Breast Surgery Q&A time – Dr Dona answers all your questions

Breasts |  Dr Eddy Dona

Tue 21st Sep 2021

Breast augmentation, mammoplasty or the colloquial ‘boob job’, is the most sought-after cosmetic procedure in Australia and one of the most common procedures worldwide. If you are thinking about joining the 20,000 Australian women undergoing breast augmentation annually, you probably have many burning questions. Here are answers to the most common questions about the procedure.
If you are considering having breast augmentation surgery and would like more information, the best way to have all your questions answered is to book a consultation with Dr Dona. Please call us on 1300 373 662 or email us at [email protected] We would love to speak with you about the breast augmentation procedure.

Breast Augmentation Frequently Asked Questions

How-Much-Does-a-Breast-Augmentation-Cost?

Our standard fee for breast augmentation is $11,00. This all-inclusive price covers the plastic surgeon’s fee, the anaesthetist’s fee, all hospital and theatre fees, the cost of your implants and 12 months of postoperative care. Additional costs may apply depending on the complexity of the procedure, but $11,000 is our standard fee.

Is the Cost of Breast Augmentation Covered by Medicare or Insurance?

Medicare does not cover elective surgical procedures completed purely for cosmetic purposes. Breast augmentation is primarily a cosmetic procedure, but it may be medically necessary, and in such cases, you may be eligible for a Medicare rebate. If your breasts are causing chronic discomfort or distress, you may be eligible for a rebate. The best option is to speak with your general practitioner and get a referral for a plastic surgery consultation. Without a referral, a claim cannot be made even if you are eligible.
Whether your private health insurance covers breast augmentation largely depends on your policy. If you have private health insurance with hospital cover, you may be eligible to have the hospital and anaesthetic components subsidised. Please clarify with your health insurance fund what will be covered before you book the surgery.

What Is the Difference between Saline & Silicone Breast Implants?

Silicone implants are silicone pockets filled with a thick silicone gel that mimics the look and feel of breast tissue. Saline implants have silicone shells filled with a sterilised saltwater solution. Saline implants are more likely to show rippling and may cause slight sloshing when you move. We use silicone implants almost exclusively because they look and feel more like natural breasts. Depending on which factors are most important to you, we may sometimes recommend saline implants.

Should I Choose Teardrop or Round Implants?

Round implants are a compressed circular sphere of either saline or silicone. Teardrop implants, also known as anatomical implants, are shaped to imitate the asymmetric appearance of natural breasts. The implant is thinner at the top and gently slopes down into a fuller, more rounded base; hence, the teardrop shape. There is a common misconception that round implants always create round unnatural breasts and that teardrop implants always create natural-looking breasts. The truth is that both types of implants can look natural and beautiful, providing they are the correct size, shape and profile for the patient. The key to achieving the best results is to have a surgeon who understands the best choice based on your body type and desired results.

Do Implants Need To Be Changed Every 10 Years?

Many women mistakenly believe that breast implants must be replaced every 10 years. The truth is, there is no expiry date on implants! Although the average life span of a breast implant is typically 10–15 years, breast implants only need to be replaced if you have an issue such as implant rupture or capsular contracture or your aesthetic preference has changed. Unfortunately, your body changes over time and breasts are no exception. Weight fluctuations, pregnancy, breastfeeding and natural aging are likely to affect the appearance of your breasts and replacing implants may correct these changes in appearance.

Which Breast Implant Pocket Is Best?

The implant pocket refers to the placement of an implant in comparison to the pectoralis muscle. The pectoralis muscle is the chest muscle that covers the collar bone, outlines the breastbone border and stretches along the ribs near the lower breasts. A breast implant can be placed in three primary pockets. Placing the implant above the pectoralis muscle and underneath the breast mound is called a subglandular or prepectoral placement. Placing the implant underneath the muscle is considered a submuscular or subpectoral placement, which can be further distinguished by placement entirely under the muscle (totally submuscular) or partially under the muscle (dual plane). There are advantages and disadvantages of each pocket location, and after making an assessment, your surgeon will recommend a pocket placement that considers your individual anatomy, lifestyle preferences and desired look.

How Long Does It Take To Recover from Breast Augmentation Surgery?

Although the breast augmentation procedure may only take a couple of hours and be done without an overnight stay, recovery will take up to six weeks. It is important to understand that recovery can take time and is different for everyone, but here is what you can expect. After the procedure, you will be sent home with a waterproof dressing, surgical bra, pain medication and antibiotics. Typically, the first week is the most uncomfortable, and you will likely experience some swelling and bruising. After a week, you will return to us for review, when we will change your dressings and check your wounds. Then, with your surgeon’s approval, you may gradually ease into daily activities, such as walking and light office work. The discomfort should be reduced at this point, but labour-intensive jobs and any strenuous physical activity, such as going to the gym, should be avoided. You will see us again at six weeks for another review; this time, we will take your dressings off permanently and discuss scar management. Most of your swelling should be gone at six weeks, and you can engage in most activities with caution. Complete healing can take up to six months; your breast will have settled and softened by then. For the first 12 months, your surgeon will examine you at each milestone, examining the incision, breast fold and scar tissue and ensuring that they are healing correctly. The six-month appointment is when you will have the opportunity to discuss the results of the procedure.

Can You Breastfeed with Implants?

Most women can breastfeed with implants. Whether the implants go under or over the muscle during breast augmentation surgery, they do not interfere with the breast ducts or mammary glands from which milk is excreted. Hence, breast augmentation does not affect your milk quality or ability to breastfeed.

Can You Breastfeed after a Breast Lift or Reduction?

Although it is possible to breastfeed after a breast lift or reduction, your ability to produce milk may be compromised. A breast reduction is more invasive than a breast lift as it removes significant amounts of glandular tissue. Many breast lift and breast reduction surgery patients can breastfeed without any issues, but there is an increased risk from these surgeries that breastfeeding may be affected.

Will Having Children Ruin My Breast Implants?

Pregnancy and breastfeeding will not affect the integrity of the implants; however, pregnancy and breastfeeding may affect the breasts’ appearance. Your breasts will continue to change throughout your pregnancy, thanks to surging hormones such as estrogen and progesterone. The breasts swell in preparation for milk production and continue to remain engorged throughout breastfeeding. When the nursing period ends, the breasts typically shrink to their near-original size. The breasts may then appear to be deflated, stretched and sagging. The skin may also have lost elasticity, and it may struggle to contract completely around your smaller breasts. In this situation, you may wish to have further surgery. However, in some women, there may be little to no difference in breast appearance. Because pregnancy does not affect the integrity of the implants, you can focus on having a safe and healthy pregnancy before correcting the potential aesthetic issues that may arise. Just be prepared for the possibility of corrective surgery to restore your breasts’ appearance.

Will I Lose Nipple Sensation If I Have a Breast Augmentation?

Changes in nipple sensation are very common after breast augmentation surgery, including under or overly sensitive nipples. The good news is that neural pathways can heal and re-establish themselves, meaning normal nipple sensation should fully return in most patients. This process can take a couple of months to a year to complete. Unfortunately, in approximately 10 per cent of patients, nipple sensation may be permanently lost. It can be difficult to predict which women will have lasting sensation loss after a breast augmentation, so it is important to be aware of the risk.

Do Breast Implants Cause Cancer?

Breast implants do not cause breast cancer. Studies have found no difference in breast cancer severity, aggression or survival rates between women with and without implants. Implants do not affect the ability to detect changes in your breasts, and breast cancer can still be detected early in women with breast implants. While breast implants do not cause breast cancer, a possible association between women with breast implants and anaplastic large-cell lymphoma (ALCL) has been found. ALCL is a type of non-Hodgkin’s lymphoma that is a cancer of the scar tissue capsule. It is very rare and associated with textured, not smooth, implants. Approximately 1 in 86 thousand women are diagnosed with ALCL depending on the type of implants, and the cancer can be treated effectively if it is detected early. We advise patients to continue with monthly breast self-examinations and annual mammograms, just as they did before receiving implants. Look for lumps, distortions or swelling in the breasts and armpits that warrant further investigation. If you find a change in your breast, see your doctor without delay.

Can You Have a Mammogram with Breast Implants?

Yes, most women with implants can and should have regular mammogram screenings. Mammograms may be less effective for some women with implants because the implant can obscure some of the breast tissue. However, studies suggest that mammograms are still very effective in screening for breast cancer in women with breast implants. We advise you to find a clinic where the radiologists are experienced in performing mammograms on women with implants and interpreting the results; tell the staff that you have implants.

What Bra Should I Wear after Breast Augmentation?

After surgery, you will be given a surgical compression bra that is not underwired. Although these bras are not attractive or appealing, they are essential for avoiding infection and allowing your breasts to heal post-operation. They are designed to support your breasts comfortably while assisting with swelling, inflammation and healing. You will wear the surgical bras day and night for the first six weeks. After six weeks, you will no longer need to wear the bra at night-time; however, you can continue to wear it overnight if you find it more comfortable. You may also go and buy some new bras. A very supportive sports bra that minimises breast movement is recommended for the first couple of months.

Can I Go Bra-Less after a Breast Augmentation?

Generally speaking, you should not be bra-less for at least six weeks after breast augmentation—potentially longer, depending on your surgeon’s recommendation. Your breasts need to be thoroughly supported to ensure optimal healing and results. After six weeks, you may occasionally go bra-less for special occasions, but do not make this a habit.

Will Breast Implants Affect My Areola Size?

In most patients, the areolas do not dramatically enlarge after breast augmentation. They may stretch slightly because of the larger volume of the breasts, but it is uncommon for them to become substantially bigger. Often, the areolas appear much smaller relative to the larger breasts. Many women want their breasts enlarged and their areolas reduced in the same surgery, but this combination is not advisable. During breast augmentation surgery, the breasts are under much tension. Making the areolas smaller is counterproductive because it becomes a tug of war between the thick breast skin and the weaker areola skin. Inevitably, the areolas naturally stretch back out. It is best to wait until after the breasts have softened and healed, which will be approximately six months after augmentation, and if you are still concerned about the areola size, we can surgically reduce their size.

Is a Scar-Less Breast Lift Possible?

Although the term ‘scar-less’ breast lift gives the impression that there will be no scarring, all invasive surgery guarantees some scarring. Scars may lessen in intensity and be strategically placed to minimise visibility or cleverly concealed. With a well-planned and well-performed breast augmentation, a significant lift can be created without causing scars on the breast mound. This procedure is generally referred to as a scar-less breast lift, although it is technically a breast augmentation where the scar is hidden in the breast instead of the mound. In more extreme cases of sagging, breast lift scars may be unavoidable without compromising results. A breast lift incision typically outlines the areola and traces down from the bottom of the areola to the crease below the breast. This scar naturally resembles a lollipop. In the beginning, the scars will be raised with a reddish-pink appearance. As they heal, the scars will eventually flatten and fade. The scars from a breast lift may not be as noticeable or as scary as you might think.

What If My Implant Pockets Stretch Too Big?

During implant surgery, your surgeon creates an appropriately sized pocket to hold the implant firmly, ensuring that the implant is secure. Sometimes, the implant moves around the pocket too much. There are two reasons movement may occur. First, an inexperienced surgeon might have created a pocket that is too large for the implant. More likely, however, there is a weakness and a lack of elasticity in the breast tissue. So, even though the pocket was an appropriate size at surgery, the implant continues to affect the envelope by stretching it out. Weakness and a lack of elasticity in the breast tissue can be caused by genetics, pregnancy, breastfeeding and weight fluctuation. Whatever the underlying cause, the implant pocket needs to be surgically corrected to make it smaller. Correction involves operating along the same scar, typically to suture and tighten up the pocket. If the cause of the problem was weak tissue, smaller implants, more supportive bras or implant removal may be advised.

Can Breast Implants Come Out of Their Pocket?

Breast implants can shift or become displaced from the desired and original position. Displacement can be caused by capsular contracture, healing and surgical issues, weight fluctuations and trauma to the breast. Larger implants are more likely to be displaced than smaller implants. The implants may migrate to your armpits (lateral displacement), towards the midline of your chest (symmastia) and downwards, which is referred to as ‘bottoming out’. Revision breast augmentation surgery may be needed to reposition the implant; surgery usually involves tightening up the pocket around the implant. Wearing an appropriate and supportive bra and attending all postoperative appointments can reduce the likelihood of implant displacement.

Can Breast Implants Burst?

Breast implants are very resilient and do not rupture easily. Although unlikely, implants can rupture due to intense physical trauma to the breast, intense compression during a mammogram, accidental perforation during a breast biopsy and other exceptional circumstances. Symptoms such as an abrupt loss in breast volume, ongoing breast ache or pain or misshapen and lumpy breasts may indicate a ruptured or collapsed implant. If your breast implant has ruptured, you will need corrective surgery to remove or replace the breast implant.

Do You Accept Interstate Patients?

Surgery is commonly performed on interstate patients. That being said, it is essential that you have access to your surgeon in the first couple of days of recovery. You can fly home two or three days after surgery, but it is important to maintain contact at regular intervals to ensure that you are hitting recovery milestones. Some, but not all reviews can be facilitated virtually.

Can Overweight Women Undergo Breast Augmentation?

If you are overweight but in good overall health, you absolutely can undergo breast augmentation surgery. Given that there is a much higher complication risk for overweight breast surgery patients, it is important that you discuss your suitability for surgery with your doctor and that you are aware of the potential risks. Nevertheless, if you have a fuller figure, it is possible to have breast augmentation surgery.

How Long Do I Have To Wait after Breast Augmentation To Have Another Surgery?

After breast augmentation, your breast tissue needs time to heal and adjust to the presence of a breast implant before you can fully appreciate the final results. At your six-month postoperative appointment, your surgeon will examine, discuss and critically review your results. Here, you will have the opportunity to approve or suggest further surgery, such as an areola adjustment or the insertion of bigger or smaller implants.

Can I Transfer Fat to My Breasts?

Fat transfer, commonly referred to as fat grafting, is an emerging technique that involves transferring fat from your troublesome areas via liposuction and injecting the fat into the breast. While I do offer fat transfer, I do not recommend it often. The issue is that fat grafting is less effective, more unpredictable and less reversible than breast implants. When fat cells are injected into a new location, they are not guaranteed to take. The body breaks down much the fat, and only a small percentage of fat cells receive enough blood supply to survive. It is difficult to predict the size and symmetry of the breasts after a fat transfer, so you may require several follow-up procedures to achieve the desired result. Although many surgeons feel that fat grafting provides the most natural-looking result, in successful procedures it typically increases the breast by only a single cup size.

What is Capsular Contracture & How Is It Treated?

Capsular contracture occurs when the scar tissue that normally forms around the implant becomes abnormally thick and tight, contracting around the implant. The scar tissue capsule is essential, as it holds the breast implant in place and prevents slippage, but if the scar tissue contracts too tightly, it can cause the breasts to become hard, distorted and even painful. When capsular contracture begins to present visible distortion or causes discomfort, corrective surgery to remove the capsule and replace the implant is necessary. You can minimise the risk of capsular contracture by wearing a supportive compression bra and ensuring your breast incision sites are clean. Having textured implants inserted can also help to avoid the implants moving.

What Is the Difference between Textured & Round Implants?

Textured implants have a rough surface, similar to sandpaper, that adheres to the breast tissue. The texture stabilises the implant in position and reduces the risk of capsular contracture. Anatomically shaped implants, also known as teardrop implants, are textured to avoid rotation and typically feel firmer than smooth implants. Round implants, however, can be textured or smooth. A smooth breast implant shell is thinner than a textured shell, which can make the breast feel softer and more natural.

Can You Be Allergic To Breast Implants?

Breast implants are made of silicone and sometimes filled with a sterilised saline solution. These are biocompatible materials that are suitable for living tissue and pose no risk of injury or rejection by the immune system. Silicones can be found in everyday items, such as antiperspirants, shaving creams, shampoos, cooking utensils, soaps, laundry detergents, fabric conditioners and contact lenses, so you have likely already been in contact with silicone. If you have experienced allergy symptoms post-surgery, it is more likely due to the medications or adhesives used during the surgery.

Is Breast Implant Illness Real?

Breast implant illness, commonly referred to as BII, is a term that some women and medical professionals use to refer to a wide variety of symptoms that appear to have developed after breast augmentation surgery. In some but not all cases, women who have had their breast implants removed have reported improved symptoms. BII is a very difficult topic as it is not currently recognised as an official medical diagnosis, and there is no scientific evidence proving an association between medical grade silicone breast implants and chronic illness. However, where does that leave women who are experiencing symptoms? The only treatment that surgeons can offer is to remove the implants, but there is no guarantee that the symptoms will disappear.