the edge of the implant. This achieves a softer edge and looks more natural in terms of not seeing an obvious “cut-off” line where the chest meets the implant.

When we talk about “behind the muscle”, we mean “partially behind the muscle”, as the lower half of the muscle needs to be detached from the chest wall to allow the implant to sit optimally in the breast and achieve a natural shape. This technique is called “dual plane”. Detaching half of the muscle weakens it, so women who use their pectoralis major muscle for sport will need to weigh up the options carefully. However, most women don’t notice much difference day-to-day. The other drawbacks of dual plane are a wider cleavage, and an ‘animation effect’ when contracting the muscle.

There are three main sites to insert an implant.

Our preferred incision site is in the breast crease (inframammary) because the scar usually heals well and is very difficult to see. It leaves no scar on the actual breast itself and does not restrict the type of clothing that can be worn even if it is still visible.

Some believe that an incision around the nipple (peri-areolar) produces the best result. This is true in some people; however, it depends on how a person heals scar tissue, as an incision can be quite noticeable in this location, and it is also a sensitive part of the breast. An incision in this area has a higher risk of reducing the sensation of the nipple and the ability to breastfeed.

Another way of inserting an implant is through an incision made in the armpit (axillary). Again, the problem with this incision occurs when the scar is prominent and thus can be seen when the woman lifts her arm. Patients with these types of scars are often unable to wear clothing that may show their armpit scar if they raise their arms – such as sleeveless items like bikinis, strapless dresses, halter neck garments and singlets.

Breast augmentation is performed under a general anaesthetic in a day hospital. You can leave the hospital after a couple of hours in recovery and after a period of postoperative observation.

Usually, pain is manageable and can be controlled with pain relief tablets for a few days. Drains are not routinely used, and dressings are minimal so that a shower can be taken the day after surgery.

Some patients can drive a car and go shopping the next day. After about five to seven days, most patients can return to work provided that they do not need to raise their arms or need to do any heavy lifting as this can be uncomfortable, particularly if the implant is under the muscle.

All sutures are dissolving, so there is no need to remove them, but we do like to see patients at the one week stage to check on their recovery. A nurse will review the wounds and provide you with a scar-reducing silicone gel to use.

There is usually some swelling in the first few weeks as the tissues heal. This settles gradually and is usually minimal by about a month after the operation. The size of the breasts at the one-month stage is what they will be long term. By the two-to-three month stage, they will soften and continue to improve for about a year.

A soft bra (without underwire) is optional for the first four weeks, and no activities undertaken that bounce the breasts (such as aerobics or jogging). After this time, patients are free to resume normal activities gradually. Pools and spas should be avoided in the first month to reduce the risk of wound infection.

Breast implants should not affect breastfeeding, whether the implant is above or below the muscle.

There is no increase in breast cancer risk for implants, and mammography, ultrasound, and MRI can be performed normally. Regular breast screening recommendations apply and should be followed.

Implants should be considered permanent and do not need to be removed by a specific time or date unless for medical reasons.

Making the decision to have cosmetic surgery is a serious one, and patients considering a procedure should also keep in mind that they need time to recover, they will need support, and possibly time off work. They may also need other therapies such as massage and compression garments.

During your consultation we will discuss the range of options available to you and recommend treatments that have the best chance of achieving your desired goals. Part of this conversation will cover, in more detail, the types of complications and risks that apply to your specific circumstances. In general, the risks and complications of surgery are:

• disappointing aesthetic outcome
• infection
• bleeding
• scarring
• significant asymmetry (a large difference between sides)
• pain
• change in skin sensation (eg. numbness)
• allergic reaction
• anaesthetic complications
• prolonged recover and wound healing
• collections of fluid

All of these may result in the need for further treatment or surgery.