Also known as augmentation mammaplasty, breast augmentation involves using implants to increase breast volume, breast projection and provide upper pole fullness. It can be used for purely to increase natural volume, or to restore breast volume lost after weight reduction, pregnancy or breast feeding.
Breast augmentation is not indicated for breast ptosis (drooping of the breast tissue), unless an increase in volume is also an objective. In fact, augmentation surgery cannot completely correct severe breast ptosis (drooping of the breasts). Sometimes to achieve both an increase in volume and correction of ptosis, 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 would only be suitable for individuals who:
- are physically healthy
- have realistic expectations
- have fully developed breasts
In Queensland, breast augmentation surgery for cosmetic purposes are illegal for those under the age of 18. It can only be performed for specific reconstructive purposes in children and teenagers.
How do I arrange a consultation?
It is required by law for you to have a referral from your GP if you would like to have a consultation for cosmetic breast augmentation. This would ensure that before your consultation, your GP has considered and assessed your general health status and that your screening mammograms are up to date if it is indicated.
To make an appointment, you or your GP must send or email us the referral with your medical history first. Once received, a file will be created for you on our system awaiting you to contact us. This process takes approximately 1-2 working days. You can then organise an appointment by calling our reception staff on 3353 6165. We do not offer appointment via email, social media or text message.
Read more about how to book an appointment.
It is a requirement from the Regulations for Cosmetic Surgery, for you to have two consultations prior to surgery. Your first consultation will involve a general discussion of your health and your expectations to see if you are suitable for breast augmentation surgery. If surgery is appropriate, there will be a discussion about the procedure recommended (and trial of implant sizers), postoperative recovery, realistic expectations and possible risks. At the end of your first consultation, you will receive an estimate of fees and costs.
A psychological assessment is part of the regulation requirement, and this is done through a number of questions that your surgeon will ask you. Testing may occur either during your first or second consultation. If there are any major concerns with the testing result, you may not qualify for surgery and may be referred to a psychologist for further assessment.
The second consultation will be a re-discussion of the procedure, outcomes, risks and possible complications. A second trial of implant sizers will also be performed to make sure that the correct implants are chosen. The second consultation will also involve signing of consent forms, measuring for the postoperative bra, and addressing any questions or concerns you may have. After your second consultation, we will provide you with a list of potential available dates for surgery.
According to the regulation, you will not be allowed to book your procedure date until 7 days after your second consultation (known as the 'cooling-off period', at which time you will be able to contact us via phone or email to book in your procedure. A booking fee will apply to secure your surgery date.
Further consultation can be made if you have more questions or concerns prior to your surgery. Similarly, if you require reassessment due to any recent health issues or body changes (e.g. newly diagnosed medical conditions, new medications, change in weight, recent hospitalisation), our surgeon may require you to attend additional appointments. Please note that your surgery consent is only valid for 6 months, if you book in for surgery more than 6 months after your last consultation, you will need another consultation prior to booking your procedure.
Procedural Steps - What happens during breast augmentation surgery?
Breast augmentation is only performed under general anaesthesia for your comfort. Medications are administered to induce full anaesthesia and maintain your sleep during the surgical procedure.
Incisions are made in inconspicuous areas to minimize visible scarring. Your surgeon will discuss which incision options are appropriate for your desired outcome. Incision options include:
- Inframammary Incision: under the breast
- Transaxillary Incision: in the armpit
- Periareolar Incision: under the nipple
Incisions vary based on the type of implant, degree of enlargement desired, your particular anatomy, and patient-surgeon preference. Most surgeons in Australia currently favour the inframammary (IMF) incision as it allows placement of implant of all sizes, good visualisation and control of pocket/implant position. The scar is also more predictable and well-hidden, with minimal disruption to the nipple, breast ducts and breast tissues.
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)
- Under the fascia (lining) of the muscle but above the muscle (subfascial 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 information 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.
The desired breast size and shape are important when choosing breast implants, so be honest and open about your expectations when talking with your surgeon. However, it is also equally important to understand that the final result is not just dependent on the Implant type and size, but also on your breast anatomy, breast tissue texture, skin elasticity and underlying rib cage structures.
To find out more about breast implants, click here.
What size would be recommended for me?
Breast implant size (and shape) is often chosen based on your breast width and height. Thus, the upper limit in breast implant size is the width of your chest wall. Implants are made in a variety of sizes but generally speaking, the bigger the volume the wider 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.
At Creare Clinic, we are strong advocate of breast enhancement in proportion to 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
- gives a more natural enhancement
- 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
- decreases potential postoperative complications with implants
During your first consultation, you will be asked to wear a ‘sizing bra’ where different size implants are placed into the front pocket of the bra to mimic the possible outcome. 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 'look' that you would like to achieve.
Other important considerations:
Before choosing breast implants for breast augmentation, you also need to consider:
- breast implants generally do not 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, thus revisions may be required for cosmetic purposes (i.e. change in size).
- breast implants can affect the accuracy of mammograms, thus affecting detection of breast cancer and other breast diseases.
- breast implants require monitoring during your lifetime.
It’s important to know that your breast implants are not permanent and may require replacement during your lifetime. Although there is no set time for revisions, but regular monitoring can pick up problems early. Revision is not usually recommended unless there is a cosmetic or medical issue. Natural breast may also change due to aging, weight fluctuations, hormonal factors and gravity. Thus, further breast procedures may be required years after your augmentation to restore their cosmesis.
It is also essential that you attend follow-up visits, as your implant integrity and health will need to be reviewed regularly. At Creare Clinic, we recommend yearly reviews for all patients who have had implant surgery with 2-yearly ultrasound imaging of the implants, which should be accompanied by regular mammograms for those who are 40 or older.
Are there any reasons why I can't have breast implants?
There are no absolute contraindications for breast implants or breast implant surgery. Every patient is assessed on an individual basis and honest recommendations will be discussed with you. Generally, if there is significant risk to your health or specific factors that can give rise to surgical complications, any form of cosmetic surgery would not be recommended, including breast augmentation surgery. Here are a few examples which may affect your suitability:
- General health issues which preclude safe general anaesthesia and a safe surgical procedure (e.g. bleeding disorders, heart conditions, lung problems and others)
- Smoking: smokers are more prone to implant complications such as infection, wound healing issues, as well anaesthetic issues.
- Active infections: it is important when implant surgery is performed that there are no active infections in the body, oral/nasal cavities or on the skin, as this may cause either an acute or chronic implant infection.
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.
Your surgeon 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 is accepting of potential risks and complications.
These risks include:
- Unfavourable scarring
- Bleeding (hematoma)
- Infection (with removal of implants)
- 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 (known as rippling)
- Anaesthesia risks
- Fluid accumulation
- Blood clots
- Pain or discomfort, 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. These will be discussed 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 or a bit of preoperative stress. Don’t be shy about discussing these feelings and any specific concerns with your surgeon or any of our staff members.
Our 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 8 weeks to give your new breasts support and protection. Instructions will be given to you with regards to wound care, scar and implant massage during your postoperative appointments.
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 8 weeks. You should not wear any under-wire bras for at least 12 weeks. You will have two postoperative appointments in our dressing clinic and then a final review with your surgeon around 2-3 months. More appointments may be made for you if required.
Results and Expectations
The results of breast augmentation are immediately visible. Over time, post-surgical swelling will resolve, and incision lines will fade. This will allow the shape to settle into a more natural curve, which normally occurs at around 3 months. The implants tend to 'drop' with time and become softer over 6-12 months, giving less upper pole prominence and more lower pole fullness. The scars often mature around 6 months, sometimes up to 12 months.
Costs associated with Breast Augmentation
Private health insurance will not cover cosmetic breast augmentation surgery and it excludes cover for related complications or revision surgery of implants.
Costs associated with cosmetic breast augmentation are:
- Hospital Fee +/- any tests required before, during or after the procedure
- Anaesthetic Fee
- Surgeon's Fees
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. It will not cover any subsequent surgery or revision surgery.
A booking fee is required to secure your surgery date. This will be subtracted from the total of your surgeon's fee. This booking fee is not refundable as it will cover the cost of administrative work, as well as the delivery of implant orders. It is important that you do not book in for surgery until you have made a definitive decision to proceed.
The quote given to you with your financial consent will also have the contact details of a selection of hospitals where you can have your procedure, and the specialist rooms of your anaesthetist. It is your responsibility to contact them to check their fees before booking your surgery.
It is standard practice that all fees are paid 10-14 days prior to surgery. You will be notified when payment is due. If prepayment is not received within the specified timeframe, your surgery will be cancelled. Your booking fee will not be refunded and rebooking will not be considered.
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: 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; similar to an X-ray or CT scan, but the images are created with a magnetic field.
- 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 a 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)