Breast augmentation

Why have a breast augmentation

Breast implants increase the breast size for women who feel their breast shape and size is too small or dont want to continue to wear a padded bra. This is usually due to a lack of development ( not growing breasts during puberty) or sometime, breasts become smaller from disease, injury or after having children. Some breasts are asymmetrical and augmentation can be used for reconstruction.

When to have a breast augmentation

The decision to have breast augmentation should be carefully made by you and in conjunction with the plastic surgeon. When there is no breast development abnormality, and the breasts have not grown, breast implants are usually performed after the development phase at 19 -20. Otherwise, where there is a congenital abnormality, augmentation can be performed earlier. Some women elect to have breast augmentation after having a family because breasts do change with pregnancy and lactation and the breasts become relatively more stable after this point. If you are due for a mammogram please get this done and bring the results with you to your appointment.

What would contra indicate breast implant surgery?

A patient should be both medically and psychologically well to have a breast implant. Whilst there is no age limit to have an implant, the patient should be physically well or any medical problems under control. Any diseases of the breast should be stable, talk to us in the practice. Since augmentation is elective, it is not critical for your health. A breast implant does not solve any social or psychological problems. Any patient who does not have realistic expectations is also not a good implant candidate. Sometimes we may wish for any medical or psychological issues to be addressed prior to having an implant.

What is the breast implant made off and what does Dr Mahajani use?

Breast implants are made of a shell made of silicone. The filling of the breast implant is either made of silicone or saline but Dr Mahajani does not use saline implants. The outer shell that Dr Mahajani prefers has a textured surface. The silicone used nowadays is a cohesive silicone gel, therefore it tends to remain as a solid if the implant breaks. Dr Mahajani's practice will show you examples of this.

What shapes are the breast implants?

Breast implants have 2 general shapes, the tear drop shape or the round shape. The tear drop has a more natural shape like a natural breast. Dr Mahajani tends to use this for the more mature woman who is post pregnancy. It enlarges the breast but gives a more natural shape. It can also help lift some nipples when there is some sag after childbirth. The round implant is generally used for the younger woman when a more round shape is desired. It produces more fullness in the upper breast. Both implants increase the cleavage to some degree. Younger women and older women can have both types of implants but Dr Mahajani will discuss this with you after examination.

What size implants can I have?

Dr Mahajani will examine you with the chaperone and breast measurements are taken. Based on the measurements, Dr Mahajani will, in discussion with you, discuss the size of the implant. The practice will then give you implants to take wtih you to wear in your clothes and underwear. Occasionally, other medical tests like blood tests and xr type tests may be requested. You take these home and then represent for a second consultation at which time, the implants are decided. Sometimes, the implants a patient selects may not be physically appropriate which your body cannot tollerate. Dr Mahajani will discuss this with you. For example, too small an implant may not be noticeable for you and too large an implant is too difficult to do or have a higher chance of complication. It is important to know that we dont deal with sizes like ABCD because of the large variations in this system. The best system is measurment in cubic centrimetres like a 400 cc implant. When you take the implants to try, wear these in a bra and see what size it is. Once you have decided on the implant size, we will advise you in relation to support bras to wear after the surgery

Before the operation

Discuss any queries regarding the operation and post operation requirements with Dr Mahajani and his staff. Any fee enquiries please discuss with the practice administration. Do not smoke 2 weeks before the operation to 3 months after the operation. Smoking significantly affects breast implants. Stop any medications you have been advised to by the anaesthetist. Go to your anaesthetic appointment. We will give you the name of your anaesthetist so you can make contact with them. We will give you your operation date and time. The day before operation you will come for a mark up where the nipple position is determined and the operation is discussed. Please bring the completed consent form with you. The practice will also advise you about a bra to wear after the operation.

How much do implants cost and does private cover fund breast implants?

Where there is some development problem, a difference in 10 % between the breast sizes, some disease or trauma, then there is some medical rebate and the health funds may fund the cost of implants. For the cosmetic implant, breast implant surgery in this practice costs approximately $11,000 to $12,000. This is to cover the fee for surgeon, anaesthetist, assistant, theatre facility fee and the cost of the implants. Whilst there is no rebate for the initial implant, if there are complications from the implant or at some later stage there is a problem, heatlh funds generally do cover the cost of implant complication surgery including the cost of the replacement implant. That is why the practice insists on the patient having private health cover for the initial implant and recommends that you maintain the private cover afterwards. Costs are best discussed with the practice administration staff.

What incisions are made to place implants?

Breast implants are inserted by making a cut on the skin. The most common incision is the inframammary fold where the chest meets the breast. This is Dr Mahajani's most common incision. He finds it gives the best approach for him, the best scar, and the best visualization to most accurately place the implant and control the shelf on which the implant sits. The other incision is the periareolar incision. The incision is made on the areolar. This is rarely used by Dr Mahajani but may be used if the areolar is too large and requires reduction or other operations are needed. Dr Mahajani will discuss this with you. Breast implants have been inserted from incisions in the armpit, Dr Mahajani does not use this.

Where are implants placed?

In Dr Mahajani's implants are placed usually under the muscle ( subpectoral ) implant or occasionally infront of the muscle ( pre pectoral). Most women have insufficient breast tissue to cover the implant and so placing the implant just under the breast will mean the implant is more visible, the muscle provides a better implant cover. The other benefit for a subpectoral implant is that there is an interface between the implant and the breast for the sake of later mammograms and thirdly and perhaps more importantly, implants under the muscle have a lesser incidence of capsular contracture. Placing implants under the muscle is initially a little more painful but this tends to settle. Dr Mahajani places most of his implants under the muscle. 

If a patient has sufficient breast tissue and or cannot have an implant under the muscle, it can be placed just under the breast. The slight advantage is that it is less painful but there is no interface between the implant and the breast and higher incidence of capsular contracture. Dr Mahajani can discuss this with you.

If you are a body builder, the placement of the implant requires very careful consideration. Dr Mahajani will discuss this with you, as under the muscle the implant is prone to move with the pectoralis major muscle and as this group has very little breast tissue, placing the implant just under the skin means the implant is very visible. Dr Mahajani will discuss the pro's and con's with you.

What happens at the operation

You will come to the practice a day before for markup and photos. You come to the hospital fasted and the operation is performed under sedation or general anaesthetic. Incisions are made in the skin and the pocket is made. The implants are placed into this pocket with correct orientation and the incisions are closed. The stitches are dissolving. There are usually drains in place. The dressings are done and you wake up.

After the operation and returning to normal activities

You are allowed home the same day with oral antibiotics and pain killers and come back the next day to the office to remove the drains and dressigs. You can wear the bra at this time. You will then come 1 week after for a review and then at the 6 week mark when final photos are taken. We would like you to rest for 1-2 weeks. It is common to be tired. The pain in general decreases over 2 weeks. You will come for dressings and reviews. The support bra is worn for 6 weeks. You can return to work after 1 week for an office job and 2 weeks for other jobs. You can drive after 1 week but be careful with seatbelts. Do not lift anything heavy for 6 weeks. Sexual actvitiy should be avoided for 3-4 weeks. After 6 weeks, you can return to normal activities.

What to watch out for after operation

Bleeding, feeling unwell, temperature, redness, increased pain, shifting or moving implants, new lumps, changes in the breast or implant shapes, breast texture or anything that is of concern to you.

Surgery Expectations, Risks and Complications

For most people breast augmentation is a safe and straightforward procedure. We would however like you inform you of what to expect along with risks and complications. Please note that whilst breast implants are safe it is a medical device and should not be taken for granted they will last a lifetime.

Scar

The operation does produce a scar at the base of the breast. In the majority, this is a fine thin scar about 5-6 cm. This scar is red up to 12 months but then settles down. In some people the scar may thicken or stretch. These scars are permanent but over time the majority do lighten. Whislt we attempt to make scars as fine as possible, scars in these areas can thicken and we cannot predict how scars will manifest.

Wounds

Generally heal over 2 weeks but can take longer. They tend to settle down finally at the 6 week mark and the scar matures thereafter.

Incisions can get infected and usually only requires antibiotics to treat. Occasionally stitches that infect need removal. We will help manage your dressings. Rarely some wounds break down and the patient needs a revision of this. Infections that require more than antibiotics like severe necrotic infections requiring surgery are very rare.

Asymmetry

Both breasts are always different, whereas the implants are symmetrical. The operation is designed to make the breasts as symmetrical as possible but there may be some minor asymmetry between side to side. Mostly this is not significant or noticeable and it rarely needs any correction. In most instances people may notice asymmetry in the breasts after implants but it is the asymmetry that was there before that they never noticed.

Bleeding and swelling

It is unusual to have significant bleeding but if you do bleed, we may be required to stop the bleeding and or give a transfusion. There are drains which help indicate this. After a breast augmentation, the breast swells before it settles down. People notice this much more at the start as it is a sudden change for them. It takes usually 6 weeks to 3 months to completely settle.

What size will I be?

As discussed above, with implants we try as hard as possible to make you the size you request and what is possible. But it sometimes difficult to be precise. If the implant is under the muscle there is said to be a compression effect of 10 % so people often chose an implant that is just slightly bigger than one that is initially chosen. The ABCD... breast system really does not work with breast implant size.

Numbness and pain

With inframammary crease incisions, after augmentation, sometimes numbness may occur in the area of the skin above the incision however it is rare and this usually resolves over weeks or months. Occasionally it is permanent but doesnt interfere with function. Incisions in the areaolar may cause the nipple to become numb. The nipple may lose erectile or sexual sensativity. Pain lasts 1-2 weeks and settles down after this over a 6 week period in most people but can take longer. Subpectoral implants are more painful than subglandular implants. Sometimes one side is more painful than the other and why this happens is unknown. In some patients, nerves can be irritated and cause pain that is very severe or longer to resolve. This is unexpected but occasionally occurs. If this happens, our practice will help you to manage this where we can.

Problems in the areolar and nipple

Numbness in the areolar can occur. It may have been pre existing but can occur in up to 1 in 5 patients after breast reduction and lift. In about 1 percent it is permanent. Injury to the nipple and areolar causing loss of the nipple and areolar is very rare. Usually it is more common when there has been a previous breast reduction or incisions around the nipple or if the nipples have a long way to move in the breast reduction. I have never lost a nipple indoint a breast reduction in my practice but if a nipple is lost, then a nipple areolar reconstruction is required. Sometimes an areolar scar is not fine and a patient desires a correction of this.

Capsular contracture

The body forms a wall ( capsule ) around any foreign implant and this happens to all breast implant. In some patients the capsule may thicken or contract causing problems which include moving the implant, causing a shape change in the implant, pain or a hardness in the implant. It occurs in about 5% of patients with implants. We try and reduce capsular contracture by using antibiotics, textured implants and placing implants in subpectoral pockets. But nothing can predict implant contractures. If this happens, sometimes just the capsule needs removal, occasionally the implant and capsule needs removal and replacement. It usually happens years after implantation. If implants are repeatedly removed and replaced, and the patient continues to develop capsular contracture, then that patient may not be suitable for implants and may need these removed.

Leaking implant

The newer implants which are form stable, if injured tend to stay in one piece and are much safer than previous implants.However, implants can and still do leak even if it is just gel bleed. If this happens, and it lies within the capsule, it may be fine as long as the implants dont cause any other problems and remain the same size. If however the breast implant leak outside the capsule or there is significant distortion of the implant, then this will need implant removal and replacement.

Implant movement

The implant may move in any direction, up down, towards the midline or laterally. If implants move then this may create problems. When we place implants in place, we bear in mind the position of the muscle. If the muscles are too wide appart we may not be able to narrow the cleavage as this may cause breast implants to move inwards and the breasts implants join the breasts together (known as synmastia) . Breast implants can also migrate in any other direction and all of these may need correction if significant.

Implant fliip and rotation

Implants may rotate. For round implants, this doesnt matter. For tear drop shape, this will cause a shape change and may need correction. Bear in mind that rotation is very uncommon in tear drop shape implant and Dr Mahajani would suggest you not use this reason for deciding upon the type of implant you chose. If round or tear drop implants flip inside out, then this needs correction, this is extremely rare.

Breast lumps, granulomas and changes to the breast after implants

At any time after the breast implant there may be new lumps detected. This may or may not relate to the implants. Sometimes calcium deposits around an implant. This is usually not a problem but may sometimes mimic a breast cancer and any calcium deposition needs investigation on its own terms. Silicone can leak and cause a granuloma. This again needs investigation on its own terms. Some lumps are totally unrelated to the implant and will need investigation. Fluid can also accumulate in the capsule of breast implants and this should be investigated.

Implant infection and extrusion

It is rare for cosmetic implants to get infected. If an implant infects, then it needs removal or it will extruded itself ( especially if antibiotics dont fix the problem) . Infection problems are very common in smokers and we encourage you not to smoke. If there is trauma to the area, then the implant may extrude. It is important to be careful and avoid physical activity and lifting after the implant. If implants are inserted for reconstruction after breast cancer and radiotherapy, then extrusion rates are higher.

Implant wrinkles

Sometimes the edge of the implant folds over creating a wrinkle in the implant. This may be felt by the patient and is not usually a problem unless it is severe or annoying. It usually does not create a skin distortion. If it does happen or distresses the patient it may need revision.

Chest wall deformity

Implants can indent the chest wall creating a shallow grove on the ribs however it does not usually cause any health problems.

Breast implants and other diseases

Breast implants are inert themselves and do not cause allergies. So far as we know there is no good evidence that they cause other problems like autoimmune disease like rheumatoid arthritis, connective tissue disorders. In general the consensus is that implants dont cause these diseases, however there are anecdotal case studies that women with implants may develop these conditions but it is not proven that implants have cause this. If someone does develop these conditions after implants then it has to be carefully considered if removal is necessary as removal may not necessarily solve the problem. Should this occur, it should be carefully discussed with the plastic surgeon.

Other complications

General complications from any anaesthetic include, sore throat, chest infection, deep vein thrombosis, irritation from dressings, rare complications from anaesthetic ( your anaesthetist will discuss ) .

Pregnancy after breast implants

Whilst most women have breast implants after having a family, there are women who desire implants before starting a family. Pregnancy and lactation will affect the breast shape and size. It may not be possible to breast feed see later. It may make the breasts larger ( or smaller if the breasts involute) and it may not return to the pre pregnancy size or shape and further surgery may be desired.

Changes over time

Breasts change over time and they change with events such as pregnancy, lactation, menopause, the menstrual cycle and weight changes. These can affect the shape of breasts. Over time gravity may affect the position of the nipples or implants and this may need to be addressed with surgery.

Breast implants and psychological well being

Breast implants should not be used to solve any psychological or personal problems. If you have such concerns let us know before the operation. Sometimes people get some changes to their affect from an operation such as ups and downs, anxiety, depression. It should pass but if any such problems persist, then please advise the practice and we may need to refer you for psychology.

Breast implants and cancer

The common type of breast cancers are not caused by breast implants. Recently there has been a suggestion that some women with breast implants have developed a form of cancer called ACLC ( anaplastic large cell lymphoma) in the breast implant capsule . This is a very rare with some 34 cases amongst a world wide population of about 5-10 million implants worldwide. The basic inference is that is ' watch this space' but it is very very rare, and patients who have increased size or fluid that they develop in an implant should be investigated.

Breast implants and breast feeding

Breast implants usually dont affect a persons ability to breast feed. People may or may not be able to breast feed and this cannot necessarily be attributable to the implant. If there are complications this perhaps , could affect lactation. Silicone is an inert compound and as far this practice is concerned, babies are not affected by breast implants. Silicone is found in lots of products including medicines.

Breast implants and mammograms

Breast implants can interfere with cancer detection. If there is cancer history in yourself or family, please let us know. The mammogram process can also injure the implant so make sure the x ray technician is aware. Always examine the breasts and perform mammograms as per your GP's recommendation. If there are any lumps that you detect please report to the practice. It is always safer to do the mammogram when indicated rather than avoid this for the sake of the implant.


This information is designed to provide you with as much information as possible. Despite all due care, sometimes complications do develop. We discuss as far as possible, the complications that could potentially occur but its not possible to discuss with you each and every problem or the consequences of those problems. However we will always attempt to help you when humanly possible. If you have concers outside those that have been raised, then please discuss this with Dr Mahajani.

In Dr Mahajani's practice, if Dr Mahajani has to surgically fix a problem where he has done the primary implant, as long as the patient maintains their private health cover, he bills the health fund. This may not be necessarily so if the patient just wants a change in size. He cannot guarantee the fees that other practitioners, or health organizations that may need to be involved. If Dr Mahajani has not done the primary implant, there may be a fee to the patient but a rebate may be available from the health fund.

The Department of health has a section on breast implant information via the TGA or therapeutic goods administration and we would recommend you to also read this. It is available at www.tga.gov.au. If you have any doubts whatsoever, we do suggest you obtain a second opinion and if you wish we are happy to help you with this process.