With so many different implant sizes and shapes available, breast implant selection is an important part of the pre-operative planning process to ensure the best shape for your body type is chosen.

Breast implant shape

round

anatomical (teardrop)

Breast implant fill and shell

polyurethane-coated silicone

textured silicone

smooth silicone

saline with a textured shell

saline with a smooth shell

Silicone feels more natural and is less prone to rippling than saline. It is important to note that saline implants have a silicone shell as there is the common misconception that saline implants don’t contain any silicone. In any case, silicone has been proven to be safe in large multicentre trials in tens of thousands of patients. There has never been any proven association with joint disease, autoimmune disease or any other illnesses.

Dr Simone is not affiliated with any implant manufacturer. Whilst she will advise during the breast augmentation consultation which implant would be best for a particular body size and shape the ultimate decision as to which implant a patient ultimately wants rests with them. Whilst Dr Simone can give you guidance, she does present you with more than one option. No implant is perfect and without risk or complication, it’s about working out the advantages and disadvantages of the options presented.

In patients with adequate tissue to cover the breasts, it is better to place the implant on top of the pectoral muscle.

Many patients presenting for breast augmentation, however do not have enough tissue to cover the implant and this can lead to visibility. When placed under the pectoral muscle (it is actually the upper part of the implant that is under the muscle) Dr Simone uses the dual plane technique. The lower part of the implant sits directly under the breast tissue or lower pole of the breast.

Patients with breast asymmetry may not want to have breast implants, especially if one breast is an adequate size. It is rare to be able to achieve a good correction of breast asymmetry with an implant on the smaller side only. A breast implant always sits higher than the non implanted side, therefore the majority of patients who have breast asymmetry corrected with implants end up having one in both breasts.

Patients who are in their teens with a constricted or tuberous breast who have severe asymmetry in clothing and swimwear may benefit from early release and correction with breast fat grafting without committing to a big decision such as breast implants at such a young age.

In the majority of patients, Dr Simone places the incision in the inframammary crease (the crease under the breast). This incision is around 5cm and when it fades, is the least visible place for a scar.

In some patients the periareolar (around the nipple) approach is used. This is preferable if the nipples are large or asymmetrical.

Dr Simone does not use the armpit incision as this is the only socially visible scar, implants cannot be placed easily through this incision and all revision surgery needs to be performed through an incision in the crease or the nipple.

Dr Simone uses the smallest possible incision to place your implant. Following surgery, you are given a scar management regimen. Your scars are closely monitored in the months following your breast augmentation to ensure if you are prone to more significant scarring due to genetics or other factors, extra scar management is instituted early to give you the best possible result.

Surgery is performed in a accredited hospital under general anaesthetic with an anaesthetist. It is day surgery in the vast majority of people.

Patients usually go home the same day of surgery and must be accompanied by a responsible adult.

No drains are needed for a first time breast augmentation. They are only necessary in revision cases.

Patients go home with regular pain relief prescribed. Local anaesthetic is injected at the time of surgery to help with post-operative pain relief. It is normal for the breasts to be bruised and swollen after the surgery.

With regular pain relief, the pain is manageable. The worst of the pain settles within the first few days. In the uncommon event that pain after the surgery is not under control, Dr Simone and her anaesthetist are available at any time after your surgery to advise about pain relief.

Waterproof dressings are placed over the wounds at the time of surgery and these should remain in place until you come for your follow up. Showering is permitted during this time. A firm bra is to be worn day and night.

This depends on the type of work, some patients can be back within a matter of days to a desk job.
For people with an active job, polyurethane implants allow an earlier return to activities.

This depends on the the type of implant used and whether the pocket is under or over the muscle. For a more rapid return to exercise, particularly upper body work, a polyurethane implant has an almost zero risk of rotation or movement.

One of the overriding advantages of breast fat transfer are due to the tiny incisions and rapid healing time which means there are no major restrictions to exercise after the surgery. Exercise is mainly limited due to pain, which is highly variable and usually dependent on the liposuction sites and volume as breast pain is minimal.

Instructions will vary slightly if a fat graft has been performed and with different pockets or types of implants.

Implants do not require massage or any specific taping. They are precisely placed at the time of surgery.

Most breast implants are said to last around 10 years. They are a device, and therefore after several years, it is usually a deterioration in cosmetic appearance that brings people to have them removed and replaced. This is usually the result of a capsular contracture, but can also be due to other factors such as changes in the overlying breast tissue, weight changes and ageing of the breast. Rupture is a much less common reason for removal these days as the gel is cohesive (like a jelly baby) therefore does not leak even in the event of a rupture.

Implant warranties vary slightly according to the manufacturer. All brands used by Dr Simone carry a lifetime warranty against rupture.

Polytech textured implants are the only implants to carry a 10 year warranty against capsular contracture, rotation and movement for a primary breast augmentation.

There is currently no scientific evidence that breast implants are responsible for symptoms of autoimmune disease, joint disease or other non-specific complaints.

Severe capsular contracture can cause pain and discomfort in patients with breast implants.

There is a very rare form of cancer known as ALCL (Anaplastic large cell lymphoma) which has been diagnosed in just over 300 women worldwide. As numbers are small and research regarding this topic is in its infancy,  it is difficult to make any defintive conclusions at this stage regarding this form of cancer. It usually presents with a mass or a fluid collection which in the majority of cases are visible to the patient as a change in their implants.

Although some very thin patients may not have enough fat for a breast augmentation with fat transfer alone, they may have just enough to be injected into regions where their breast implants are visible. This can often occur in the cleavage area or upper part of the implant if there has been weight loss after surgery. 

Tuberous breasts typically present with not only constriction of the breast (especially the lower pole) and a high tight inframammary fold, and usually some breast asymmetry. Fat transfer helps maintain release of the tight fold and lower pole constriction and assist with maintaining this correction much better than an open release alone with reduced rates of double bubble deformity. This is where tight tissues springs back to their original position following release and indent the implant across its surface creating the appearance of two folds.  Tissue lack in the lower pole of the breast and cleavage area and precise asymmetry correction is helped with a fat transfer even if breast implants are used.

Read more here about tuberous and constricted breasts.

Dr Simone Matousek specialises in revision breast augmentation surgery with a combination of fat grafting and breast implants. With each exchange of breast implants, there is a need to remove the capsule and in the presence of scarring and thinning of the tissues, fat can be beneficial in masking the visibility of implants and dealing with small asymmetries. Dr Simone also recommends a special type of polyurethane-coated silicon implant in this situation which has a significantly lower rate of capsular contracture, movement and rotation in the published literature. You can read more about these implants here and why they are an excellent choice for breast augmentation revision.

Many patients will be happy with the tissue rearrangement and lift provided by a mastopexy alone and not need an implant for volume augmentation.

In some cases, the breast lift and implants may need to be staged in two procedures. Which one is performed first is dependent on the individual patient situation.

In patients with more ptosis or breast “droop”, an implant does provide some lifting capacity and can avoid or delay the need for the scars associated with a breast lift.

In some patients, the size of the implant required to give adequate lift may not be acceptable to them or proportional to their body size.

This link gives the common general risks of all plastic surgeries involving general anaesthesia.

Haematoma or seroma This is a collection of blood (haematoma) or fluid (seroma) around the implant. This is a rare occurence, however, may require operative or radiological drainage.

Breast asymmetry – Almost all women have some form of breast asymmetry. This can become apparent after augmentation and can include asymmetry of nipple height, inframammary crease height and breast shape.  Whilst every attempt is made to improve more significant breast asymmetries, it is important to understand perfect correction cannot be achieved.

Palpable or visible implant edges In slender people, it is normal to feel implant edges particularly where there is less coverage in the lower and outer breast. Coverage can be improved by placing the implant under the pectoral muscle (this only tends to cover the upper part and cleavage area) and with fat grafting.

Rippling of the implant As the implant ages, this can become more apparent, especially in people with thin skin.

Suture reactions Some stitches used in breast implant surgery, even if placed deep to the skin can cause reactions and be palpable following surgery, especially if the skin is thin.

Capsular Contracture Every foreign body forms normal scar tissue around it to wall it off; this is known as a capsule which is the body’s own scar tissue. When formation of the scar tissue becomes excessive, it can cause distortion, hardening and pain in the implant. The risk of this increases with the time the implant has been in, however, in rare cases can occur soon after implant surgery. This is the most common reason for implants requiring exchange or removal in the future.

Animation of the implant With pectoral muscle activation, implants can be visibly compressed and move laterally (towards the armpit) over time. Most implants placed under the muscle will have some element of this, however, is more severe in people with large pectoral muscles that do a lot of upper body exercise.

Implant rupture All implants inserted carry a lifetime warranty against rupture. If a rupture does occcur, whilst not a medical emergency, will generally require removal. Ruptures within the capsule (intracapsular) can be asymptomatic for some time before becoming extracapsular. Once extracapsular, they can cause hardening and distortion of the implant.

Lymph node enlargement Trace silicon can be visualised in lymph nodes after breast implants and lymph glands can become enlarged at anytime following insertion. This is usually mild, and of no consequence and is not dangerous. Medical grade silicon is inert and tends to sit in the lymph nodes (the body’s filtration system). Very rarely, especially with older more liquid silicon lymph glands can become extremely enlarged and form silicon granulomas.

Implant rotation or malposition This can appear as a change in shape and is more common with implants placed under the pectoral muscle (Dual plane or subpectoral implants). Rotation is a specific risk with teardrop implants.

Changes in result over time Weight fluctuations and pregnancies and the effect of gravity over time can change the cosmetic result.

Inability or difficulty breastfeeding Most people following implants will be able to breastfeed and it is safe to do so. A small percentage may not be able to, particularly those who had pre-existing breast constriciton.

Altered breast sensation It is not uncommon to have patches of numbness following breast augmentation; these can be permanent. To have very significant numbness or total loss of nipple sensation is rare, however, can occur. Some patients can experience hypersensitivity following surgery and in the majority this settles but may take some months.

Breast pain Most breast pain settles in the weeks following surgery. Control of post-operative pain is important in preventing long term pain. Capsular contracture if significant can cause breast pain.

Changes in mammography or breast imaging As the implant is behind the breast tissue, it should not impact breast screening. However, any breast surgery can cause fat necrosis, scarring and imaging changes. Rarely these can result in calcifications and require further investigations with breast biopsy.

Need for investigation in the future MRI imaging may be necessary to detect a rupture or issue with the implants. This imaging is not covered by Medicare or your health fund and may be needed to determine an issue with the implant.

Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) This is not a breast cancer but a rare type of non-Hodgkin lymphoma that can occur in the fluid around breast implants and eventually spread into the capsule. The risk depends on the type of implant used and all textured implants are thought to carry a small risk of this.  Statistics of current implants and number of cases of this can be found here. Lifetime risk is 1 in 40 000. In most, the cancer is low grade and is treatable with removal of the implant and surrounding capsule.

Unknown risks of current implant technology The rare cancer associated with implants took years to detect and was found to be most common in an implant deemed safe through studies that had been performed over many years. Therefore, some risks may take years to become apparent. There is no robust evidence that breast implants have the ability to cause autoimmune issues or systemic illness.