Bilateral Breast Augmentation

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    Breast augmentation is a surgical operation performed to enlarge the breasts for a number of reasons:

    • To enhance the body contour of a woman, who for personal reasons feels that her breast size is too small.
    • To correct a loss in breast volume after pregnancy.
    • To balance breast size, when there exists a significant difference between the size of the breasts.
    • As a reconstructive technique to restore breasts after mastectomy or injury that has resulted in partial or total loss of the breast.

    Replacement of breast implants following complications of enlargement with implants.

    Implants should not be used for women who:

    • have existing malignant or pre-malignant cancer of the breast without adequate treatment
    • have active infection anywhere in the body
    • are currently pregnant or breast feeding

    Breast augmentation is one of the most common cosmetic surgical procedures performed.

    Breast augmentation is an elective surgical operation that is normally performed under general anaesthetic.

    Types of breast implants

    In Australia there are 3 main types of breast implants - normal saline, silicone gel or a double lumen implant with a saline filled core and a silicone periphery. All breast implants have an external silicone shell and the internal material is either saline (salt water) or silicone .

    Currently silicone implants from several manufacturers are readily available in Australia.

    Breast implants are available with either a smooth surface or a textured surface. Surgeons have their own preference as to which they prefer.

    Implants can be round in shape with differing diameters (sizes) and projection (heights)

    "Tear drop" or anatomical shaped implants are also available and are popular with some surgeons.

    Surgeons may have their own preference as to which they prefer.


    Anatomy of a normal breast

    The breast is made up of fatty tissue (orange in the illustration), milk ducts and glands (purple in the illustration) covered with skin.

    It is the fatty tissue that makes the breast soft and gives it its shape. Below the breast lies the pectoralis major or chest wall muscle. Breasts contain no muscle tissue, so there is no point in doing exercises in order to enlarge them.

    Factors affecting breast size and shape
    Breasts that are composed of a lot of glandular tissue and a little fatty tissue tend to be firm. With age, the glandular tissue gradually makes way for the fatty tissue and this is why breasts become a little flabbier in the course of time.

    Gravity will cause the upper part of the breasts to become emptier, which means that the breasts droop more.

    Weight loss causes loss of fatty tissue from the breast and sagging of the breasts.

    Pregnancy and breastfeeding also affects the shape of the breasts.

    The shape and size of the breasts prior to surgery will influence both the recommended treatment and the final results.


    The procedure

    Breast enlargement is accomplished by inserting a breast implant either behind the breast tissue (subglandular) or under the chest wall muscles (submuscular).

    The subglandular placement may make surgery and recovery slightly shorter and may be slightly less painful than the submuscular placement. However, subglandular placement may result in more palpable or visible implants and more difficult imaging of the breast with mammography.

    The submuscular placement may make surgery and recovery slightly longer and may be slightly more painful. The possible benefits of this placement are that it may result in less palpable and visible implants and easier imaging of the breast with mammography.

    Incisions are made to keep scars as inconspicuous as possible, usually under the breast or around the lower part of the nipple/areola.

    The incision around the nipple/areola is well concealed, but may be associated with a higher likelihood of inability to successfully breast feed, as compared to the other incision sites. Numbness around the nipple may be more common with this incision.

    The incision in the fold under the breast fades well but may not always sit exactly in the skin fold.

    The method of inserting and positioning breast implants will depend on your preferences, your anatomy and your surgeon's recommendation.

    Other considerations

    Implants may be more easily felt in the following circumstances:

    textured implants, larger implants, subglandular placement and the lack of adequate skin/tissue available to cover the implant.

    Implant size is one of the most important considerations in breast augmentation surgery. You should try to determine the desired size of your augment with your surgeon prior to your surgery.

    When choosing size take care not to go too small as you will be disappointed in the long term. To the contrary choosing a size that is excessively large for your chest may result in complications such as visible implant edges, skin thinning and accelerated sagging of the breasts.

    Please note that large implants in a large person may appear smaller than moderate size implants in a small person.

    The final result that can be achieved from breast augmentation is very much dependant upon your initial appearance.

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    Silicone Research
    There have been multiple scientific studies with respect to the safety of silicone breast implants. Silicone is a polymer that is in the form of a liquid, gel or solid.

    It is found in cosmetics, some medications and many medical devices such as intraocular lenses, heart pacemakers and tissue expanders.

    Costs of breast implants

    Medicare benefits are payable in relation to the following medical services:

    The insertion of breast implants where surgery is required for medical reasons eg, following mastectomy or for significant breast deformity.

    The removal and/or replacement of your implants where clinically indicated. In view of the concerns with silicone medicare benefits are payable for the removal and replacement of silicone breast implants.
    Tests for autoimmune disorders if you are experiencing symptoms of these disorders.
    It is recommended that you find out the total cost of any procedure or treatment before having it performed.

    If you have private health insurance, your insurer may pay some of these costs.
    It is up to you to find out whether your private health insurance will cover these costs.

    Medicare will not assist with the costs listed below:

    The costs for surgery to insert the implants, or for reconstructive surgery following the removal of implants, where the surgery is performed for cosmetic purposes, ie, to improve the appearance of your breast.

    These costs can be quite high, and would include the cost of the anaesthetic and any assistance at the operation.


    The cost of the actual implant device.

    The costs of health screening services (eg, mammography, ultrasound, magnetic resonance imaging) where you are not showing actual symptoms but just want to have a routine check of your implants.

    In general, the costs of any surgery will depend on where your surgeon chooses to perform the operation and whether you go into hospital as a public or private patient.

    Private patients in either public or private hospitals are required to meet accommodation and all other charges by the hospital, either personally or through private health insurance. If you do not have private health insurance the hospital costs may be quite high and it will be your responsibility to find out these costs

    Breast Implant Register

    This web site allows your surgeon to record information specifically regarding the implants used in your surgery. This information is confidential but can be accessed by you in the future using your log in name and password.

    • This has been established with several purposes in mind:
    • To enable direct provision to you of new information regarding your device, should problems become apparent.
    • To enable assembly of a broad database valuable to ongoing medical research
    • To provide a secure, safe haven for details of the device you have received, for your own future reference.
    • The register contains your name, date of birth, contact details, date of the procedure, name of the hospital or surgery and the particulars of the device or devices implanted.

    This information is securely archived by this web site.

    Certain information is also stored electronically on a database used for ongoing medical research and assessment. Access to the database is limited to recognised medical research personnel and is strictly controlled, however as a failsafe protection of your privacy, names and contact details are erased prior to transfer of information. The database is anonymous.

    In the unlikely event of future complications, you know where your data is archived.

    If you forget your password in the future, contacting the web site and completing our privacy procedures to confirm your identity will allow us to issue you with a new password. Alternatively you may contact your treating surgeon for details regarding your implants.

    It will not matter if you move interstate or change your doctors, or whether your surgeon retires, relocates, or has your records destroyed. Your information will still be available to you.

    Please ask your surgeon for more details.


    Alternative Treatments

    Breast augmentation is an elective surgical procedure.
    The alternatives to surgery are not undergoing the operation.
    Suitable clothes may be worn to cover up breasts or enhance the breasts such as push-up and padded bras.

    Gel inserts may be used inside a bra to make breasts appear larger

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    All surgery is associated with some risk

    It is important that you understand that there are risks involved with any surgery.

    Whilst the majority of individuals undergoing surgery do not experience any complications, a minority do and there cannot be any guarantees in surgery.

    With every type of surgery the best possible outcome is sought. The importance of having a highly qualified surgeon and professional surgical team and facility cannot be overestimated.

    Risk to benefit

    The choice to undergo a surgical procedure should be based on the comparison of the risk to the potential benefit to you.
    Make sure that you take time to read and understand how each potential complication can impact on your life and try to make the risk to benefit comparison specifically for yourself.

    Informed consent process

    Before any surgery, your surgeon should explain to you the risks of the procedure and the possible complications that could happen. The informed surgical consent web site will help you to understand the risks that your surgeon has already discussed. It may also bring up other issues that will require a second surgical consultation to clarify. You should not feel that you are being an inconvenience by seeking another consultation and clarification of any questions that you may have.

    You should take the opportunity to read this informed surgical consent website carefully and at your own pace. The questionnaire at the end will help to clarify your understanding. There is also opportunity to make note of specific concerns and issues that may be relevant to you. Discuss these concerns with your surgeon.

    Impact of complications

    The risks of surgery involve possible inconvenience if a complication occurs. It may result in an extension of your recovery period and in some cases may need further surgery. Infrequently, complications may have a permanent effect on your final result.

    Financial risks

    Financial risks are involved with any surgery. Private health insurance is strongly recommended. If you do not have private health insurance then a complication or further surgery will add to the overall cost of your surgery.

    Risks related to general health

    Your general health will impact on the possible risks of surgery. Many of the risks associated with surgery can be predicted, however, your general health plays a vital role to the outcome of your surgery.
    Age carries a greater risk with any surgery. Being overweight carries a greater surgical risk. Other medical conditions such as high blood pressure, high cholesterol, diabetes, heart and lung disease may also increase your surgical risk.
    Smoking greatly increases all risks and complications of surgery.

    What else?

    Finally other factors, that may not be obvious, can influence the outcome of your surgery and the risks are beyond anyone's control.

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