Note: The below discussion has been taken from and expanded on a video where I go over the common questions I discuss with patients during their first Breast Augmentation surgery consultation. Feel free to watch the video or if you prefer a written expanded version below.
In this article I discuss some of the common topics I go over with patients during their initial breast augmentation consultation. While this is not an exhaustive discussion, nor can it replace a one on one consultation tailored to your unique circumstances, it may answer some of the questions you currently have at the start of your breast surgery journey.
What are some of the common reasons why patients consider breast augmentation surgery?
There are many reasons why someone would think about having a breast augmentation, however some of the more common reasons that patients mention include:
- That they have thought about it since their younger teenage years and it is something they have always wanted.
- That they were congenitally born with smaller breasts and have always thought about or wanted larger breasts.
- Some patients come in after they have had a few pregnancies and have finished with family. They feel a little bit deflated after childbirth and want to regain some of the shape and volume of their pre-pregnancy breasts.
- And lastly, some patients come in wanting to fix their congenital asymmetry. This is where someone is born with a degree of unevenness between their two breasts and would like that corrected, to even out when one is smaller than the other. In these cases, sometimes we do need to augment one and sometimes we need to reduce the size of the other whilst trying to address the matter of shape and position at the same time.
What can patients hope for or expect out of breast augmentation surgery?
I like to say to my patients that breast augmentation is something that doesn’t cure any diseases and it’s important for me to continually reiterate that because it will not solve any, what I would call, psychological problems that one might present with, especially in terms a patient’s self-esteem.
It is true that having this procedure can certainly increase a person’s self-esteem, boost their self-confidence and make them feel a lot better about themselves. They will be able to go out shopping for clothes that they may not have thought about wearing in the past, and, a lot of women simply come in saying to me that they would like to feel a lot more womanly and that’s why they are considering undergoing breast augmentation surgery.
But it is especially important to understand that at the end of the day this is a cosmetic operation and with every operation there are risks with both the surgery as well as the anaesthetics. I remind my patients that they need to keep in mind that we are not trying to fix something that is broken. Everyone is born the way that they are and so I always ensure that patients considering breast augmentation are well informed before deciding to proceed, so they can make the best, most well-informed decision possible.
What types of implants are available and what do you typically use?
Patients often come in asking for quite different shaped implants and often have a few preconceived ideas about what type of implants we all use. The truth is every plastic surgeon is going to use different types and brands of implants for their patients, which is a mix of professional preference and experience. As a general overview there are three different implant types (shown above). You have textured implants which are opaque in appearance due to their textured outer shell (hence the name), smooth implants, which appear transparent and there is also a special type of expander implant, which are adjustable in size. We do not typically use expander implants for cosmetic operations, although on occasion it may be appropriate for example when combined with reductions/lifts, however, it is most often used for breast cancer reconstruction surgery.
The smooth round and textured implants are the most often used implants in a typical breast augmentation procedure. Textured implants are mostly used in a form referred to as teardrop shaped, which gives a formed tapered like shape to the implant compared to a more uniform smooth round implant. The reason these implants are textured is because you do not want a teardrop shaped implant, which is designed to stay in a particular orientation, rotating upside down, as that’s going to give you a very strange looking breast. Comparatively a smooth round implant has a smooth shell casing because it is uniform in shape, so no matter which way you rotate it, it is still going to be of the same vector. That is, it is not going to give you an upside-down lopsided looking breast in the same way a rotated teardrop shaped implant would.
When it comes to deciding which is ideal for an individual patient, this comes down to the patient’s needs, their physiology, body shape, amount of breast tissue, look they are after, size of implant as well as several other factors. Of course, there are pros and cons to both smooth and textured implants and I discuss these with patients when we are determining the appropriate implant for them.
How long do implants ‘last’?
Some patients are not aware that implants do not last a lifetime, or more accurately, commonly do not last a lifetime. There is also a common misconception that implants have some sort of use by date where they expire, however that’s not really the reason why we tell patients that they may need, not always, but may need revision surgery down the track after they have had a breast augmentation.
The main reason implants do not typically last a lifetime, is that at the end of the day they behave as a foreign object inside your body. Additionally, they do weigh a certain amount depending on how large an implant a patient chooses, therefore all implants are affected by the effects of physics, which is gravity.
As the weight of the implant weighs down on the human body tissues inside a woman’s breast, it is going to exert forces on the skin and the surrounding breast tissue. Depending on the elasticity and the integrity of a person’s tissues this will respond very differently within each person. So in some cases you might have some loose skin that could develop over time, along with the aging process, and that may or may not cope as well as someone with more youthful, thicker and more elastic skin where these effects aren’t as pronounced. Implant size will also be a contributing factor. The bigger you go, the heavier the implant and the greater the potential that this might cause significant stretching forces to happen to the skin.
There are other things that also need to be considered when it comes to the life of implants. In some cases, a fibrous capsule could form on the outside of each implant as time goes on. This capsule can give you no problems, it can thicken to the point where it causes a bit of discomfort or even pain, and it may even cause some deformity in some patients. For these reasons, as a guide, we tell patients that they may need to consider revision surgery at around somewhere between the seven to ten-year mark after a standard breast augmentation.
What are some of the general complications a patient should know about before having breast augmentation surgery?
Some of the general complications that I normally discuss with my patients who consider undergoing breast augmentation surgery include more general complications such as pain after the operation and leading infection, which are both very general risks that we warn all patients about every time they have any type of surgery.
A more specific breast surgery complication would include a device failure, such as an implant rupture. In saying that, implants now are of quite high quality so that if one was to rupture or if you were to actually cut one in half, the gel inside them is fairly form stable and they don’t tend to spill everywhere like they used to in the past. The rupture or failure rate of an implant varies depending on the brand of implant being considered (the data for specific brands/company’s failure rates is available). When it comes to implants there are a multiple number of high-quality well-respected brands available each with slight differences in their implant sizes, dimensions and failure rates.
Another potential complication of breast augmentation is called capsular contracture, where a ‘capsule’ of harder tissue forms around the implant. This will potentially give you some discomfort, deformities or position problems down the track and is one of the more common reasons for breast augmentation revision surgery. There are ways to assist in reducing the possibility of this occurring post your surgery.
Rippling is another issue that we sometimes see in patients that do not have a lot of subcutaneous tissues, that is patients who are very skinny. Depending on how the implant is positioned (for example above or below the muscle tissue) you could find that some of the fine wrinkles that you would see when an implant is in a vertical position might become more obvious through the skin, because there’s not a significant amount of tissue to effectively smooth out or hide the implant below it. This is why deciding on the placement of the implant in patients of varying sizes, skin thickness and existing breast tissue is important.
Something else we sometimes see in cosmetic augmentation patients is double bubble deformities in the lower part of the breast where the implant has migrated underneath the breast crease. This can be quite complex to fix as far as revision surgeries go.
Finally, over time as a patient ages, we might find that the breast actually succumbs to gravity and ends up falling off the most prominent part of the implant, and so you end up with an implant sitting quite high up on the chest wall where the breast actually comes off the side and down towards the bottom half of the implant. This is what we call a waterfall deformity. This often presents quite later on in time and again, as with double bubble deformities, can be something that can be quite a complex surgical process to fix.
Start your journey with a consultation.
If you are thinking about having breast augmentation surgery and would like to discuss your options or any other questions, you can request a consultation here.
Dr Marion Chan