Project Description

Breast Augmentation

The CAPS Clinic specialises in breast augmentation (breast enlargement / breast implants). Over the past ten years enhancing the breast shape and size has become one of the most popular cosmetic procedures world wide.  Women are taking control of their situation and embracing the many options available.

Dr Taylor has performed thousands of these procedures over the years and has seen and repaired many more.  Augmentation mammoplasty is a surgical procedure which should be tailored to the individual.  Type, size and placement of implants, as well as the method of insertion should be determined following a discussion of lifestyle, medical history and expectations.

Breast Augmentation is a major life decision and should not be
entered into without careful thought and planning.

Dr Alastair Taylor is available for consultations to determine if breast augmentation surgery is suitable for you.

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Reasons

In some women breast tissue simply doesn’t develop.  These are the women with ‘A’ or ‘AA’ breasts who just want to look and feel more feminine.
It may surprise you how many women have asymmetrical breasts.  These can vary from less than one cup size and can go as large as three to four cup sizes ie ‘A’ cup on side and ‘D’ on the other.

In some cases a breast reduction is required on one side and augmentation on the other or possibly a unilateral reduction and bilateral augmentation.  Although these cases are difficult, with correct planning and surgical execution an even balance can be achieved.

Tubular breasts are often described as nipples on a stick.  These are breasts that have developed with tight subcutaneous tissues forcing breast material into the nipple.  Whilst the surgery to correct this condition is not simple it is definitely achievable.  In most of these cases a medicare and therefore health fund rebate is applicable.
Having a child is one of the most wonderful things women can do and breast feeding develops a beautiful bond between you and your baby, but it can take its toll on your body.  It sometimes shocks women the condition their breasts are left in following this experience and often they come to us feeling disappointed and embarrassed about the condition of their breasts.  Breast Augmentation is one of the options available to restore breast fullness.
Breast Augmentation has been around since the mid 1960s.  In our practice we have seen many women who have had the very first breast augmentations in Australia and their implants have lasted them 20 – 30 years.  However these implants were not fantastic and most of these women now have very hard, deformed balls for breasts.  The newer styles of breast implants are much better and are designed to provide years of soft, natural shape.  However, there are no guarantees they will last forever and there are reasons women will need to have surgery again in the future to replace them (see Risks).  Whatever the reason for replacement remember everytime your breasts are operated on it becomes harder for the surgeon to achieve a natural look.

Removing and Replacing Breast Implants for a Medical Reason is rebatable on both Medicare and if you are covered for Plastic and Reconstructive Surgery your surgery and replacement implants may also be claimed from your Private Health Fund.

Breast Implants

The look you wish to achieve is a very personal choice.  Some women want enormous breasts and don’t care if they look fake and others want a more natural look and prefer to keep the surgery private.  Determining which look you want will also give you an idea of which surgeon to go to.  Dr Taylor prefers the more natural look and the portfolio on the website showcases this.

If you are looking for the ‘out there’ look then look for a surgeon who uses large, round implants.  These will be cheaper as the round implant is significantly cheaper than the anatomical.  Conversely if you are looking for a more natural shape then look for a surgeon who uses anatomical implants and sizes them to fit your chest.  Anatomical implants are around $1000 more expensive than round.

When doing your original research with surgeons – ask about the shape of the implant and ensure you are getting what you paid for.

There are a lot of implants on the market and the choice is bewildering. Each company will tout their research with clinical papers showing how ‘safe’ their implants are.  But how does the average person find out which implant is the best for them?

In Australia all implants on the market are TGA certified for use.  But –  so were the PIP implants that have now been proven to be clinically unsafe and caused significant turmoil in not only Australia but also across the world.  Again this comes down to your surgeon.  PIP were popular because they were cheap, for no other reason were they used.  At less than $1000 a pair the PIP implants allowed surgeons to either offer a more competitive price to their patient or increase their profit margins to unsuspecting patients who didn’t ask questions.

As a patient you have a right to know what brand and type of implant is being used and why the surgeon believes it is the right implant for you.   Post surgery you also should request the clinical evidence this implant has been used.  All implants come with stickers which are placed on the operation report and the clinical notes in the patient file.  You should also receive a copy of these stickers and keep them in your medical notes at home.

Implants range in price.  Round smooth implants are the cheapest on the market at around $1,400 a pair, whereas anatomical, textured implants are $2,600-$3,100 a pair.  As you can see the choice of implant will significantly alter the price you should pay for your procedure.

At CAPS we use three different brands, choosing the implant which best fits the patient and their lifestyle.

• McGhan 410 (anatomical, textured $3,100)

• Mentor CPG (anatomical, textured $2,600 or Round, textured $1,950)

• Silimed Polyurethane (anatomical $1,900)

Round implants are the most commonly used implants in the world today. Most patients however come wanting a subtle enhancement of their breasts and not obvious or fake. They want the option of telling others they have had the procedure rather than letting the augmentation shout it for itself. The best option in this situation is a contoured “teardrop” or anatomical implant. It makes sense to use an implant that looks like a breast to create an enhanced breast shape. Anatomical implants will fill the upper pole of a breast in a bra but still not be excessive. Allergan anatomical implants are the most subtle, Mentor anatomicals are a bit more full in the upper pole and look a bit rounder, but not as round as round implants. High projecting round implants are rarely used at the CAPS Clinic as boulder shaped breasts aren’t our aesthetic. Another factor is that for any base diameter or projection a round implant will be heavier than a contoured implant and we are trying to find the lightest implant we can use because you have to carry it for a long time. 
When implants were first introduced they were round silicone implants with thin, runny gel inside a silicone envelope that was quite thin and permeable to the silicone gel filler. Silicone leaked out of these implants the way  petrol can leak out of a plastic bucket because they are both hydrocarbons. The body couldn’t deal with this leaking silicone gel by digesting it or taking it away so it walled it off with more and more scar tissue. This ensured the implant felt quite hard soon after implantation and in time this scar envelope even grew bone. Silicone could seep outside this shell and create inflammatory nodules (granulomas) throughout the breast, up into the armpit and even down the arm. These old style implants were withdrawn in the early 1990s and saline implants were used instead. Saline implants are a silicone shell with a valve through which the saline is inserted to inflate the implant. These implants looked and felt quite round and firm as water couldn’t be compressed. They could ripple and when they ruptured the breast would go flat. This was annoying as it needed another operation to fix it but it wasn’t harmful. The body absorbed the saline. They were not, however, leaking silicone and creating granulomas so were a much safer alternative. The capsular contracture rate was much lower – down from 70+% to about 5%.

There are now better silicone alternatives. Modern silicone implants have a much thicker gel (cohesive) that can be made into shapes and keeps the shape even after compression. This thicker gel is encased in a much thicker silicone shell which is laminated with 4 layers, one of which is a layer to stop silicone from leaking out. These modern implants are much tougher than the old silicone and saline implants and their capsular contracture rate is comparable to a saline implant. .

How Big?

The width of the implant is important.  Patients often come to us querying why their implant size is less than their friends.

If you are looking for a natural look then the footprint of the implant must ‘fit’ the width of your breast.  Women’s chest sizes vary, the average women has a breast width of 12cm but this can vary from 10.5 – 15 cm.  An ‘A cup’  woman with a chest width of 12cm might have a 325gram implant to take her to a ‘c cup’ but woman with a 13cm chest will need a 495gram.  Weight doesn’t matter, fit does!

The surgeon should measure this and offer an appropriate choice to patient.  There is nothing more unattractive than implants too wide for the chest wall and sitting up under your armpits!

The ability of breast implants to give cleavage outside a bra is really dependent on chest shape and the width of your sternum (breast bone).

Implants can’t go over the sternum, the skin here is too thin and there will be visible rippling.  A wide sternum means your breasts will always be some distance apart.  Some women also have breasts that face outwards, as the implants sit on the ribs, a sloping laterally chest wall means the breasts face out.A bra is needed to push the breasts together and create cleavage.

Breasts that face forwards with a narrow sternum will create a natural cleavage following augmentation

Most implants are placed under the muscle, sitting on the ribs and pushing the breast forward.

Placing the implant as deep as possible means a better longer term shape as implant placed above the muscle will gradually erode the subcutaneous fat and breast material, becoming more visible over time.  This can be especially prominent in the upper, inner edge of the implant where everyone can see it. This erosion does not occur when the implant is placed under the muscle.

Going under the muscle however, does involve cutting the lower border of the muscle which makes it smaller and the muscle weaker.  Generally this weakness is compensated by the remaining muscle but in elite atheletes and body builders it is better to place the implant on top of the muscle.

Many young women present wanting large implants but there are a number of things a patient should consider before choosing size.   First and foremost you should consider the future!  Having large implants now may sound great but will you still feel that way after you have ‘carried’ them around for a few years?

Dr Taylor performs over 80 Breast Reductions a year so he understands balance and the life altering issues women with bigger breasts have to deal with every day.

What about children? If you haven’t had them yet, chances are you will in the future.  How big will you be nine months into your pregnancy and how sore?  What about when your milk comes in and you begin to breast feed  Most women will increase 2-3 cup sizes when pregnant or breast feeding so now a “DD” becomes a “F” or “G cup”. What condition will your breast be in after you finish having your children?  What are the odds of you requiring revisional surgery to reshape the breasts back to their pre-baby state?

What about menopause, what will your breast do then? In some cases breast size can increase when a women goes through the ‘change’.

All these questions and more should be considered.  In our experience we have found creating a natural well suited shape will serve the patient well throughout this period of time.  A ‘C’ or ‘D cup’ provides a beautiful curve on the chest, allowing the breast to expand whilst breast feeding and significantly reduces the need for revisional surgery.

 

Risks

Breast Augmentation is touted as ‘simple surgery’ but in reality no surgery should be considered ‘simple’.  It is precisely that attitude that gets this industry in trouble.  Surgery is surgery and as such comes with risks which must be considered when contemplating breast augmentation.

The risks of this surgery are numerous, however they are often skimmed over in the interest of throughput and to take advantage of the patient’s ‘want’ attitude.  This is a mistake, patients must consider not just the short term but also the long term risks associated with surgery.  Risks specifically associated with Breast Augmentation include:

  • Capsular Contracture
  • Implant Rotation
  • Implant Rupture
  • Double Bubble
  • Loss of Nipple Sensation
  • Stretch Marks
The natural tendency of the human body is to ‘wall’ off foreign material with a capsule of fibrous scar tissue as part of the process of healing. If this scar is thick and contracts (which it does as it matures) the shape of the implant may be altered making it more spherical. The implant then feels hard and the breast no longer looks natural. This is much more noticeable in a thin person and furthermore, it may occur on one side only.

There is no way of predicting who will have a problem with capsular contracture, but modern methods of breast enhancement have reduced the incidence of this complication greatly. Severe capsular contracture may require another operation to remove the scar tissue and replace the implant.

Contoured implants need to be placed accurately during augmentation surgery and supported in the position for at least six weeks to prevent unusual shapes occuring. Adhesion of the implant is vital for this to occur. If implant rotation occurs, another operation may be required to reposition the implant and to ensure it stays in place. In some cases this may require the use of a polyurethane coated implant.  Certain breast types are more prone to rotating implants.  Dr Taylor will assess this at the consultation.

Dr Taylor reduces the risk of implant rotation by using drains in the initial procedure.  By removing the serum as it occurs, the process of implant adhesion is accelerated and the risk of rotation is minimsed.  Wearing a compression bra for the first six weeks post op is another way this risk is reduced.

The risk of rupture of modern implants is much lower than than it was 10 years ago.  It is, however, still a risk and there is a possibility a second operation may be required in the patient’s lifetime to replace the implant.  This is done on an ‘as needed’ basis.  Implants do not have to be replaced every 10 years.  Implants that look and feel odd or have changed shape need to be assessed by ultrasound and MRI.
This occurs when the implant descends below the breast into the upper abdomen.  Another operation is required to push the implants back up and frequently a polyurethane  implant is utilised as well.
Nipple sensation may be altered. Frequently there is an increase in erotic sensitivity, sometimes it is decreased.  It is can also be different from one side to the other.  Generally nipple sensation has returned to normal after 6 month.

Surgical Options

Many surgeons perform this type of surgery in a private hospital but there are some who will operate in their own private rooms.  Hospitals should be state and federally licensed to operate, they should also have accreditation with an external body such as ISO or ACHS.  Private rooms often do not have this form of license or accreditation and therefore may not be able to provide adequate support in the case of emergency.  So the questions you should be asking are:

  • Where is the surgery performed?
  • Does the hospital hold a State Licence and is it Accredited, or will your surgery take place in the your surgeon’s rooms?  (Consulting rooms often do not have appropriate equipment or adequate drugs to handle medical emergencies).
  • Will the surgery be performed under sedation or general anaesthetic?
  • Is there a qualified anaesthetist present or is the Surgeon managing your anaesthetic as well as your surgery?
  • Are there adequate staff present to handle an emergency (either medical or environmental)?
  • Will qualified nurses be taking care of you post operatively or will you be left unsupervised as you recover from your anaesthetic?

Answeringthese questions should reassure you both the surgeon and the facility can manage any unexpected situations and significantly reduce the risk of your surgery.

The world is moving towards to ‘shorter stay’ surgery but is this really what we want as patients?  Certainly some surgeries are minor, require simple anaesthetic and minimal recovery, these surgeries are well suited to a ‘day stay’ procedure.  However the issue faced by these facilities is the ‘what if’.

  • What if the patient does not recover well from surgery?
  • What if the patient is nauseous after surgery?
  • What if the patient cannot cope with the pain of the surgery?
  • What if something happens in theatre which may delay the recovery of the patient?

Surgery should only be performed as day case if the hospital has the ability to keep the patient overnight or transfer them to a private licensed hospital.  The patient should be made aware of any costs incurred if this is required.

Some surgeons prefer to perform this surgery as a day case, at CAPS we believe in providing an overnight stay.  We want our patients to take their time to rest and recover.  It also provides us an opportunity to ensure their pain relief and post op nausea (if present) is well controlled before being discharged to the care of their family or friends. 

Dr Taylor uses drains postoperatively.  The use of the drains provides a number of benefits to the patient.

Following surgery, fluid builds up around the implant, drains remove this fluid and therefore the swelling and stretching is reduced as is the pain associated with this.  The fluid can hinder the attachment of the implant to the breast and therefore the risk of rotation is lower and finally the drains provide Dr Taylor with a clear picture of what is happening inside – if there is a problem it can be seen in the drain and acted on immediately rather than when you are at home and not sure what to do.

In the excitement of the surgery patients often overlook the importance of preparing for it.  What  patients do in the lead up to surgery and knowing how to plan appropriately for your recovery can make the difference between an anxious process or a more relaxed one.

Because we were frequently approached by patients who wanted to know what they could do in preparation for the surgery we put together a “pre-surgery program”.  Now seven years later we know the value of this program and offer it to our patients as part of the service we provide.

If your surgeons doesn’t offer this then you can do it yourself.  We use a multivitamin to ‘detox’ the body which aids recovery getting patients back on their feet faster.  We also use a herbal medication to reduce the bruising and swelling associated with the surgery, again we have found this to be highly effective.

Knowing what to expect is vital to the planning of your recovery.  Understanding what you can and cannot do will ensure you are not put in a position where you put yourself or the success of your surgery at risk.  All this will depend on your personal situation.  How much time do you need off work? Do you need to drive?  Do you live alone?  Do you have a family that relies on you? Do you have small children? Do you have to lift children or heavy objects in your day to day life? Do you play sport? What is going on in your life for the first six weeks after surgery?

Again answering these questions will ensure you have planned appropriately for your surgery and your recovery.

Breast augmentation can be expensive but it is important to know what you are paying for.  Some surgeons will offer a ‘set fee’ others will break it down for you to choose what you want.  Basically there are five fees associated with the surgery;

  • Surgeons fee
  • Anaesthetic Fee
  • Cost of the Implant
  • Theatre Fee
  • Hospital Accommodation Fee

Your surgeons fee should include the fee for the surgeon to perform the surgery and all post operative care including any post operative complications or the management of any adverse event

Your Anesthetic fee should include the fee for the anaesthetist to administer anaesthetic (sedation or general anaesthetic).

Your implants – based on the choice made with both you and your surgeon

The theatre fee includes the cost of equipment, consumables, drugs, staff, insurance and overheads associated with performing the surgery.

The Hospital accommodation fee may either be a ‘day stay’ or an ‘overnight’ fee.  It will include the bed, staff, drugs, insurance, consumables and overheads required to recover a patient from an anaesthetic or surgical procedure.

You can expect to pay $9,600 for the Surgical, Anaesthetic, Theatre and Overnight Stay in a private, ensuited room in Sole’vita Surgery.  The final fee will be dependant on the choice of implant.

Living With Breast Implants

Dr Taylor recommends an overnight stay in hospital (see Day vs Overnight stay) one week off work and six weeks of light duties.  A medical certificate is provided to ensure patient recovery is not compromised.
No-one wants or expects complications from surgery but these can and do happen. All CAPS patients will recieve detailed post operative instructions and handbook on “Taking Care of Their Breasts” following surgery.

It is a well known fact breast augmentation is a cosmetic procedure and therefore does not attract a medicare or health fund rebate. However most patients are not aware if there is an issue post surgery then as a medical issue  these rebates can and do apply.  The moral to this story – if you are considering breast augmentation, do look into health insurance.  We recommend all our Breast Augmentation Patients invest in Health Insurance before the surgery takes place ( make sure you take out a policy that does includes Plastic and Reconstructive Surgery). 

With the operation behind you, you may be feeling sore and anxious about how you will cope over the next few weeks. The best thing you can do is REST. The body cannot heal and function at the same time – that is why you need to SLEEP.

Taking regular pain medication will ensure you remain comfortable – follow the instructions given to you at discharge – DON’T BE HERO – there are no prizes for not taking it.

Results may be compromised by complications, always contact us if you;

  • are unable to cease or slow bleeding of the wound after applying pressure to the area.
  • feel any heat or increasing pain developing in your wound.
  • notice excessive swelling and bruising accompanying pain and tenderness.

Rapid intervention will reduce the chance of a complication becoming a real issue.  Ensuring you have planned appropriately for your recovery will make an enormous difference.

Most importantly – Relax and ENJOY IT.  When else are you going to get the opportunity to catch up on the lastest DVD series or read that book getting dusty in the corner?

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Help Text

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner (eg. your GP).