Breast Augmentation Questions Answered

Dr Turner: Hi

Patient: Hi Scott Turner, I’m looking to get a breast augmentation, do you mind going through with me the different types of implants that you offer?

Dr Turner: There’s multiple different types of implants, and when we look at implants we break it down to sort of a 5 or 6 different types? So, first thing we look at is the shape of the implants. The implants can typically be a round implant where the width and the heights the same, then you can adjust the different projection of the implants and that’s how we adjust the volume. Or they can be anatomical shaped or teardrop type implant where the top is more natural compared to a round one and there’s a lot more volume at the bottom. And with teardrop or anatomical implants we can adjust the width, the height and the projection differently so we have a bit more variability with the teardrop implant.

Then when we’re looking at implants we’re looking at the substance of implants. Implants can typically contain silicone or they contain saline. Saline implants used to be used a lot especially when you’re concerned about the safety of the silicone. But now we almost universally use a silicone gel implant. And the gel inside the implant, depending on a round implant or a shaped implant use a different cohesitivity so depending how viscous the gel is. So when some of the round implants, they’re really a soft gel, so they feel quite natural. And then with the more anatomical shaped implants they’ve got a bit of firm gel and its almost like Turkish delight, if you cut these in half and squeeze the liquid doesn’t run anywhere compared to older gel implants. So if there is ever a rupture they don’t leak to the glands in your armpit like the older implants.

Then when we look at the implants, we look at the shell of the implants. Implants can either be typically smooth or smooth silicone implants or it can be textured where the implants are a little bit roughened. Roughened implants were (invented really to) minimise what we call capsular contracture, the hardening around the implant. And there are different types of textures from the different brands and they have some slight pros and cons between them. And then you have what we call Polyurethane implants which is basically a smooth implant with a Polyurethane coating volcanised on the surface of the implant. And these are really use to minimise capsular contracture and they’re very grippy so once you put them in they don’t move or rotate. But that Polyurethane coating is degraded by the body over after 5 years then it becomes a smooth implant again.

Patient: I was wondering about, scarring whereabouts we’re going to do the insert, if it’s going to be under the muscle or above and where about the scars would be.

Dr Turner: And then we look at implants where we put the implants. So we can put the implants in on top of the muscle or below the muscle or a combination or what we call Dualplane. And we go the pros and cons why we choose one of the other and a lot has got to do with soft tissue coverage under your chest, and the volume of your breast tissue. Looking at your breast anatomy, do you have a very natural breast shape, or do you have a breast anomaly like a tuberous breast. What you need – if you got a little bit of breast ptosis where your breast is dropped and you need a little bit more lift and we can go through that when we do the examination.

And then with scar where we placed implants, so there’s 3 typical locations that we put a implants into the breasts is either in through the inframammory fold so the breast crease, around the areola or through the armpit. Almost universally now we put implants through the inframmamary fold, the breast crease. And this comes back to the incisions around the areola. With the small form type of gel implants because they’re not compressible like old saline implants you need a slightly longer incision about 4 and a half to 5 cm. With the old saline implants you can put them through a small 2 or 3 cm implant. But with modern implants especially you need a slightly longer incision most people with areola isn’t big enough to put an implant through there.

Also, the areola and the nipples is an area of the breast where there’s lots of bacteria so we prefer not to use that site because there’s increase risk of contamination of the implant when we put it in, and that increases your risk of capsular contracture. So using the Infermammory fold, or the breast crease, is much cleaner site and has a lower risk of revision. Same with the armpit. The armpit is full of bacteria and has a high risk of contamination during implant insertion. And you can’t use a shaped implant when you put it through an armpit because you can’t control the rotation of the implant when we put it in.

So those are the few basic points that we get through when we select different implants.

Patient: My last question is, I was just wondering about breastfeeding. I’m looking forward to have children in the next few years and I was wondering how would I go with breastfeeding with implants in.

Dr Turner: With breast implants, breast implants shouldn’t interfere with breastfeeding. When we put an implant, even if we put the implants on top of the muscle or below the muscle we’re not interfering with the basic nipple areola complex or the gland. So the innovation to the breast gland and the nipple is intact so your ability to breastfeed should be the same. What we don’t know is how responsive your breast tissue will be once you get pregnant and you breastfeed. So some people can have small breasts, they breastfeed and their breast become quite large and their skin doesn’t tolerate it and they stretch. So if you have an implant in you might be more likely to have breast ptosis after breastfeeding with an implant than if you did not have breast implant. Also, some people can have a like C cup breast and aren’t able to breastfeed and their breastfeed aren’t overly responsive and so that they don’t get anything stretching. So theres a little bit of unpredictability, especially if you have a bigger implant and then you breastfeed you might stretch your skin more. And have a high risk you might need a lift in the future that you may not have needed if you didn’t have a breast implant.

Also in going forward over time we know probably about 50% of women by 10 years needs some form of revision. Whether it’s because they’ve breastfed and the breasts have dropped or they want bigger implants, smaller implants, they’ve have a complication such as capsular contracture. So, most people have another procedure at some stage in their life. By 10 – 15 years, over 50% will have another procedure, but almost a hundred percent you’ll have another procedure at some stage in your life with a breast implant.