What is a breast augmentation?
Breast augmentation is a procedure designed to produce larger shaped breasts. It involves the placement of breast implants—usually filled with cohesive silicone gel—behind the breast or chest wall muscles in order to achieve the desired result. Breast augmentation surgery is performed under general anaesthetic and is normally done as a day procedure.
These before-and-after photos are of patients that have had surgery performed by Dr Craig Layt. These patients have consented to the photos being shown. These are actual photos and have not been altered or digitally enhanced. Every patient is an individual and therefore final surgical results will vary from patient to patient.
Who is a candidate for breast implants?
Candidates for breast enlargement include women who desire larger breasts, and often women with a mild to moderate degree of breast ptosis and smaller breasts. Breast implants do not actually ‘lift’ breasts; however, by filling up the current breast envelope, we can often alter the shape to disguise the amount of ptosis affecting the breast. If the amount of ptosis is excessive, a mastopexy (breast lift) may be required. Breast augmentation can also assist women who have one breast that is noticeably smaller than the other (asymmetry). If you are looking to change your pre-pregnancy body, this procedure coupled with an abdominoplasty ( tummy tuck ) or liposuction.
What does the breast augmentation process involve?
Getting a good result is not about putting big implants in the breasts. It is a complex interplay of making smart decisions about what will get the best result in every individual patient and educating the patient as to what those decisions need to be and what result is possible. In the world of information overload we live in, it is sometimes hard to sort the facts from the fiction. That is why the initial consultation is often the most important part of the process. Every patient has a different body, different breasts, and different wishes and desires. Just as a dress that looks great on your friend may not suit you, so it is with breast augmentation. We have multiple consultations as required to educate you and make decisions with you about your breast augmentation. These consultations are aided by diagrams, PowerPoint presentations, and of course our VECTRA® 3D imaging systems, which are now available at our Gold Coast location, and soon at our Ballina location. Dr Layt travels the world educating colleagues at major meetings and has designed the education program for you at The Layt Clinic to mirror that experience.
Every patient is an individual and therefore final surgical results will vary from patient to patient.
What size do you want to be?
The final size after breast augmentation is a result of your breast tissue plus the implant. This means that placing the same implant size in two different people will give two different results. Implants can be the same size but one may be narrower and push out more or vice versa. Dr Layt likes to use the analogy of building a house. He will measure the width and height of your desired breast and decide on the best width and height of an implant to achieve that result. This will form the basement of your house. The volume of the breast then depends on projection (moderate, high, etc). So, the size of your house is determined by the basement and number of floors. Sometimes, because of the shape of your current breast and chest, it is better to have an implant that is wider that it is high or vice versa, in which case a shaped or teardrop implant may be more appropriate. Together we will be able to work out the best implant for you. Our VECTRA® 3D imaging system helps a lot with that process. Breast implants are not lifetime devices and will be required or desired to be replaced or removed during the lifetime of most patients.
Where do you want the breast implants placed?
Breast implants can be placed in front of or behind the chest wall muscle. Placing the breast implant behind the muscle tends to give a smoother line and less chance of feeling the edge of the implant, particularly at the top of the breast. There is also evidence that it reduces the incidence of hardening of the implant. It is particularly useful in women who have very little breast tissue. The most common positioning of the implant is where the top half of the implant is covered by the pectoralis major muscle and the lower half is in contact with the breast. This is called “dual plane.” Positioning the breast implant in front of the muscle may be advantageous in women who do a lot of chest exercises.
Where do you want the breast implant incisions placed?
Nowadays, most augmentation is performed using the IMF (inframammary fold) approach. Evidence has shown this gives the most predictable result with the lowest risk of complications. With modern planning techniques, the scar can usually be accurately placed in the new fold created during the augmentation and remains in that position in most cases, making it hard to see.
The periareolar (around the nipple) approach results in a semicircular scar around the areola; however, this technique has been shown to have a higher risk of infection and capsular contracture, so it is used less commonly nowadays.
Placing the implant through an axillary (armpit) incision results in a scar which is hidden in the armpit creases. This approach is only suitable in certain cases and, as it has a higher risk of infection, capsular contracture, and reoperation, it is rarely used these days.
What type of breast implants do you want?
There are numerous different types and brands of breast implants for augmentation. In the simple case, many of these implants will be suitable and give an excellent result. In other, more difficult cases, only one or two implant types will work. This is why it is important to choose a surgeon who has experience with different implant types and techniques to advise which implant and technique will be best. All silicone implants are filled with a “cohesive medical grade” silicone gel of varying thickness. The breast implant can be filled with either saline or silicone. Saline implants are rarely used in Australia as they do not feel as natural and tend to deflate. The implant shell can be either smooth or textured. Each has its own pros and cons. Textured has a documented lower capsular contracture rate and tends to result in a breast which stays more stable as the years go by.
The selection of the implant is a joint decision between the patient and Dr Layt. Dr Layt will discuss the pros and cons of the various implants, including the appropriateness of size, shape, placement, implant filling, and implant shell in relation to the individual patient.
What is the Internal Bra technique?
For many patients, Dr. Layt is able to perform what’s known as the internal bra technique. He has been utilising this technique for many years, and can implement it as part of his patients’ surgical plans, if needed. This innovative approach can be helpful in numerous types of breast surgery procedures, including breast augmentation, breast lift, revision breast augmentation, and breast reduction. While the name “internal bra” may cause one to think that it serves as a kind of long-term replacement for the use of a regular bra, it is actually not designed to accomplish that goal. Rather, this advanced technique is focused on giving the breasts improved internal support, which can enhance the results of breast enhancement.
In breast augmentation procedures, the internal bra technique essentially creates an internal “underwire” to further improve the stability and shape of the breasts. Using a special suturing approach, Dr. Layt will add sutures in precise areas inside the breast pockets and beneath the breasts that can reinforce the outer borders and add structural support. The internal bra technique essentially works to help the breast implants maintain an ideal position and produce natural-looking curves. Additionally, by enhancing the strength of the breast pockets, an internal bra can help reduce the risk of breast implants eventually developing a “bottomed-out” appearance.
What can you expect after the breast augmentation operation?
Rapid recovery from the surgery is possible with modern techniques involving careful planning, gentle surgical technique, post-operative exercises, and medications. It is important to stretch the chest muscles a little to stop spasms that may cause pain after surgery. This involves gentle chest exercises, which are demonstrated in the video toward the end of this page. Drains are almost never required. Your pain will be controlled by oral medications. You will have an appointment to see us 24-48 hours after the operation for review of dressings, medications, and exercises, and to check that your bra is the correct fit and to provide you with a second bra. If distance is a problem, we can often address this over Skype, FaceTime, or phone. You will also be seen approximately seven days post-surgery to change dressings and review your surgical progress. Light activities can be resumed as tolerated. Aerobic activities can be started in about three weeks. We are always available to help should concerns arise. We will arrange an appointment to see you for 3-month and 12-month reviews with Dr Layt.
How noticeable are breast augmentation scars?
The noticeability and extent of scarring after breast augmentation surgery will ultimately depend on the specific surgical technique utilised during the procedure. As noted in the section above regarding the placement of breast implant incisions, there are a few different techniques that can be performed; however, in most cases, the standard inframammary fold (IMF) approach is the one used here at The Layt Clinic. With this technique, there will be scar formation in the underside of the breast where the breast meets the chest. Fortunately, this places the scar in a rather inconspicuous area that is difficult for others to see. Additionally, it is important to note that Dr. Layt takes great care to minimise the appearance of residual scarring, and scars typically fade to a certain extent over time. We will also provide instructions for your recovery that include information on how to optimise scar healing after surgery.
How long do breast implants last?
Breast implants typically last approximately 10 years, and some patients have their implants for much longer periods. Many of today’s breast implants are designed with materials that are extraordinarily durable. With that in mind, breast implants are not impervious to “wear” over time, and if certain complications arise (such as an implant rupture), the implants will likely require removal or replacement. Breast implants are not lifetime devices. Every patient is different and their experiences are unique. While some implant ruptures or other complications may be immediately noticeable in some cases, they may not be visible in others. This is why it is vital for breast augmentation patients to attend regular breast screenings as recommended by their doctor and perform routine self-exams each month to look for any possible irregularities that have developed. When it’s time to have the implants removed or replaced with upgraded implant models, a revision breast augmentation procedure can accomplish those goals.
Can I breastfeed with breast implants?
In general, if a patient is naturally able to breastfeed prior to undergoing a breast augmentation procedure, she should retain that ability afterward as long as proper precautions are taken during surgery. This is why it is important to let our plastic surgeon know during the initial consultation of any plans you have for future breastfeeding so he can design the treatment plan accordingly. Please note that a rather significant percentage of women are not naturally able to breastfeed; however, if you do have the natural ability to nurse, Dr. Layt can craft the treatment plan with surgical techniques designed to avoid interference with areas responsible for milk production.
What are the potential risks and complications of breast augmentation?
Surgery is not an exact science. Incisions and scars are part of any surgery and the location and extent of the incisions will be discussed with you. Every effort is made by the surgeon to minimise scarring. Scars will fade over time, but they are permanent. They can also become hypertrophic or keloid. Scars vary from person to person and are related to each individual’s skin type, genetics and the ability of their skin to heal.
Every surgical procedure involves certain risks and complications (as per the ASPS brochure) including, but not limited to:
Asymmetry is evident physically in every person. No two sides of the body are ever exactly symmetrical in shape, position or size and the surgeon will make every effort to achieve as close to symmetry as possible but some asymmetry is normal.
Delayed Healing, Infection and Suture Reactions can all be possible healing issues and may require antibiotics or in some cases surgical exploration.
Bleeding, Haematoma or Seroma Collections may resolve themselves but, in some cases may require further surgery.
Loss of Sensation and Numbness may also be experienced. In most cases this will improve over time on its own. In some cases this can be permanent.
Bruising and Swelling may also be a short term effect from surgery and will usually settle in one to two weeks.
Allergies to dressings, medical lotions, sutures or other materials can occur with some patients. You will be advised to cease the use of the dressing, lotion or material that is causing the reaction. In some cases anti-inflammatory medication may be prescribed.
Breathing Difficulties may be due to a general anaesthetic or breathing tube during the operation which has caused some swelling, noisy breathing or discomfort.
Blood Clots can also occur in some surgeries and may require urgent treatment and hospitalisation.
Pain thresholds vary from patient to patient. This may lead to different pain management and/or different recovery times to resume normal activities.
Achieving excellent results with minimal risk is a joint effort. It is important to disclosed to the surgeon and clinic and understand the following:
Full disclosure of your medical history including: allergies, personal, physical and mental history, previous surgeries, current medications and co-morbidities (including but not limited to, smoking, vaping, diabetes, prescription and illegal drug addictions, blood or heart disease, obesity or anorexia).
Co-morbidities may impact on outcome and healing post surgery.
Smoking, vaping, or taking recreational drugs must be ceased in the 6 weeks prior to some operations and during the healing phase. Failure to do so may increase the risk of complications, decrease your healing ability and affect your surgical outcome.
You should not take aspirin based prescription drugs 14 days prior to surgery and during the healing phase of the operation unless advised otherwise by the surgeon.
As per the Australian Health Practitioner Regulation Agency (AHPRA), all non-rebatable (cosmetic) procedures require a validated screening of Body Dysmorphia to be undertaken.
If Dr Layt is concerned about your mental state or physical state prior to the procedure, he may request evaluation by a psychologist, psychiatrist, general practitioner or other specialist. This referral is to assess your suitability, increased risks during surgery or any underlying physical or psychological problems which may affect your recovery or mental health.
In some cases this may require surgery to be postponed or cancelled by the doctor in his primary role to consider your care and personal well-being.
Complications with Breast Implants
Pregnancy may cause breast enlargement, cause breast tissue to stretch and a degree of ‘drooping’ of the breast tissue. This may require the breast to be surgically lifted however some poor skin integrity may have a tendency to stretch and continue to ‘drop’.
Capsular Contracture (less than 1%) occurs when the scar surrounding the implant thickens and tightens around the implant. This can make it feel hard, look unnatural, feel uncomfortable and may occur months to years later. Should this occur, a capsulectomy and a remove and replacement of implant/s may be required in the future.
Implant Rupture can occur after injury or years of repetitive action in the same part of the implant. MRI is the gold standard to assess this as Ultrasound shows a false positive reporting for rupture in approximately 30% of cases. A ruptured or leaking implant will require surgery of removal and replacement of the implant.
Implant ‘Wrinkles’ and Palpability can also be noticed. All implants ripple to a degree. If there is reasonable tissue coverage this will not be noticeable. If there is little overlying breast tissue and fat this is more likely.
Anaplastic Large Cell Lymphoma (ALCL) is a rare tumour of lymphoid cells in the breast which has recently been found to have an increased incidence in patients with textured breast implants. ALCL relates to a patients genetics, a textured implant and bacteria being present. This may present as a unilateral swelling of a breast due to fluid accumulation. When detected early, this is treated by removing the fluid and the implant. Dr Layt has and continues to perform this procedure utilising the 14 point plan to minimise the risks of ALCL, capsular contracture and other complications relating to using an implant.
In summary, the risks of bleeding, haematomas, capsular contracture, ALCL, infection, asymmetry, scarring, seroma, pain, palpable implant, loss of cleavage, sensation, implant malposition, implant rupture/leakage and breast feeding are discussed through the ASPS and The Layt Clinic information on Breast Augmentation. Implants may be removed and replaced over time and they are not lifetime devices. Implants used are registered with the Therapeutic Goods of Australia (TGA) and patients will be sent Patient Information Leaflet (PIL) regarding the implants chosen.
All surgery carries risks and it is important to understand these.
Every patient is an individual and therefore final surgical results will vary from patient to patient. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified practitioner.
Any surgical procedure carries some risk of infection, severe bruising, or reaction to anaesthesia. In the case of breast augmentation, there is also the possibility of complications related to the breast implant, such as rupture, rippling, or capsular contracture. All of these potential risks will be discussed with you during your pre-surgical consultations and you will be given a comprehensive list of pre- and post-operative instructions. The ASPS information which you receive has a full list of complications from the more common through to the extremely rare. Following these instructions carefully will reduce the chances of complication, speed healing, and improve your chances of a successful surgery.
There have been recent news articles regarding textured breast implants being linked to the cancer known as Anaplastic Large-Cell Lymphoma (ALCL). For more information regarding this risk, please view our page discussing Anaplastic Large-Cell Lymphoma (ALCL), or contact us with any questions you may have.
How much does breast augmentation cost?
The cost of breast augmentation can differ, based on each patient’s unique needs. The surgeon’s fee and costs associated with use of the operating theatre and anaesthesia will be included in the total estimate, as well. It is very important to note that the price of breast augmentation is often significantly variable among patients due to the customised nature of this procedure. Factors such as the type of breast implants placed, whether additional treatments (such as a breast lift) are also part of the treatment plan, the fees associated with the surgeon, anaesthesia, and use of the surgical facility, and other associated expenses will all be taken into account. Once your customised treatment plan is developed during the initial breast augmentation consultation, we can put together a total cost estimate and present it to you for review so you will have a detailed quote from the outset. We will be happy to answer your questions about the convenient payment options available here at The Layt Clinic.
Specific Pre-Operative Instructions
WASHING: Wash the evening prior to surgery and the day of surgery, paying particular attention to the breast region. This decreases the bacterial count and should decrease the risks of infection. Do not shave or wax under your arms in the three days prior to your surgery. This is best done prior to this.
PRODUCTS: Do not apply moisturisers, make-up, perfume/deodorant, nail polish, or hair products after washing. Remove all jewelry.
CLOTHING: Wear loose, comfortable clothing and footwear. A shirt with a button or zipper opening is ideal for removal.
SMOKING: Smoking and vaping increases the risks of complications significantly and should be ceased 6 – 8 weeks prior to surgery.
FASTING: You should have nothing to eat or drink for 6 hours before your operation. If you are required to take medication during this time, please speak with us to check if this can be taken before the 6-hour fasting period or after your procedure.
MEDICATION: If you are having the operation as a day case, you will be given a script for antibiotics and pain relief tablets that you will need to purchase from the chemist and bring with you on the day of your procedure. Do not take these prior to surgery. The nursing staff will advise you and your carer after your procedure on how to administer them.
Certain over-the-counter products and prescription medicines can cause complications before and after surgery. They can reduce the ability of your blood to clot and could increase your tendency to bleed during and after surgery. Do not take any medication containing or related to aspirin 2 weeks prior to your procedure. This includes NSAIDS, anti-inflammatory medications, and blood thinning medications. Also avoid Vitamin E supplements and red wine. Stop all herbal medications before surgery. The most common herbs used are Echinacea, Ephedra, Garlic, Ginseng, Ginkogo, Kava, St John’s Wort, and Valerian. They may adversely affect anaesthetic drugs, prolong bleeding, and impair healing after surgery. If you are unsure, please check with your doctor regarding the medication and when to cease. *This is not an all inclusive list*.
ADMINISTRATION: Unfortunately, paperwork is a necessary evil. Each theatre complex has its own procedures. We have attempted to make it all easy by providing a simple series of steps to follow titled “THINGS TO DO FOR YOUR PROCEDURE” specific to the surgery centre you are attending. Please follow these instructions. If you have any queries about this or anything else don’t hesitate to contact us on (07) 5597 4100.
Specific Post-Operative Instructions
POSITION: During the first week, attempt to sleep on your back instead of your side. We want your implants to stay in a perfect position during the initial healing process. This is not a “life and death” issue, however. If you cannot sleep on your back, sleep in another comfortable position.
DRESSINGS & DRAINS: Drains are now rarely used for routine breast augmentation. Light ‘splash proof’ dressings are applied at the time of surgery. These should be left intact until your one-week visit. You will be fitted with a support bra, which you should wear day and night for two weeks after surgery. (You may, of course, remove it to shower and launder.) After two weeks, you may sleep without the bra. You should not go braless during the day for 4–6 weeks after surgery. Once the swelling has decreased you can buy new bras to fit your new size. This usually takes three months. It is recommended you not wear an underwire or push up bra for three months.
SHOWERING: You may shower, remembering that your dressings are splash proof rather than waterproof. If water gets underneath the dressing it is best to change it. If you prefer to bathe, do not allow the incision lines to soak for more than a few minutes in the bath water. It is fine to take off your bra while you bathe or shower.
SUTURES: All sutures are under your skin and self-dissolving. There is usually a tail from the suture that will be snipped at your post-op appointment.
SUNLIGHT: Scars take at least one year to fade completely. During this time, you must protect them from the sun. Even through a bathing suit, a good deal of sunlight can reach the skin and cause damage. Wear a sunscreen with a skin-protection factor (SPF) of at least 15 at all times when in the sunshine. Be extremely careful if areas of your breast skin have reduced sensitivity.
ACTIVITIES: You may take a gentle walk the day after your surgery. It is advised to try to get up and move about as soon as you feel you can. Do not return to aerobic exercise for 3 weeks. You may drive when driving does not cause you pain, if your vision, reflexes, and thought processes are not impaired, and you are confident in your driving ability. This usually occurs in 4–7 days if you have a car with power steering.
TAPE: At your one-week review we will check your wounds and retake with Fixomull, which you can leave on for 10 days to 2 weeks. You can shower over this and allow it to dry, or dry with a cool blow-dryer (avoid any hot air too close to the skin). Once you take this off you can use the Siltape® we have supplied in your post pack. We would advise using this for 3 months or more after your operation for optimal scar healing. Further supplies of Siltape® can be purchased from the practice or a chemist if required.
TED STOCKINGS: You may be required to wear TED stockings for compression to prevent DVT (blood clotting) post-operatively. If required, these will be fitted at the hospital on your admission day. The nursing staff will advise you on how long you will need to wear these.
MEDICATION: Take your pain relief and antibiotic medication as directed. Most routine medication can be restarted after your surgery unless it causes thinning of the blood. If you have any questions, please ask. Some medications or pain relief may also cause constipation, please keep hydrated and eat well to minimise this effect. Sometimes drinking pear or prune juice may also help with constipation.
It is important to stop your muscles from going into spasm. You would not have a gym workout without stretching at the end of your session. To aid in healing and your comfort we recommend you stretch your chest muscles. To do this, place your hands on the back of your head and push your elbows back. It is also good to retract or roll your shoulders back. You should try to do this hourly whilst awake. This will make your recovery much more rapid. Please refer to the video below.
To learn more about breast augmentation (enlargement), or if you have further questions about the cosmetic procedure and the types of breast implants you can choose from, contact our practice on the Gold Coast, Queensland today. Our team will also be happy to provide you with information on other breast surgery options, such as breast lift or breast reconstruction, as well as other procedures that can help you reach your cosmetic goals. We will be happy to answer any questions you have or schedule your consultation with Dr Craig Layt.