What is a breast augmentation?
Breast augmentation, is a procedure designed to produce larger and more shapely 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 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?
Candidates for breast enlargement include women who desire larger breasts and often women with a mild to moderate degree of breast sagging and smaller breasts. Breast implants do not actually ‘lift’ breasts but by filling up the current breast envelope we can often alter the shape to disguise the amount of sag of the breast. If the amount of sag is excessive then a mastopexy 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 restore your pre-pregnancy body, this procedure coupled with a tummy tuck or liposuction can help you feel better about the overall shape of your body and breasts – often called a ‘Mummy Makeover‘.
What does the process involve?
Getting a great result is not just about putting big implants in the breast. 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 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 looks great on your friend may not suit you, so it is with breast augmentation. To achieve this 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 and soon at our Ballina locations. 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 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.
Where do you want the implant 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 the implant is where the top half of the implant is covered by the pectorals 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 incision?
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 intros position in most cases, making it hard to see.
The periareolar (around the nipple) approach results in a semicircular scar around the areola but as it has been shown to have a higher risk of infection and capsular contracture 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 is rarely used these days.
What type of implant 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. Another more difficult cases only oneoptwo 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 can you expect after the 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 spasm which may cause pain after surgery. This involves gentle chest exercises which is demonstrated in the video below. 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 your bra is the correct fit and 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 three month and 12 month reviews with Dr Layt.
What are the potential risks?
Modern breast enlargement surgery is safe. There is, however, no such thing as risk-free surgery. The important thing is to understand any potential risks and take steps to minimise their occurrence.
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 has been recent new articles regarding textured breast implants being linked to the cancer known as Anaplastic Large-Cell Lymphoma (ALCL). For more information regarding this risk, please or you can read a statement from ASAPS and ASPS here.
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 moisturizers, 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 increases the risks of complications significantly and should be ceased 6 – 8 weeks prior to surgery.
PRODUCTS: Do not apply moisturisers, make-up, perfume or deodorant nail polish or hair products after washing. Remove all jewellery.
CLOTHING: Wear loose, comfortable clothing and footwear. A shirt with a button or zipper opening is ideal for easy removal and changing after your surgery.
SMOKING: Smoking 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 NSAID’S, 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 effect 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.d *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 your pain, 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 10days 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 need to wear these for.
MEDICATION: Take your pain relief and anti-biotic 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, 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.