Surgical Procedures

Breast Surgery

Breast Enlargement

The breast is a very important symbol of femininity and has a very strong association with self-image in self-esteem. While breasts of many different sizes are completely normal for different women, a breast that is perceived as small can have a significant psychological fallout for that woman.

Some women have small breasts from the outset of breast development. Other women will have a breast size they are comfortable with before pregnancy and then suffer from post lactational involution of the breast and will end with a breast size far smaller than their pre-pregnancy breast.

To consider breast enlargement is an extremely personal decision and there are a lot of people who feel free to offer an opinion. Very frequently, these people do not suffer from having a breast size that does not match their self-image. This problem is one that can only be understood by a woman in this position. This does not make the problem any less significant for those who suffer from it.

Am I suitable for breast enlargement:

The commonest groups of women that consider breast augmentation are:

• Young women with small breasts
• Women who have had children and post lactational involution
• Women who have had children and have breast ptosis (sag) with a loss of firmness and shape to their breasts
• Women who have breast asymmetry (different sized breasts)
• Women who have had breast tissue removed surgically

What types of implants are used today:

There are two primary implant types and these are silicon or saline. Silicone is like plastic in many respects, by changing its chemical structure it can be firm and pliable like a sheet of rubber or sticky and runny like molasses. Saline implants are covered by an external silicone shell and are inflated with saltwater. Silicone implants have a similar external shell, however they are filled internally with silicone of a different structure so that it is soft and feels more natural than the firmer outer shell.

Older styles of implant had a very runny gel like honey. This type of implant is still used by some surgeons. When Dr Magnusson uses silicone implants he uses "cohesive gel" implants that have a similar consistency to the inside of a Turkish Delight.

Is silicone safe?

There have been several generations of silicone implants. The initial implants inserted in the seventies had a fairly firm/tough capsule. Many of these implants are still removed intact today.

The next generation of implant was made to be softer and hand a much thinner capsule and a very fluid gel.

The current range of breast implants that Dr Magnusson uses have a much more complex and tougher capsule that makes rupture less likely. This type of breast implant has been used since the early nineties. The rate of removing these implants is perhaps 5% 10% (or 1% per year) over the same period of time. Dr Magnusson has yet to see one of these implants rupture.

The other issue to consider is wether silicone itself causes disease. In the early nineties silicone was removed from general availability in Australia and in the United States of America. It was felt that there may be an association between silicone implants and disease.

This led to the now infamous court cases against Dow Corning. The problem for Dow Corning was that they needed to demonstrate there was no association rather than the plaintiffs demonstrate that there was. This information did not exist at that point however there is now a vast body of evidence demonstrating no association between silicone and disease. As a result of this research demonstrating its safety, silicone breast implants were again approved by the Therapeutic Goods Association (TGA) in Australia for general use in 2001.

What shapes do implants come in:

There are generally two broad categories of implant shape: round and anatomical. Anatomical implants are generally based on a more natural breast shape having more projection "beneath the nipple", and they don't have a perfectly round circumference. In this way, they more closely match a natural breast shape.

The choice of a breast implant for each individual woman comes down to a number of factors. Firstly it is important to understand what the patient is trying to achieve in shape and size. There are also physical factors to consider such as the tightness of the breast skin, the amount of breast tissue present, the presence of breast ptosis (sag) and whether or not a woman has previously been pregnant or breast-fed. The individual choice for a patient cannot be generalised without a full discussion and physical examination.

Dr Magnusson uses both round and anatomical implants on the basis of these considerations.

Should the implant be placed in front or behind the muscle:

In different women both choices will be appropriate. Women with a very small volume of breast tissue however are far more likely to require implants behind the muscle. Is also important to consider social factors such as occupation and hobbies. A woman with a very active lifestyle or an avid involvement in competitive sports may be better with implant above the muscle. In general though, most women will have an implant beneath the muscle. The individual choice for a patient cannot be generalised without discussion and examination.

Can I choose my final breast shape:

It is important to understand that we are starting with your breast. We will be increasing the size of your breast and not providing you with someone else's. As an example, two women with a similar breast size may have different chest shapes, a different amount of cleavage to commence with and different amounts of breast sag. Both these women may achieve an excellent outcome for them yet the final result will be individual.

How large can I go:

The proportions of your current breast will dictate the maximum volume implants that Dr Magnusson will suggest. In general, a medium-size implant is going to give you a more natural result than a large implant beyond the maximum volume suggested for your breast dimensions. Breast implants don't come as cup sizes. They are available as different volumes. The final aim of surgery is to create a general breast form rather than a specified cup size. It is important for you to set a goal for your final outcome as the combination of this goal and your examination by Dr Magnusson will set the course of your discussion with Dr Magnusson. During this discussion he will provide advice but you will ultimately choose your own implant size. Dr Magnusson will guide you with this selection.

What if my breast is already saggy (ptotic):

For some women, especially following pregnancy/breast-feeding or significant weight loss, a breast implant alone will not achieve the desired result alone. In these women it may be necessary to consider a breast lift/mastopexy as well as an implant to increase size. If your nipple is pointing down and has fallen below the fold beneath your breast (intramammary fold), this increases the chance that you will require a breast lift to achieve the ideal outcome.

Is there any assistance from Medicare or my health fund:

For the vast majority of women, choosing to have breast augmentation is considered a cosmetic procedure and has no assistance from Medicare or health funds. Small group of women with significant breast asymmetry (differences in size) will gain approval for the enlargement of one breast. Women who have had a mastectomy and require a breast enlargement on one side will also gain approval for enlargement of the affected breast. For further information about your own policy you should contact your health fund.

Resources:

Inamed Corporation (McGhan and CUI breast implants)
Mentor Corporation (breast implants)