Am I suitable to have a breast augmentation?

The most common reason to have an implant is for an enhancement in your self image. Some patients get implants for reconstruction after mastectomy as well as developmental disorders. Small breasts may be from normal development or involution, especially after pregnancy. Patients from all different personality types and spectrums may seek this procedure to help with their self-image or esteem. When surveyed after surgery, the vast majority of women would undergo the operation again.

Most will not have contraindications to breast augmentation. Here is a list of conditions that may make you unsuitable to have the procedure

• active infection of the breast
• active breast cancer
• pregnancy
• history of autoimmune disease
• current radiation treatment
• unstable medical conditions
• known sensitivity to silicone.
• those with psychological instability or unrealistic expectations should not have this surgery

Best timing for surgery

Augmentation surgery is best performed after completion of breast growth.  If you are planning a family within the next 12 months, it may be better to delay surgery until after the baby is born and breast feeding has been completed.

What is involved with the surgery?

Augmentation surgery is performed under a general anaesthetic and usually take up to 90 minutes to perform.  You can usually be discharged home the same day. Revision breast augmentation is a much more involved procedure as it not just involves taking out the old implant and replacing with a new one, but will usually  also require removal of the fibrous capsules surrounding the implant. Revision surgery may take up to 3 hours and will usually require at least an overnight stay in hospital.

Breast implants can be inserted through incisions in the axilla, areolar or most commonly, under the breast fold. Dr Teh prefers to perform his incisions in the breast fold. Regardless of how the original implants were inserted, breast fold incisions are generally required when breast implants need to be removed and/or replaced.

Once the incision is made, the breast implant can be placed either under the breast gland, deeper under the pectoralis major muscle or in between the two (so called dual plane technique). Depending on the look that you are seeking and your chest characteristics , Dr Teh will give you an opinion as to which of these methods would suit you best.

Your consultation will also include a recommendation of a range of sizes that would suit your chest dimensions. It is important to remember that one size does not fit all. While a particular size  might look great in a photo, it may look completely different in you due to variabilities in breast volume, chest girth and the projection of your ribs.

For care following surgery, go here.

What kind of Implants are used?

There are 2 main types of breast implants: saline filled or silicone filled, but both have an outer silicone shell. Saline-filled implants are filled with sterile saline at the time of surgery and allows the surgeon to ‘fine tune’ the final volume. Silicone filled implants have an outer shell that is comprised of solid silicone. They are then filled inside with a viscous medical grade silicone gel. Saline implants are generally softer than silicone filled implants. However they also ripple more easily so it is less suitable if you have only very thin skin cover over the implants. 

The implant shell can come as smooth or textured. The texturing in the shell of the implant vary with different manufacturers – some have quite rough texturing to promote tissue adherence (macro textured) and others have more fine texturing (micro or nano texturing). They can be filled with saline or silicone. Dr Teh mainly uses silicone filled implants but will also use saline filled implants on request. He has used all the major breast implant brands but most commonly uses implants made by Mentor and Motiva.

Are breast implants safe?

Breast implant surgery is the most common of all cosmetic surgeries. It is practiced widely worldwide, with millions of women have had breast implants inserted be it for cosmetic or reconstructive purposes. Of all the implantable medical devices, breast implants are one of the most researched, and guidelines for their safe placement have been refined over half a century.

Despite this, there has been safety concerns in particular with its connection to a rare form of malignancy called anaplastic large cell lymphoma. This has been found to occur in up to 1:4000 in patients with macro textured implants, but much less frequently in smooth or micro/nano textured implants. Based on current evidence, we do not think breast implant-associated cancer is related to either the contents (saline/silicone) or shape (round/teardrop) of the implant. As such, macro textured implants are no longer used. The absolute risk remains low with incidence estimates of 1 in 500,000 to 1 in 3000000 of all breast implant patients.   It is also important to note that most patients who have the disease confined to the implant capsule have a good prognosis, with the majority achieving complete remission

Since the 1960s, there has been a reported link between silicone and autoimmune disease. This syndrome is now termed Breast Implant Illness and symptoms include fatigue, chest pain, headaches, photosensitivity, chronic pain, joint aches, rash, anxiety, sleep disturbance, depression, neurologic issues and hormonal issues. It remains a poorly defined entity with no definitive cause as the studies have been hampered by poor design, confounding factors or find no evidence.  Consequently, the debate continues as to whether or not the link is one of cause or effect. 

Other complications of breast implant surgery include scarring, breast pain, infection, sensory changes, implant hardening(capsular contracture), leakage or rupture.

For further information about breast implant safety, read the guidelines for patients from the TGA

What is Capsular contracture?

Symptomatic capsular contraction is one of the most common reasons to have a breast implant replaced. The formation of a “capsule” of scar tissue around any kind of implant (medical or cosmetic) is a normal part of the healing process. The body automatically reacts to any foreign object it detects within it and attempts to isolate the object by creating a wall of scar tissue around it. In the case of breast implants, this is usually a good thing – the capsule helps to keep the breast implants in place, preventing slippage. In some patients, however, this capsule of scar tissue becomes unusually hard and starts to tighten around the implant. This can lead to both aesthetic problems such as rippling or increasing visibility of the implant and, in extreme cases, pain in the breasts. Research shows that about one in six breast augmentation patients experience some degree of capsular contracture, though not all cases present with obvious symptoms. Generally, capsular contracture occurs during the healing process. About 75% of all capsular contractures will occur within two years of the patient’s implants being placed. Sometimes capsular contractures occur many years after breast augmentation surgery, but this is the exception rather than the rule. If this does occur, the patient’s breast implants should be checked for ruptures. Ruptured implants are the most common cause of late-onset capsular contraction. Early capsular contractures can be caused by a genetic predisposition, subclinical implant infection (biofilm) and bleeding around the implant. 

Risk of contracture may be reduced by using a textured implant rather than a smooth implant. Saline implants seem to have a slightly lower risk than silicone implants. A placement below the muscle may reduce the risk slightly from 12-18% (above muscle) to 8-12% lifetime risk of developing capsular contracture. An inframmammary incision may have a lower risk when compared to a periareolar or transaxillary approach. Placed into context, these variables only have a small impact if you consider that the overall need of reoperation for capsular contracture is quite low (around 4%). 

How long will my implant last?

The average saline or silicone implants may last anywhere from 10 to 20 years. However, some are removed sooner due to complications or cosmetic concerns. The risk rate for reoperation is about 10% at 3 years. Research have shown that the most common reasons for reoperation is implant malposition (36%), capsular contracture (33%), and the patient’s request for a change in implant size or style (20%).