Breast Augmentation
Professor Mark Ashton
MB., BS. MD. FRACS (Plas)
Specialist Plastic Surgeon
Professor Mark Ashton is a Melbourne-based plastic surgeon who specialises in breast augmentation procedures. He is chair of plastic and reconstructive surgery at Epworth Freemasons Hospital, and former head of plastic and reconstructive surgery at the Royal Melbourne Hospital (2001-2016) and Royal Women’s Hospital (2000 – 2016).
The following information is designed to help you understand our process, including assessment and suitability, and will emphasise essential information to consider before proceeding with breast augmentation surgery.
AHPRA registration number – MED0001135718
Breast Augmentation Melbourne
What is Breast Augmentation?
Breast Augmentation, or Breast Augmentation Mammoplasty, is a cosmetic surgical procedure that alters the appearance of breast size, shape and contour, as well as congenital breast asymmetry and syndromes via the placement of breast implants.
Breast implants can be placed sub-glandular, meaning directly under the breast tissue, or placed in a sub-muscular pocket, under the pectoralis muscle to various degrees. When people refer to breast implants placed ‘under’ or ‘over’, they are referring to the position of the implant to the pectoralis muscles.
The decision to undergo breast augmentation surgery is a very personal and private one, with every person having their individual reasons and goals.
Despite being one of the most common performed cosmetic surgeries worldwide, Breast Augmentation, like all surgical procedures, carries inherent risks. Therefore, it is crucial to prioritise seeking more than one consultation to ensure you are well informed regarding the various options available and have all your queries addressed, and you feel confident in your ability to provide informed consent prior to scheduling your surgery.
CONSULTATIONS
Our aim is to provide a comprehensive, informative and personalised patient experience. During the initial consultation process, you will have the opportunity to meet Prof Ashton, our dedicated nursing and administration staff, and our practice manager.
We encourage every patient to seek a second opinion with a qualified specialist plastic surgeon, before proceeding with any surgical procedures.
INITIAL CONSULTATION
Your initial consultation with Prof Ashton will require a valid referral from your general practitioner (GP), or other qualified healthcare provider. It is preferable that your referral is from your usual GP, as they will ensure all relevant medical history is included in your referral.
During your consultation, you and Prof Ashton will discuss your treatment objectives. With your written consent, clinical photos will likely be taken for medical purposes, and Mark will assess your medical history to ensure that all suitable and relevant treatment options are thoroughly discussed with you.
Our nursing staff and practice manager will also provide additional information regarding the procedure discussed, to ensure you are well-informed and you understand your choices. You will be afforded adequate opportunity to address any remaining questions prior to leaving our rooms, we are always happy to answer questions you may have.
SECOND CONSULTATION
If you decide to progress with your surgery, after having reviewed the information provided to you at your initial consultation, you will then be booked for a second consultation with Prof Ashton for further discussion. At your second appointment, you will also meet with one of our nurses again to discuss the necessary surgical documentation, including the initial preoperative and postoperative care instructions.
Whilst you may be enthusiastic to schedule your surgery as soon as possible following your second consultation, if your procedure is determined as purely cosmetic – thus not eligible for an item number, a mandatory 7-day cooling off period must be satisfied in accordance with the current AHPRA guidelines. Following this cooling off period, you will have the ability to secure a surgical date and pay the required deposit.
Call 8560 0590 to learn more about our breast augmentation procedures or to schedule a consultation with Professor Ashton.
Communication
Communication is one of the most important aspects of your Breast Augmentation consultation process and surgical planning. It allows you and your surgeon the ability to ensure your concerns and the related surgical and implant options have been adequately discussed.
The range of breast implants used in Breast Augmentation surgery has expanded significantly over the last ten years, where there are now a variety of brands, shapes, sizes, projection, implant content, and texture of the implant shell, giving you more options than ever before. Our bodies are all unique and no two people will have the same implant with the same results. There are several key factors that need to be considered, such as existing breast tissue and nipple positioning, and chest wall measurements and shape. These factors are critical in determining the most suitable implant for you.
The choice of implant for your surgery should be decided after extensive discussion with your surgeon, in which the benefits and disadvantages of each option is discussed to ensure the implant will be appropriate for you, your body proportions and surgical results.
Our bodies are all unique and no two people will have the same results. In our practice, we find most patients invariably have a pre-determined result in mind. Therefore, it is critical you are always afforded a platform to openly and clearly communicate with your plastic surgeon, to ensure they understand the results you are hoping to achieve, prior to your surgery.
We find one of the most effective tools to communicate your wishes is via images. We encourage you to bring screenshots or photos to your initial consultation to articulate this.
During your consultations, we will show you clinical photos of our patients’ breasts (patients who have provided written consent to disclose their clinical images), which resemble your body frame. We also utilise 3D computer imaging, so that Prof Ashton can digitally augment photos taken by our nursing staff, to show you what the different types, shapes and sizes of breast implants could look like on your frame. In addition, where suitable, we also utilise breast implant sizers placed inside a bra.
Types of Breast Implants (Devices)
There has been a radical change in the type of devices and breast implants used for breast augmentation surgery in recent years. In the late 1990’s and early 2000’s the most common type of breast implant used was a saline breast implant, this has now rapidly been replaced by a cohesive silicone gel breast implant.
The 3 main considerations when choosing a breast implant type are:
- Saline or Gel filled breast implant.
- Round or tear drop / anatomical shaped breast implant
- Micro-textured or smooth breast implant
i) Breast implant fill
Saline breast implants were used in the early part of this century as they avoided many of the issues associated with the original free-flowing silicone breast implants manufactured in the late 1980’s and 1990’s. They were not without their own issues however, and it was not infrequent for patients to complain of rippling, particularly at the medial portion of the cleavage. In thin patients, this was particularly difficult to correct, and subsequently saline breast implants were often regularly over-filled to avoid rippling, giving a more rounded appearance. A further concern was the tendency of saline breast implants feeling noticeably cold, particularly following swimming or during cold weather conditions.
On the other hand, the advantage of saline breast implants, was their ability to be inserted through a small incision, as they were often filled once placed inside the breast implant pocket. Saline implants are still at times used and can be similar to silicone gel implants in their outside shell, available in both textured and smooth coatings, as well as tear drop and round shapes.
In recent years, there has been a progressive development of the newer cohesive gel-filled breast implants. These breast implants avoid many of the issues associated with the original silicone gel breast implants, by offering a more stable silicone gel. This ensures the gel remains contained within the implant even if the breast implant capsule or shell ruptures. There continues to be progressive development in all types of cohesive gel breast implants with many manufacturers now on to their third or fourth model.
We currently find most patients choose a cohesive gel breast implant to avoid the issue of medial cleavage rippling. In addition, these implants are more resistant to the temperature changes seen in the saline filled breast implants. The newer implants are also soft to touch and difficult to detect once inserted behind your breast, providing a more natural feeling breast.
The disadvantage of cohesive gel breast implants over saline, is their insertion requires a slightly larger incision, around 3cm to 4.5cm, due to their pre-filled shape and volume.
ii) Breast Implant Shapes:
Breast implants broadly fall into two distinct shapes: Round and Anatomical (teardrop).
Round breast implants are considered the classic, traditional shape of breast implant, and may create greater upper pole fullness. Placing anatomical shaped implants requires a more precise breast implant pocket formation, and as such, many practitioners still tend to prefer a round implant. Round-shaped breast implants are still considered the most prevalent implant type showcased on the internet, in magazines, and on social media. These implants are available with either a smooth or textured coating on their shell.
In the late 1990’s, two American Plastic Surgeons, Patrick Maxwell and John Tebbetts, developed an anatomical breast implant, primarily for use in breast reconstruction. Diverging from the round implants, these implants featured a teardrop shape with a bevelled upper portion, designed to closely replicate the natural contour of a breast following mastectomy. With increasing use in breast reconstruction, these implants are now widely used for breast augmentation procedures as well. They are particularly suited to patients who have very little breast tissue, allowing the breast implant to represent the entire breast mound, or for patients choosing to have a more natural looking breast shape with minimal upper pole fullness.
Contrary to common misconceptions, when precise surgical techniques are employed and the breast implant pocket is accurately dissected to match the shape and size of the anatomical implant, these implants generally exhibit minimal rotation under normal circumstances.
To ensure the stability and prevent rotation or movement of anatomical (teardrop) breast implants due to their distinct shape, they are exclusively offered with a slightly textured (nano-textured) shell. This slightly roughened surface facilitates adherence to the surrounding breast tissue or muscle, to assist in preventing potential movement.
iii) Textured breast implants versus smooth breast implants:
As mentioned, breast implants are available in either a textured or smooth finish. It is thought that a textured finish may be associated with a lower incidence of capsular contracture, however, this has not been conclusively proven. There is still debate over the advantages and disadvantages of the texture types, and as mentioned previously, all anatomically shaped breast implants are somewhat textured.
Breast Implant Placement Position
surgftoPosition of the breast implant in relation to the underlying pectoralis major muscle:
Underneath your breast is a large fan-shaped muscle called the pectoralis major. This muscle extends from your shoulder down over the chest wall to attach in the middle part of the chest wall near the sternum. In patients for whom there is minimal breast tissue overlying this upper chest wall, the implant can be placed behind the muscle to provide extra tissue layers over the implant, providing a more natural breast appearance. The general guide is usually referenced to approximately 2cm of tissue, that is, if you have less than 2cm of soft breast tissue in the upper pole or portion of your breasts, you may prefer to have your implant placed behind the muscle to avoid a visible ridge at the upper edge of the breast implant.
In many cases, we find that patients choosing a round breast implant can still benefit from having their implants placed behind the muscle, even if they have thicker breast tissue (more than 2cm). This approach may help to avoid the appearance of a visible ridge along the upper edge of the breast implant.
The placement of breast implants behind the muscle is a slightly more complex procedure and may carry a higher incidence of bleeding. Moreover, it tends to be more uncomfortable in the early postoperative period compared to implants placed on top of the muscle or sub glandular. This discomfort is particularly evident during activities involving arm movements that engage the pectoralis muscles, such as raising your hands above your head whilst dressing yourself, brushing your hair, or hanging out clothes.
In cases where there is minor breast ptosis or ‘sagging’, it may be possible to address this by placing the implant directly behind the breast. This approach may help to avoid breast lift surgery, and the associated additional scarring.
According to recent literature, breast implants positioned behind the muscle are reported to exhibit lower occurrences of capsular contracture. This observation could, however, be attributed to the fact that implants behind the muscle are better concealed by the muscle itself, making it more challenging to detect any external signs of capsular contracture, if it were to occur.
Incisions
There are three main types of incisions used to insert breast implants.
Of these, the inframammary fold incision is by far the most common, and is the incision used in almost all revision surgery. This incision allows direct visualisation of the breast tissue and allows for adjustment of the inframammary fold. In our practice, we place this incision on the underside of the breast, in the skin crease at the junction of where your breast meets your chest wall. The incision is 3cm to 4.5cm in length.
Alternative incisions such as the axillary or peri-areolar incisions, were once popular choices; however, they are now less frequently employed due to their higher risks of bacterial contamination and infection.
Breast Asymmetry
Whilst your plastic surgeon will endeavour to dissect both breasts in an identical manner, there will always be small discrepancies between your left and right breasts. This is further complicated by the fact that most women’s breasts have a pre-existing degree of asymmetry, which may or may not be accentuated by the placement of a breast implant. From our experience, breast asymmetry is more likely to be noticeable in patients who are very thin, where any irregularity in the underlying pocket dissection is more likely to be seen. Some surgical techniques, such as the use of an axillary approach, are also associated with a far higher incidence of breast asymmetry.
Things you must know before considering Breast Augmentation surgery
It is important to understand the risks involved with any surgery. The choice to undergo any surgical procedure, elective or urgent, should be based on the comparison of the potential risks to the potential benefits. Although most patients do not experience severe surgical complications, you must always discuss the risks versus the benefits with your surgeon, to ensure you understand all the possible consequences of your planned surgery.
There are risks associated with any surgery, and Breast Augmentation is not immune to these risks. Some of these are common to all forms of plastic surgery, and others are specific to breast augmentation procedures. If any complications arise, it may be necessary to bring you back to theatre to address and resolve these concerns.
It is important to remember that breast implants are not lifetime devices, and host a range of risks, some of which require further breast surgery.
Two particularly important potential complications relating to Breast Augmentation are:
Capsular contracture
Capsular contracture is the complication that causes the most distress to patients and plastic surgeons. A layer of scar tissue known as a capsule, invariably forms around all breast implants. In most cases this scar tissue remains soft and pliable and has little effect on the shape of the breast. In a percentage of patients however, around 5 % to 9% between 5 to 10 years after implant placement (1), this scar tissue undergoes progressive thickening and shrinking. This is called capsular contracture. In most cases this change is subtle, but in severe cases, the implant may compress to such an extent that the implant becomes particularly hard and takes on a ball like shape. It is important to acknowledge that no trial has been able to show any significant difference between breast implant shape, surface or location to date. It is possible to reoperate and remove this thickened scar tissue, via either capsulectomy or capsulotomy, but there is no guarantee the contracture will not recur.
1. Breast implants: A guide for general practice. Kaderbhai, A, et al. 2021, AJGP.
Infection
Infection occurs after breast augmentation in up to 5% of patients (1). The risk of infection does not appear to be related to the type of breast implant, its location, or the incision used, and can occur despite using antibiotics in the post operative period. It appears to be more common in patients who continue to smoke post operatively, or who have comorbidities such as diabetes. With early and aggressive antibiotic therapy, it may be possible to salvage the implant, however, in severe cases the implant may need to be removed and replaced at a later date. There are other specific risks associated with surgery that you should always discuss with your surgeon prior to consenting to any surgery.
1. Breast implants: A guide for general practice. Kaderbhai, A, et al. 2021, AJGP
FURTHER RISKS
Breast tissue: Pain, infection and swelling, bleeding (haematoma), change in nipple or areola sensitivity, scarring and healing issues, fluid collection (seroma), chronic pain.
Implant: Infection, device rupture and implant content leaking, rippling, mobility or malposition of the implant, breast implant associated anaplastic large cell lymphoma (BIA-ALCL).
Some women report systemic symptoms of joint pain, fatigue and brain fog after breast augmentation, this is labelled as ‘breast implant illness’, for which further research is required to define cause and outcomes.
General Anaesthesia: General anaesthesia is commonly used; however, there is an array of potential complications which can occur during or after general anaesthesia. These complications can be as major as death or brain damage, or as minor as muscle soreness or pain at the site of your cannula. The most common complications are nausea, vomiting and sore throat, and all specialist anaesthetists are trained to avoid and manage complications as they arise.
One of our anaesthetists will be in contact with you in the week prior to your surgery to confirm your health status, and answer any questions you may have regarding the anaesthetic and post operative pain management.
Smoking: As cigarette smoke constricts the small blood vessels within the tissue, smokers have a higher incidence of wound healing problems. In particular, smokers are much more likely to develop wound breakdown and infection. For this reason, it is critical to stop smoking 2 weeks prior to surgery and for 6 weeks postoperatively.
Deep Venous Thrombosis and Pulmonary Embolism: During surgery, there is a risk that blood may accumulate in the veins of the lower legs. Post-surgery, these clots can dislodge from the vein walls of the calves and travel to the lungs, resulting in a pulmonary embolism causing problems with breathing or even death.
Please be aware this is not an exhaustive list of potential risks. Every patient responds differently to general anaesthesia and surgery. Please ensure you always discuss the surgical risks with your surgeon prior to moving forward with any surgery.
Common questions about Breast Augmentation Surgery
What about Breast Cancer ?
Your risk of developing breast cancer is unaltered by your breast implants.
If you do find a breast lump any investigations require specialist imaging and often cannot be done via a routine mammography. You may require ultrasound or MRI to thoroughly investigate a lump in your breast.
Use of bras in the postoperative period:
This is a controversial topic, and there is no right or wrong answer as to whether you should wear a bra in the early postoperative period. Some plastic surgeons prefer their patients don’t wear bras at all, whereas other plastic surgeons will advise their patients to wear a bra for the first 3 to 4 weeks continuously i.e., 24 hours a day.
To maintain the optimal position of the implant, it is recommended that patients avoid wearing push-up bras or bras that may displace the implant during the early postoperative period. This precaution is especially important for those with anatomically shaped implants, as the implant’s orientation can be altered before its surface integrates with the surrounding breast tissues.
In our practice, our patients are not required to wear a bra during the initial 2 to 3 weeks following their procedure. This is attributed to Prof Ashton’s technique, which involves creating a pocket cavity that precisely matches the size of the breast implant to be inserted.
Postoperative return to exercise guide:
- 0 – 2 weeks NO EXERCISE, strict rest
- 2 weeks Gentle walking
- 4 weeks Isolated lower body exercise and stationary bike
- 6 weeks Gentle Jogging
- 12 weeks Upper body gym, Pilates, Yoga and running
NO SWIMMING FOR 6 WEEKS POST OPERATIVELY
Postoperative recovery:
In most instances, patients can typically resume work 1 to 2 weeks after undergoing breast augmentation surgery if their work is not excessively physical. However, for utmost caution, we advise planning 2 weeks off work, and ensuring you have organised support at home.
You should be able to return to normal activities in that 2-week period, however, some activities will be a little more uncomfortable than others. These activities are those during which you raise your hands above your head – such as drying your hair, hanging out the washing, closing the boot of your car, putting on a T-shirt, reaching forward to access food from the back of the freezer and so forth.
You do not need to avoid these activities if they are approached with caution and performed slowly to ensure no adverse effects to your breasts. However, excessive activity can lead to increased inflammation and pain.
Remember: You have had surgery. Your body needs you to rest in order to heal.
If I decide to proceed, what can I expect when I undergo breast augmentation surgery?
Hospital and Admission
We perform all our breast surgeries at Epworth Freemasons Private Hospital in East Melbourne, including breast reconstruction after breast cancer, breast reconstruction for congenital abnormality, breast augmentation, breast reduction, breast mastopexy, and revisional breast augmentation surgery.
Each of our patients have a private room with an ensuite. At Epworth Freemasons there are 12 state-of-the-art operating theatres with the latest anaesthetic machines and theatre equipment. There is also 24 hour onsite medical emergency care with an onsite Intensive Care Unit.
You will need to fast prior to your surgery, usually from midnight the night prior. Your admission paperwork will be provided to you 3 to 4 weeks prior to your operation so that any questions you may have can be answered well before your admission.
Surgical Procedure
Our breast augmentation surgeries typically have a duration of up to 60 minutes. The procedures are only performed by Professor Ashton, a qualified specialist plastic surgeon, and are carried out under general anaesthesia by one of our accredited specialist anaesthetists.
In addition to your general anaesthetic, your breast tissue is infiltrated with local anaesthetic, which aids in minimising blood loss, All surgical incisions are sutured using a dissolving Monocryl suture to avoid the need for removal of sutures in the postoperative period. Dressings will be applied to your surgical incision sites; they must remain dry and in-place until we see you in the rooms for your postoperative review. This means no showering immediately after your operation.
Postoperative Care
Following breast augmentation surgery, you will spend time in the Post Anaesthetic Recovery Unit until you are wide awake and feeling comfortable, at which time you will be transferred to your room for the night.
You will be reviewed by Prof Ashton prior to being discharged from hospital, and the nursing staff will ensure your dressings are intact, and your discharge medications, usually antibiotics and pain medications, are ready for you.
You will be provided an information bag to take home which contains our afterhours details, as well as the dates and times for your follow up appointments with our nursing team and Prof Ashton. During your post-operative period, we will monitor your recovery and progress. We will also provide precise guidance on the level of activity or exercise you should engage with during your recovery. In addition, we will address any potential concerns you or we may have, to ensure a successful recovery.
Recognising each patient’s healing process is unique, our post-surgical care is tailored to accommodate individual needs. You will have continuous access to Prof Ashton and our dedicated team throughout your recovery journey.
Further Surgery / Revisional Surgery / What about if I had previous surgery somewhere else
Although every effort is made to achieve the planned and desired surgical outcome during the initial procedure, there may be circumstances where you and your plastic surgeon determine that revisional surgery is necessary.
During the early postoperative period, it is possible that certain discrepancies may become apparent, such as one side experiencing more swelling or fluid collection compared to the other. Additionally, pre-existing differences between your left and right breasts, such as nipple position, might become more noticeable following implant placement.
Prior to your surgery, it is crucial you are afforded the opportunity to discuss and assess these factors with your plastic surgeon. This ensures you understand the potential scenarios and what arrangements your plastic surgeon has in place, should revisional surgery be required. It is important to confirm with your surgeon who is responsible for the cost of potential revisional surgery, including any additional fees such as anaesthesia, theatre and hospital related costs.
BREAST AUGMENTATION FAQ
Should I choose over or under the muscle?
This is a personalised decision that should be thoroughly discussed with your plastic surgeon, taking into consideration your desired results, as well as your existing breast tissue and skin.
We find our patients elect for under the muscle implant placement when they have a slim physique or choose to have a more natural augmentation result. On the other hand, those who choose for their implant placement to be placed over the muscle, often seek fullness in the upper pole of the breasts and a more obvious rounded cleavage.
The choice is yours to make, and you should never feel pressure to choose one way over the other.
I want a natural look, should I use a tear drop implant?
In our experience, a natural or subtle result is typically achieved by placing the implant under the muscle. A tear drop implant offers a subtle upper pole and softer cleavage, whereas a round implant will provide greater upper pole volume.
A natural result is, however, possible with both round and tear drop implants, and we recommend talking to your surgeon about the options and methods available to you.
How much time should I take off work?
We recommend you take a minimum of two weeks off work and that you have support organised at home during this initial healing process. You will require assistance with driving and, if applicable, caring for children during this 2-week period.
Do I need to stay overnight?
While straightforward Breast Augmentations can be performed as a day procedure, we generally prefer to keep our patients in hospital for one night. This allows us to continue IV antibiotics, provide pain management, address any anaesthesia-related nausea, and closely monitor you for any signs of potential complications prior to you going home.
How long do the implants last?
The implant manufacturers offer a lifetime guarantee; however, research suggests they have an estimated lifespan of 10 to 15 years. To ensure the ongoing health of your implants, we recommend an ultrasound or MRI every 5 to 10 years to assess for any potential complications. If these scans confirm favourable results, there is no need to replace the implants.
How much does it cost?
The fees for your breast augmentation depend on several factors.
The first being how complex your augmentation is likely to be. If you have experienced significant weight loss or have breastfed, there may be some loss of breast structure, which could indicate the potential benefits of combining a breast lift (mastopexy) with the breast augmentation.
In such cases, the surgery will be slightly more complicated and time-consuming, and any related costs are reflected in the fee for extended theatre time and anaesthesia.
Your surgeon should always tailor your surgical plan and the associated fees to align with your desired outcome and clinical needs.
Please contact our rooms at info@ashtonplasticsurgery.com.au if you have any questions regarding fees and consultations.
Interested In Breast Augmentation?
