Specialist plastic surgeon Dr Eddy Dona has become one of the most in demand breast enhancement Plastic Surgeon in Australia. Over the years, he has continued to refine his technique and apply the latest advancements to ensure he is able to consistently achieve exceptional results for his patients. So why would you want Dr Dona to look after your breast enhancement needs? Thousands of happy patients and many doctors that have been personally trained by Dr Eddy Dona believe he is more than just a master surgical technician, Dr Dona is considered a surgical “artist”.
BREAST IMPLANT LIBRARY
Dr Dona has become a pioneer in providing detailed and easy to understand patient education videos and brochures. Along with his real surgery videos, this page contains the most complete library of information about breast implants. This includes custom video animations which covers vital information that you won’t find anywhere else. Please click on the links to take you to each subtopic.
These videos explain whats involved during your first consultation, your assessment, and how Dr Dona determines what results are realistically achievable for you.
Your first consultation with Dr Dona – what happens during that visit?
For all those who have booked, or are considering booking, a breast enhancement consultation at our clinic, this video lets you know what to expect when you arrive. So hopefully this will make your first visit a little more relaxing.
Understanding basic surgical concepts about breast augmentation surgery
There are multiple things a surgeon must assess and consider prior to any breast augmentation surgery. They are far too numerous to cover in just one video, however for simplicity sake. The three key things you need to understand about the surgery are the implant type and style, the incision or scar location, and the pocket or implant placement.
Implants can be silicone or saline, also can be different shapes, round or tear drop shaped, otherwise known as anatomical.
The surface of the implants can differ, they can be either textured or rough surface or smooth.
And the profile of the implant is very important, the profile refers to how far forward the implant projects, they can be either moderate profile, high or extra high otherwise known as full or extra full.
And the consistency of the silicone gel is something else you need to know about Silicone gel can either be firm or soft.
Incision or scar location is the second key thing you need to understand. Most surgeons, including myself place the incision within your lower breast fold, however some surgeons may place the incision along your lower areolar border, and others may place it in your armpit. There are pros and cons with each of these approaches, however like I said the lower breast fold incision is the most popular.
Pocket placement is the final thing you need to understand. Pocket placement refers to whereabouts the implant is being placed with respect to your chest muscles. Now the implant can go in front of the muscle or under the muscle, however it is really important to understand that the implant is never completely under the muscle. The lower third or so of the implant is typically below the lower border of that muscle. Dual plane is the next pocket type and basically it is a variant of the under muscle approach. In fact, every under muscle approach is effectively what is called a Dual Plane Type 1. In Dual Plane Type 2 or more you are getting less of the implant at the bottom part covered by muscle. And there are pros and cons in regards to each of these approaches.
Your Perfect Implant – how does Dr Dona know whats right for you?
To determine the implant that’s right for you, a careful physical examination is required to determine what is technically possible on your frame, and then make sure that is then adjusted to precisely match the look you’re after.
One of the key variables of an implant is its width. So when it comes to determining the implant size for you, the diameter of your breast footprint, or your breast base width, is the maximum implant width we can go. Of course, this is adjusted a little depending on how much cleavage and side boob is wanted.
So for example, if someone has a breast base width of 13cm, then technically, this is as wide as we can go with our implant selection. Choosing an implant wider than this is technically not going to be possible for that persons frame.
The other issue is profile, or how far forward they project. So implants can have a moderate, high (otherwise known as full) or extra high profile (also known as extra full).
The round extra full profiles are generally for those people who are happy to let people know they have augmented breasts.
The moderate profile are a softer look and generally suited for someone who has nice breast shape but just want a soft/natural enhancement
The round full profile is somewhere in between, basically someone who wants a little bit of upper pole fullness and projection, but doesn’t want to stand out too much from the crowd.
Of course, for any given volume, the projection of one implant brand may be labelled high profile, but for a different brand that same level of projection may in fact be called extra high profile. So it can get a little confusing!
Also, for those who want extra large full look, but have limited breast base width, certain brands of implants come with a much narrower diameter for very large volumes.
When it comes to teardrops, these issues with regards to variable widths and profiles are exactly the same. Of course, the shape is very different with the bulk of the volume down the lower half of the implant with a gentler taper at the top half. This helps create a far more natural look in those wanting that, without that upper pole fullness. The only additional variable with the teardrop implants is the breast base height because some brands of anatomical implants have heights which differ from their width. That is, they have an oval shaped base and not a round base. So measuring the breast base height is also important with assessing someone’s frame.
A final note is that the difference in size between adjacent sized implants is negligible. So don’t get too hung up between one implant size and the next one bigger or smaller.
In the end, an experienced and skilled surgeon will know what’s going to work with you.
Breast Footprint – what is it and how does it determine the best implant size for you?
The breast footprint is a term which Dr Dona uses to help explain the chest wall and how he chooses the appropriate implant for your body.
In simple terms, the breast footprint refers to how much of the chest wall your ideal breast should occupy. For many breasts, your actual breast footprint is fine but it is simply lacking in volume.
However, in many women the actual breast footprint is not ideal for a number of reasons:
• Breasts may be too narrow or constricted – either at the cleavage, or sideboob or both. This basically means a very narrow breast base.
• Or, the lower breast fold could be too high
A crucial part of your physical assessment is determining your ideal breast footprint. So in surgical planning terms, we need to find an implant that’s going to occupy your breast footprint to provide the ideal breast size and shape for your frame.
One of the limiting factors for choosing an implant is how wide you can go. Ultimately you want an implant extending to your cleavage and also extending to your sideboob. So the diameter of your breast footprint, or breast base width being another term, is one of the limiting factors for your implant selection.
The breast footprint height is another limiting factor, which is important especially when looking at teardrop based implants.
So Dr Dona often describes the breast footprint like the boundaries of a property – you want to build to the boundaries rather than having a big property and a small building sitting in the middle of it.
So once the breast footprint dimensions has been determined, we then need to establish the implant style – round or anatomical – and the implant profile – moderate, high or extra high. These are determined based on the look you’re trying to achieve.
So when it comes to the implants, whilst the volume, or cc’s, is important, the key is to ensure we find the right implant to suit your body, your frame, your breast footprint and of course, the look you’re after, and whatever volume that will be, will be right for you.
Implant Pockets and “dual plane”
The chest wall muscle important in breast augmentation is called the pectoralis major muscle, otherwise known as the pec muscle. This muscle extends from the arm bone near the shoulder and attaches to the chest all near the midline. How the implant is placed in relation to this muscle is important in determining the final long-term result. The implant can be placed in front of the muscle, however most surgeons choose to place the implants under the muscle which is often referred to as a subpectoral placement. It is important to note that an implant placed under the muscle is never completely covered by muscle, with the lower part of the implant extending below the lower border of the muscle.
A standard subpectoral implant placement is often referred to as a dual plane type 1 technique. The placement of an implant in a dual plane type 1 follows several steps. Firstly, an incision is made in or near the lower breast fold. The lower end of the pec muscle is identified and then detached from the chest wall at the lower end to make room for the implant. However, as the muscle remains attached to the overlying breast tissue, it does not retract or move too far. A space or pocket is then created under the pec muscle large enough to accommodate the chosen implant. Once the pocket is created the implant is then inserted and positioned and the wound is closed. Depending on the person’s natural anatomy, in the early stages after surgery the lower breast curve, or underboob, can sometimes appear very tight and flat, sometimes even having a slight groove within it. This groove is referred to as a double bubble. As the breast softens and the implant settles, this usually goes away. However, as the muscle remains attached to the breast tissue and close to the lower curve of the breast, and as this muscle contracts, it often pulls the skin in, causing a groove along the lower breast curve. This is referred to as a dynamic double bubble and is quite common.
Another form of under the muscle implant placement is a dual plane type 2. In this situation, many of the surgical steps are the same as dual plane type 1. The incision is made at or near the lower breast fold, the lower end of the pec muscle is identified, but unlike a dual plane type 1, the breast tissue is detached from the pec muscle approximately up to the level of the nipple. The space under the muscle is then opened and the lower end of the pec muscle is detached from the chest wall. Because the muscle is now detached from both the chest wall and the breast tissue, this segment of the pec muscle retracts upwards. With the under muscle pocket created, the implant is inserted and positioned and the wound is closed. The dual plane type 2 implant placement results in the rest of the implant covered by muscle along the lower half of the implant, and this can have the benefit of a fuller, more curvaceous underboob. It also significantly reduces the potential for a dynamic double bubble as this muscle is no longer close to the skin along the lower curve of the breast. One of the negative issues of a dual plane type 2 approach is that the detached segment of muscle is no longer functional, so you can expect a slight reduction in pec muscle function. However, for the majority of people this will not be noticeable.
Chest Wall Shape – how will it affect your potential cleavage?
The chest wall, comprised of ribs and associated muscles, is vital to how your breast will appear after enhancement. The reason for this is quite simply that your chest wall is a platform or foundation on which your breasts sit and project from. An ideal chest wall is flat, however some are barrel-shaped, this can vary from mild to extreme, or others point inwards. Also, often these issues with the chest wall are not particularly noticeable when the breasts are small. They become quite evident with larger breasts, that is, after breast-enhancing surgery.
The results of breast-enhancing surgery and, in particular, the potential cleavage, is largely dependent on the person’s pre-existing chest wall shape. As stated, an ideal chest wall shape is flat. In this situation, essentially the platform of your breast is flat and pointing in a directly forwards manner. The axis of the breast is always perpendicular to the chest wall. As shown, the nipples are pointing directly forward along the axis of the breasts. As demonstrated, these lines run parallel to each other. So when the breasts are increased in size with implants, the breasts project along the axis in a directly forward manner and the nipples remain the same distance apart.
It can be appreciated through this that to improve the cleavage, several aspects of the implants are vital. Firstly, choosing an appropriately wide implant has a significant impact on cleavage. The implant must appropriately occupy your breast space width. Too narrow an implant results in a wide cleavage gap. Also, the depth of your cleavage can be altered based on the profile of the implant. The greater the profile of the implant, the greater the angle that your breast has on your chest wall. Here we have moderate, high, and extra-high profile implants and the changes in cleavage associated with each. In contrast to a flat chest wall, a barrel-shaped chest wall is like this. Immediately you notice that the angle between the breasts is much greater and we have a much shallower cleavage. Also, because the axis of each breast is perpendicular to the chest platform, they may project away from each other as each breast points outwards. Therefore, with implants the breasts are projected along this axis, so effectively the nipples end up further apart. Given this chest wall shape and the shallow cleavage area, then it follows that it is not possible to achieve the deep cleavage that is possible with a flat chest wall. This is regardless of the width or profile of the implant. The final example of a chest wall shape is concave. In this situation the cleavage area of the chest wall is deep.
Essentially the breast platform is collapsed along the midline and we can see how the axis of the breasts are pointing towards each other, so when we perform an enhancement the breasts are projected forward along this axis and effectively the nipples move closer together. Furthermore, the cleavage in this situation is typically very deep as the breasts move closer together.
Chest Muscles – will they affect your potential cleavage after augmentation?
The chest wall muscle, or pectoralis muscle, can play a significant role in the cleavage achievable after breast enhancement surgery. The pec muscles insert along the midline as demonstrated here. However, the point of insertion can vary from directly at the midline or far from the midline. Also, the skin along the cleavage area can be very tight, can tether to the chest bone, or very loose and thick. These factors can also impact on the cleavage after breast enhancement surgery. Typically, those women whose skin is very tight and tethered to the midline have pec muscles that are attached some distance from the midline, and those with very loose skin along the midline have their pec muscles attached closer to the midline, but this is not always the case. In this example, the muscles are attached some distance from the midline so after implant placement there is a higher potential for having a wide gap along the cleavage area.
In this situation, the surgeon must actively detach the pec muscles from the chest wall to allow for a wider-based implant to achieve a tighter cleavage. Of course, for those women whose midline skin is tight and effectively tethered to the chest wall, there is a limit to how much of an improvement is technically possible. In contrast, here we have a situation where the muscles are attached very close to or at the midline. This is a situation where it is technically easier to achieve a deeper and closer cleavage, however the surgeon must be very careful to not be overzealous in detaching the muscles from the chest wall, as this can result in implants sitting too close together with the central skin lifting off the midline, resulting in what is referred to as symmastia, otherwise known as monoboob. The final matter for consideration is the thickness of the pec muscles and the width of attachment to the chest wall. A thick pec muscle with a broad attachment to the chest wall can make achieving a tighter cleavage very difficult. The surgeon must at least partially detach the muscle from the chest wall to allow the implants to sit closer to the midline, and thus achieve a tighter cleavage.
Cleavage – the many factors that determine the type of cleavage that you can achieve
The cleavage achieved after surgery is dependent on many things.
- The quality of pre-existing breast tissue
- Pre-existing cleavage skin:
- Is the skin tight and tethered to chest bone
- Or is it loose and free
- The chest muscle or pectoralis muscle is an important consideration in cleavage, as its position and shape is very important when implants are placed under the muscle. This is because certain features of the muscle can affect how close the implants will be sitting to the midline.
- For example, is the muscle attached close to or far from midline?
- Or, is the chest muscle thick or thin. In other words, does it have a broad or thin attachment to chest wall near midline?
- Shape of chest wall can have an important role in the cleavage – is the chest wall flat (which is ideal), is it concave, or barrel shaped.
- Implant style – moderate, high or extra high profile. Extra high implants give the best chance of having a deep cleavage
- Does the implant make the most of the pre-existing breast footprint or desired footprint – in other words, is the implant the appropriate width for the diameter of breast footprint.
Ultimately, surgical skill and experience is vital to assess and work with all these variables to provide the ideal cleavage. However, many times due to the way the person’s natural anatomy is, it is not possible to achieve a tight full cleavage outside of a bra.
These videos cover some of the common questions and myths surrounding breast implants.
“I Want Bigger Implants!”
The commonest complaint by patients after augmentation is “I wish I was bigger”!
The reasons for this are many:
- Some surgeons are reluctant to use fuller sized implants as they lack the confidence to do so
- Many patients are reluctant to use fuller implants as they are simply scared to do so.
- However the main reasons relates to how things change during the early stages after surgery. The two issues here are:
- The initial swelling that many patients tend to like slowly goes away.
- And at the same time the patient gets used to (and likes) the larger breasts. So once the swelling has settled, this is when they realise – “I wish I was bigger”.
Human nature means that any change creates anxiety – therefore to minimize the anxiety people minimize the degree of change.
With respect to implants, that means you minimize the size of the implants.
Listen to your skilled and experienced plastic surgeon. Don’t go to your consult with a “volume” that you want in mind.
Breast Feeding after breast augmentation
Breast enhancement surgery does not affect your potential ability to breastfeed. This is regardless of whether the implants are above or below the muscle. The one exception to this is when the implants are inserted via an incision along your areolar edge. In this situation you are effectively cutting though some of the milk ducts so you can expect a reduced potential ability to breast feed.
Breast Cancer and your breast implants
The answer to this is simply NO. Silicone breast implants have been used for approximately 50 years, and extensive research has shown that it does not result in an increased risk of breast cancer. Of course, the reality is that with or without implants, a women’s risk of developing breast cancer is approximately 1 in 10. So it’s important that you undergo normal breast cancer screening as dictated by your age and family history. Furthermore, when having mammograms or ultrasounds just inform the person doing them that you have implants.
Having implants does not reduce the ability to detect breast cancer through routine screening.
Finally, routine breast self examination should continue monthly and some women would say that having implants can sometimes make breast self examination a little easier.
Change Implants Every 10 Years – is this true?
IMPLANT EXPIRATION DATE – one of the common myths about breast implants is that they need to changed every 10 years. This is definitely NOT TRUE. As long as your implants/breasts continue to look and feel good, nothing needs to change. So potentially they could last a lifetime.
However, your body will continue to change over time implants or not – time, gravity, weight fluctuations, pregnancy, breast feeding, lifestyle, genetics etc…..things will change. So for these reasons, you may wish to have further surgery at some later date.
Also large breasted women, whether they are natural or implants, gravity is far less kind to them than smaller breasted women. So it’s really important to always wear good supportive bras all the time, except for those odd occasions that warrant no bra. You support them as much as possible, and they’ll look after you as long as possible.
Upper Body Strength – will breast augmentation make you weaker?
Do you lose chest muscle (pectoralis major muscle) strength after augmentation? The answer to this is sometimes no, and sometimes yes.
Implants placed in front of the muscle do not move when the chest/pec muscles are contracted. So basically you can’t make your breasts move up and down with muscle activation – the term used for this is animation.
Also, implants placed on top of the muscle do not affect chest muscle function
In contrast, when implants are placed under the muscle the breasts typically move everytime you contract your chest muscles. This results is the breast implants separating and therefore the cleavage becomes quite wide whilst the muscle contracts. This occurs for all under the muscle implants. In addition to this, muscle contraction can often cause a dynamic double bubble affect, which refers to a significant indentation occurring to the underboob region everytime you contract your muscle.
This occurs because the pectoralis muscle remains attached to the breast tissue at this level and it pulls on it everytime you contract.
An implant inserted with a modified under muscle placement such as a dual plane type 2 technique can minimize or prevent this dynamic double bubble from happening.
However, this type of dual plane technique results in loss of muscle function due to the complete detachment of the muscle from the chest wall and breast tissue at the lower end and the subsequent retraction and atrophy of this segment of muscle that occurs.
In contrast the common under muscle technique, otherwise known as a dual plane type 1, does not result in any real muscle function loss. In this situation, whilst the pec muscle is typically detached from the chest wall along the lower sternum/breast region, it still remains attached to the breast tissue so it can’t retract and atrophy. It does of course result in a potential dynamic double bubble affect.
The following videos cover all the things you need to consider and understand about your recovery. This includes what to expect, what is normal, and when you can get back to doing your normal day to day activities.
Pain – how much can you expect after surgery and what medications will you need to take?
It’s important to know that everyone has a different experience after surgery from negligible pain to significant discomfort. However, there are certain expectations and guidelines to follow.
MEDICATIONS – When you leave the hospital you will be given antibiotics and pain killers. Take your these medications as prescribed.
PAIN – the pain is typically described as a heaviness or tightness across the chest. I usually place implants under the muscle, which is a little more uncomfortable than over, but in my opinion it provides a much greater long term result.
Pain is worst over the first 2-3 days but rapidly settles. With chest pain, taking a deep breath is quite uncomfortable, so naturally people tend take shallow breaths. So I tell all my patients to make a conscious effort to take a few slow deep breaths every hour on the hour to expand your lungs and minimize the chance of any chest infection.
When you get home don’t lay in bed all day. I want all patients to be up and mobile, but at the same time don’t expect too much from yourself. As always, common sense prevails.
Showering and sleeping after surgery
SHOWERING – You can shower the day after surgery and have water simply run over your dressings…but leave your dressing intact and simply pat them dry after the shower. Showering is fine, but submerging yourself in water such as a bath or swimming is not allowed until 3 weeks post-op at which stage you no longer have any wound dressings on and your wounds are dry and healing nicely.
SLEEPING – Sleeping is generally more comfortable on your back, although propping yourself up on a few pillows or sleeping in a recliner chair for the first few days is what many people find the most comfortable. Also, assistance getting up and down is often required for these first few days.
However, there is actually no recommended position to sleep. Basically you sleep in whatever position you’re comfortable in and listen to your body. Ultimately you move around in your sleep so no matter what position you go to sleep in, you’ll move whilst asleep and your subconscious/sleep state will always adjust itself to a comfortable position.
Surgical Wound – how do you look after it?
At the one week post op appointment your dressings will be removed and your wound inspected. Dressings (steri-strips) will then be replaced to cover your wounds. These will remain in place for a further two weeks at which stage they will come off and stay off. This is when we will advise you regarding scar massage, creams and general care required to optimise the quality of your scar.
Swelling – how much to expect after surgery?
After surgery expect a great deal of swelling! A significant amount of the initial swelling is gone after the first 2-3 weeks. Also, the amount of swelling can differ between breasts. A slight difference in swelling is fine. However a significant difference is not normal and you need to notify your surgeon as soon as possible.
Swelling is often quite extreme in the upper parts of the breasts creating quite an impressive albeit fake breast look. Not surprisingly, many women like this.
Depending on your pre-existing anatomy, this often creates a very unusual look to your breasts. If your breasts were a little droopy prior to surgery, then this upper pole swelling and fullness can magnify this droopiness creating a “long” breast appearance, or snoopy appearance. Do not panic because once the swelling settles so too will this odd look.
Also, if the bottom of your breasts was very tight or short prior to surgery (short distance from nipple to lower breast fold), then this tightness will exist immediately post-op and be even more noticeable given the upper pole swelling. You cannot expect a nice rounded underboob post-operatively in these situations. It takes time for things to settle down and slowly stretch out over time. However, sometimes due to your pre-existing anatomy, this tightness can persist.
Bruising – how much is normal after surgery?
BRUISING – just like your swelling, you can expect some degree of bruising. This typically occurs between the breasts (cleavage), the outer aspect (sideboob) region and also the bottom half of your breasts. It is normal for this to look worse before it gets better, with the changing colours of a bruise which is normal. If you experience severe bruising, let your surgeon/clinic know as soon as possible just to make sure everything’s ok.
Will “monoboob” after surgery go away?
Immediately after surgery, the area between your breasts (cleavage) is often very swollen, sometimes to the point of having a “monoboob”. Don’t panic! Some women are more prone to this than others depending on the technique, size of implant, and their anatomy.
At the one week stage we will advise you on how to massage between your breasts to start defining your cleavage. As you press in this area it’s not uncommon to have a sensation like you are squeezing fine air-bubbles, a sensation often described like popping fine bubble wrap. This is normal.
Weight gain and constipation after surgery
WEIGHT GAIN – After surgery you will be less active than normal – burning less calories. You will be at home more and likely eating more than usual – consuming more calories. Therefore, it is very easy and common to put in weight in the early stages after surgery. At a time when you should be feeling happy and have a boost in your confidence, you can easily be a little upset over weight gain. So now that you know this, do your best to avoid it.
CONSTIPATION – Constipation is an unpleasant possible issue in the first week or two after surgery. This is typically caused by the pain killers used during and after surgery which cause constipation and bloating. Also, being less mobile after surgery exacerbates this. So have plenty of fluids and fibre, and take additional products to help keep you regular such as Metamucil.
Driving and returning to work after surgery
DRIVING – No driving for five days. After that, be guided by your body. If you feel like you are safe to drive and have enough freedom of upper body movement and strength to be driving, then you can.
RETURNING TO WORK – If you work and your job involves sitting at a desk doing light office work, then you can be back at work after one week.
Anything that involves heavy lifting and significant upper body mobility and straining should be avoided as much as practical for 4 weeks. Of course, life goes on and the demands of life, especially for those that have young children, are such that you will do things that ideally you shouldn’t. As long as these are kept to an absolute minimum then you should be fine.
What odd pains and sensations can you experience after surgery?
ODD SENSATIONS – Many women comment that during the early stages they have a sensation of water sloshing around their implants or odd squishing noises! This is normal and it does go away.
SUDDEN PAINS – A heaviness or tightness type pain is normal after surgery. It can also differ between sides with one more uncomfortable compared to the other. This can vary from day to day. In addition to this, many women also experience stabbing or shooting pains – often described as “electric” shock type pain. This often just comes on suddenly and spontaneously and typically settles very quickly. This is NORMAL, and becomes less common over time.
Surgical Bra and massaging after surgery
SURGICAL BRA – All patients are placed in a surgical bra after surgery. This is put on at the end of surgery so that when you wake up it’s already on. You are expected to wear this surgical bra for 6 weeks. However, we advise all our patients to purchase one or two inexpensive sports bras or crop tops so you have something to wear when you’re washing the other during this first six week period.
BREAST MASSAGE – At the three week post-op stage you are the instructed on how to commence massaging your breasts. This is designed to help soften and settle your breasts, and to help keep them soft.
This varies slightly between patients and you will be advised by our team on what’s appropriate for you. Also, occasionally one or both breasts may need additional assistance to help them settle in position, and in this situation a breast strap will sometimes be provided to help with this.
Finally, at the six week post-op stage, when the majority of your swelling has gone, you can go out and be formally fitted and buy new bra’s and clothing.
Normal Activities – when can you get back to normal after surgery?
At the four week stage, you are generally beyond the point where your physical actions could potentially compromise your results. You are therefore free to physically ATTEMPT your normal activities. However, this does not mean you will be able to do your normal activities as you will still have some degree of discomfort and weakness. So as always be guided by your body. If you are doing something and you have discomfort or pain, pull back and work around it. Eventually you will get back to normal.
Exercising – when can you get back to training after surgery?
With all those who do a lot of sporting activities and gym work:
- You can walk from day one post op.
- At 2 weeks you can sit on a stationary bike and do some cardio work to burn some calories and maintain some cardio conditioning.
- You can slowly return to running at the four week mark. You must wear a bra or often two that helps prevent your breasts from bouncing up and down. If your breasts are bouncing up and down while you are running, then your wearing the wrong bras!
- For those who love the gym you can slowly return to that at the four week mark. However, as you would know four weeks is a long time away from the gym and you decondition a lot. Also, you’ve had chest surgery so will still have some discomfort from this. So when you do go back to the gym, start with very light short sessions and be guided by your body. Slowly and gradually build yourself up to normal training over the following weeks and months. However, unlike normal training pain where you “push through”, experiencing pain in a post-surgical state means you need to pull back a little. It’s your body saying it’s not quite ready to be pushed that hard.
- Going to the gym prior to four weeks to do “just legs” is not allowed. Any leg work requires core and upper body for stabilization etc so it’s still forbidden.
- For those crossfit junkies – you have no chance of doing this for at least two months after surgery. Go to the gym at 4 weeks post op, gradually build yourself up, and when you feel your crossfit ready (typically no sooner than two months post-op), then you can get back to it.
Sex – when can you start after surgery?
A practical question patients often ask me after breast implant surgery is when can I return to having sex?
The answer to this is quite simple – you can return to sexual activity at any stage after surgery.
However, the reality is that for the first few days at least after surgery you will be far too sore to think about that.
My general recommendations about returning to normal physical activities includes refraining from normal heavy upper body manual handing/lifting and straining for the first four weeks after surgery.
So with this in mind, you can return to sexual activity at any time, but for the first four weeks after surgery you basically need to take on a very passive role.
Also, you are also advised to commence firm breast massaging at three weeks after surgery to help your breasts soften and settle. So this also means you and your partner can handle your breasts normally from this stage. You’ll still be a bit sore, so your body comfort levels will guide you as to what you should and shouldn’t be doing.
Stretch Marks – will you get these after surgery?
Stretch marks can occur after breast enhancement surgery. Whilst you would expect this to occur in those women who get very large implants, this is not the case. The person’s genetic predisposition is largely what results in stretch marks. They can even occur in women getting very small implants with quite loose skin pre-operatively.
So we suggest moisturising your breast skin twice daily starting 1-2 weeks pre-op and continuing for the first 3 months after surgery. If however you do develop stretch marks, they will always be bright red in the beginning, but do fade to light white after about 6 months.
Of course, many women wanting breast implants already have stretch marks and often that causes a wrinkled loose skin appearance. In these situations it’s extremely unlikely that you will develop more stretch marks, and usually the skin looks so much better after implants as it is stretched out and looks smoother.
Puffy areolars after breast augmentation surgery
Women who naturally have quite full and “puffy” areolars can expect them to be much more puffy after surgery. This is because the areolar skin is thinner and more easily stretched compared to the surrounding skin. Therefore after surgery when everything is tight and under tension the area that’s easier to stretch, the areolar, stretches the most.
However, once the breast has fully settled down and softened up, which typically occurs at the 3-6month post-op mark, then the areolars should return to how they were pre-operatively.
Nipple Sensation – will this change after surgery?
Several things can happen to breast nipple/areolar sensation.
- Nipple sensation can remain unchanged to that of the pre-operative state
- Or, the nipple sensation can increase to the point of being too sensitive and sometimes painful
- Or, the nipple sensation can decrease to the point of being numb.
If the nipple sensation does change after surgery, within 12 months most women have returned to there preopative state. However, up to 10% remain with permanently altered NAC sensation – either too much or not enough.
Also, sensation here is often reduced between the scar within the lower breast fold and the lower edge of your areolar. There is a good chance this will not return to normal.
Erect nipples after breast augmentation surgery
Having constantly erect nipples can occur after surgery, at least in the initial stages. However, it depends on how firm your breast skin and breast tissue is, and how your pre-surgical nipples are. Basically, the pressure from the implants, and possibly the effects of pressure on the nerves, causes this, but if it does occur then it’s usually just a temporary thing.
Of course, if you find that your nipples are still a lot more prominent 6 months after surgery, which can occur in a small percentage of women, then it is likely to remain that way
Also, many women who have mildly inverted nipples – nipples that are inverted occasional – often they pop out, or evert, after surgery. This can sometimes be permanently “fixed”, which could be considered an added potential bonus of implant surgery for those women.
Final Results – how long until after surgery do I have to wait?
All patients should ignore how things look in the beginning as it takes time to see the final results. As a general guide, at 6 weeks post-op most of the swelling has settled and you can really start to appreciate how things are going to look. This is also when you can go out and be fitted for new bras.
However, it typically takes 3-6 months for the breasts to fully settle into position, and some people use the term “drop and fluff” to describe this stage which basically refers to the implants settling and the breasts softening.
This is also when we finally assess our results and appreciate how great they are, or on the very rare occasion, decide if anything else needs to be done to “fine tune” the result – which is quite uncommon for a breast augmentation.
The list of potential complications is not all-inclusive; however, it does include all the general and specific key issues that should be considered and understood.
General Potential Complications
Whenever someone is having an anaesthetic, no matter what it’s for, then things can potentially go wrong. That is why no surgery should be considered “minor”. Of course, whilst the chances of the following potential problems occurring are extremely small, you still need to know about then:
- Anaesthetic Heart, Lung, Stroke
- Allergic This can be very mild to life threatening.
- Superficial vein clots, which is a complication of the canula or drip that’s placed in your vein
- Deep vein clots – these can potentially spread to the lung and be life threatening. We do several things during surgery and after surgery whilst you’re in hospital to minimise the risk of you developing these.
- Wound problems and bleeding
- Death – whilst the chances of this is exceeding rare, any of the previous issues can result in this devastating complication.
All these potential problems are standard for any operation, although some operations and some patients have an increased risk of developing them.
Ruptured Implants – can this occur and what happens if they do?
Breast implants can potentially rupture, with a quoted lifetime incidence of between 1-2%. The cause of this is typically unknown and it’s not as though your physical actions would contribute to this happening. It can happen within 6 months after surgery or many years later. If a rupture does occur it’s not something which actually causes problem – you don’t develop any pain or issues like that. Indeed, often the women doesn’t even know if they have a ruptured implant. Of course, a skilled plastic surgeon can tell if this has happened. Basically, a ruptured implant is not a medical problem and is not going to cause you any health problems. So it is not a problem that warrants “urgent” treatment.
The key signs that you may have a ruptured implant are if your breast has lost a bit of shape, especially with a loss in upper pole fullness. Also, when lying on your back the breast with the ruptured implant often has a loss of projection and appears quite flat. And, when you feel a breast with a ruptured implant, it has a very soft doughy feel to it.
If a ruptured implant is suspected, then an ultrasound and/or MRI should be done for completeness.
Capsular Contracture – what is it and does it matter?
A well known potential complication associated with implants is capsular contracture. Dr Dona discusses this in an easy to understand manner.
A real case of capsular contracture
Capsular contracture is a condition that can affect women with implants. Essentially, it refers to hardening of the breasts, with sometimes distortion and even pain associated with it. Capsular contracture affects up to 5% of women. Historically it was far more common and affected up to 20% of women.
So why does it occur?
Implants are a foreign material, and the bodies natural and normal response to foreign material is to form scar tissue around it, like a capsule around it. Normally it’s a loose fit and the implant is soft and mobile.
However, in capsular contracture, for reasons unknown the scar tissue slowly starts to contract around the implant. Eventually, it gets to the point where the implant is being held under tension by the surrounding scar tissue, and that’s why they feel hard. That’s also why the breasts can become distorted.
So why is it less common?
- Silicone gel implants
- Textured implants
- Under the muscle
- Breast massage
- Meticulous technique with minimal bleeding
- Using antiseptic in the breast pocket and soaking the implant in antiseptic before inserting
- Antibiotics during surgery
- Minimal handling of the implants – the packet is only opened up prior to inserting.
Rippling – what is it and why does it occur?
Rippling is where you can see the folds of the breast implants.
To some degree, all implants develop some form if rippling that can be felt. However, it is only when it’s seen that it’s considered an issue.
Also, certain positions are more likely to cause visible rippling – such as leaning forward commonly results in rippling in the side boob area.
Certain factors contribute to the development if rippling. These include:
- How thin the person is. Very thin people have little natural tissue separating the implants from the skin….so you can see the implant.
- How much natural breast tissue the person has. Just like being very thin, having very little breast tissue has a similar issue.
- Being on top of the muscle increase the risk of rippling near the cleavage
- Development of capsular contracture can contribute to ripping as it essentially results in buckling of the implant
- The type of implant. Saline implants are very collapsible and typical cause rippling.
- Also not all silicone implants are the same. Some are a firm gel which is far less likely to buckle/ripple. However, very soft silicone gel implants are more likely to buckle and cause visible rippling.
- Sizes of implant – very large implants are more likely to buckle and have some form of rippling.
Double Bubble – what is this and why does it occur?
Double bubble is complex problem and has many different causes. The end result is basically where you have a double curve in the bottom half of your breast, from your nipple to your lower breast fold. This is caused when there has been a loss of harmony or balance between the implant and breast tissue – so we don’t have a uniform spread of the natural breast tissue over the implant. Effectively you see the breast tissue mound sitting on, or hanging from, an implant mound.
The causes of this include:
- Constricted breast base with short distance from nipple to breast fold – or very conical or pointy shaped breast tissue which typically also have a constricted breast base are more prone to double bubble
- An implant base that is too big relative to natural breast tissue base. The end result is a small natural breast tissue base sitting on top of a larger implant base
- Implant bottoming out/dropping down so that the lower part of the implant is lower than the natural lower base of the breast tissue.
- Breast tissue changing over time and becoming softer and droopier. So what was once a great breast shape with a uniform spread of breast tissue over an implant, changes with breast tissue essentially hanging from an implant mound
- A combination of any of the above mentioned issues
A skilled and experienced plastic surgeon can do a few things internally and with implant selection to minimize the risk of this happening.
If you do have double bubble, correcting it is a very difficult problem and the underlying cause will ultimately determine what needs to done to fix the problem.
Double Bubble – a customised video animation explaining what double bubble means and four different causes?
Double bubble is a problem that can develop after breast augmentation. There are a number of possible causes of the double bubble, but the key sign of it is a groove along the lower breast curve creating the appearance of a bubble sitting on top of another bubble, hence the term double bubble. One example of double bubble is that which can occur in a woman that has a very short distance from the nipple to the lower breast fold, or a tight breast base. In this example, an excision is typically placed below the breast fold. The lower end of the muscle is identified and detached from the chest all, and a space is made under the muscle to accommodate the implant. The implant is then inserted and positioned and the wound closed. In this situation, the implant position is below the original breast fold which is now sitting along the lower breast curve. Initially this region remains tight and causes a flatness or indentation. This indentation is what creates the double bubble. Over time as the breast tissue softens and the implant settles, this double bubble typically resolves, resulting in a smooth lower breast curve. However, sometimes due to a natural persistent tightness at the site of the original breast fold, this double bubble persists. To compound the problem, at the level of the original breast fold where the muscle sits close to the skin, as this muscle contracts it pulls in the skin causing a dynamic double bubble.
A double bubble can also occur in those who have a loose and well-formed lower breast curve with a long distance from the nipple to the lower breast fold. Here it can occur if the incision is placed too low, below the breast fold, and the implant is therefore effectively placed too low. In this situation, the lower end of the muscle is detached from the chest wall and the implant pocket is made deep to the muscle. The implant is then inserted and positioned and the wound closed. However, here we have the breast implant sitting too low, below the natural breast tissue mound, and the original breast fold remains tight. The end result is an implant sitting below the original breast mound with the breast tissue sitting on top of the implant mound, and with the persistent tightness of the original breast fold, this creates an appearance of a breast tissue hanging from an implant mound, creating a significant double bubble.
Another cause of double bubble is caused when a correctly placed implant drops down below where it was originally placed, otherwise known as bottoming out. In this type, if the lower breast fold remains tight, then as the implant bottoms out it ends up with a situation with the implant sitting too low and the breast tissue mound hanging from it.
The final cause of a double bubble occurs due to changes that can develop to the natural breast tissue over time. In this example we have a normal ample-breasted woman with implants sitting in the correct position and a nice lower breast curve. Over time, normal changes in natural breast tissue volume associated with natural body weight fluctuations can change the appearance of the breasts. However, if the natural breast tissue softens up and drops down, a common occurrence with weight loss or after pregnancy and breastfeeding, then the breast tissue drops down and effectively starts to hang from the breast implant mound. This can result in a significant double bubble formation.
Monoboob – what is it, why does it occur, and how is it treated?
Monoboob, or symmastia being the official term, is a condition where the two breasts are sitting too close together. In practical terms what that means is that the cleavage is not as deep as it should be with the skin along the midline lifted up. This problem can look worse with a bra or dress that pushes the breasts together.
This problem can occur after breast augmentation and is quite a difficult problem to fix. In fact, it’s not uncommon to require more than one surgery to try and fix it.
A number of things can contribute to the development of monoboob.
- Implants that are too large
- Creating an implant pocket that is too big with too much release of the pectoralis muscle from the chest wall.
- The persons natural anatomy can predispose to the development of monoboob, with some women more prone to it than others. This is especially the case in those who have very loose and mobile skin along the midline and typically these women have their pec muscles inserted close to or at the midline.
So what happens if it looks like we’re getting monoboob?
- Early treatment is massaging along the midline and massaging the breasts outwards.
- Wearing a special symmastia compression type bra is required.
- Avoid wearing push up bras.
If it’s still a problem after 6 months then surgery is required.
This includes tightening the pocket along the midline, and possibly changing to smaller implants.
Bottomed Out Implants – what is this and why does it occur?
BOTTOMING OUT is a condition where the implants have dropped lower than where they should be.
So how does a “bottomed out” breast look?
- The bottom of the breast is much fuller than ideal, with a long distance from nipple to lower breast fold.
- The upper half of the breast is empty
- With the implant dropping down, and because the nipple doesn’t physically move, the nipple is no longer central over the breast mound. Instead it ends up sitting too high on the breast mound and pointing upwards, and other than just looking odd this can cause practical problems with areolars visible above the upper end of a bra.
So before we look at what can potentially cause bottoming out a basic surgical concept needs to be explained.
Surgically, when the implant is positioned the deep aspect of the wound is stitched to form a secure rigid internal support to hold the implant in position, like an internal bra. Dr Dona closes the wound using three internal layers of stitching and this deepest layer is perhaps the most important.
So with this in mind, it follows that bottoming out can occur if this deep stitch layer is poorly performed, or not performed at all.
Or, if this deep stitch layer is not allowed to heal properly. For example, too much inappropriate physical activity too soon can potentially cause this layer to break down.
Other things that can contribute to bottoming out include:
- How heavy the implants are – heavier implants are more prone to dropping
- Smooth implants are more prone to dropping than textured
- Implants placed in front of the muscle are more prone to dropping compared to those under the muscle
- The quality of the person’s breast tissue and skin – breast tissue that’s soft and thin is less capable of supporting an implant
- Not wearing appropriate supportive bras to support the weight of your breast implants
- Or any combination of these issues
So, if you develop bottoming out, this can be an extremely difficult problem to fix, and the underlying cause will need to be determined. Of course, a skilled and experienced plastic surgeon should be able to address this problem.
Bottoming Out – a customised video animation demonstrating what happens with a bottomed out implant
Bottoming out is a condition which occurs when the implant drops below the position that it was originally placed. An ideal breast shape should have a nice upper breast fullness and a gentle taper leading down to the nipple, then a gentle curve from the nipple to the lower breast fold. The nipple should be pointing forward and centred at or just above the centre of the breast mound. This is the same regardless of whether there is an implant or not. If an implant drops down below the point where it was originally placed, then this balanced breast appearance changes. The reasons why this can occur are several, but whatever the cause is, the end result is the same. The distance from the nipple to the lower breast fold becomes much greater as the upper half of the breast empties and becomes smaller. To compound the problem, the nipple points upwards and can be very difficult to hide in a regular bra.