Breast augmentation mammoplasty (also known as a boob job) means increasing breast size by surgically inserting implants. The first breast augmentations were performed in the late 1960s. Since then many improvements have been made in both the technique of inserting implants and the implants themselves.

Breast augmentation is one of the most common and popular cosmetic procedures worldwide. Although comprehensive statistics on cosmetic procedures in Australia are not collected, it is estimated that there are more than 13,300 procedures per year. The breast implant registry states around 20,000 per year. In the United States where accurate data is collected, there were 313,735 breast augmentations in 2018 (up 9.4% since 2014). These women range in age from mid 20s to 80.

Different types of augmentation

There are three kinds of breast augmentation performed in Australia.

A primary augmentation refers to altering the size, form and feel of the breasts.

A revision augmentation refers to the need to correct the outcome of a previous breast augmentation surgery.

A primary reconstruction refers to the need to replace breast tissue as a result of damage, trauma or disease.

Costhetics invites you to learn more about breast augmentation so you can make an informed decision about whether this procedure is a good choice for you.

6 Reasons Women Choose Breast Augmentation

There are many reasons a woman might choose breast augmentation surgery. The five most commonly cited are:

1. My breasts have lost volume and firmness since I’ve had children.
2. My breasts look deflated since I lost weight.
3. One of my breasts is noticeably smaller than the other.
4. My breasts are too small for my body.
5. I feel self-conscious in form-fitting clothing like swimsuits, or in tops that have a plunging neckline.
6. When clothing fits my hips, it’s too large at the bustline.

Many women see their breasts as a vital part of their femininity and self-image. Women with small breasts may feel they look bottom-heavy, or skinny, or sexually unappealing. Breast implants can create balance to the figure and give it a curvier appearance.

Breast augmentation surgery can be quite a dramatic change, see below examples:

 

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A post shared by Dr Michael Miroshnik (@drmiroshnik)

 

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Who is a Good Candidate for Breast Augmentation?

Any woman who is in generally good health and who has realistic expectations regarding the outcome of breast augmentation surgery is likely to be a good candidate for this procedure.

Breast augmentation should be a purely personal affair. A woman who is depressed, trying to please a partner, or hoping to save a failing relationship should not have breast implants. The procedure is only appropriate for women who want it to improve their own self-image.

7 Things to Consider About Breast Augmentation Surgery

When you’re ready to have breast implant surgery, there are a few other decisions to be made. You and your surgeon will meet to discuss your options including:

Silicone or Saline – Breast implants are filled with either silicone or saline. There are pros and cons to each choice. Both implant types are coated on the outside with silicone, but the fillings are different.

Silicone implants are filled with a semi-solid gel. Because the implant material is a solid, there is very little risk of leakage. Saline implants on the other hand, are filled with a medical grade saline solution. Should these implants rupture and leak, the saline is absorbed into the body.

Silicone is said to feel more natural, but some women prefer saline because it’s similar to the fluids found in the body. Silicone maintains its shape much better than saline. If a saline implant loses its shape, it can cause the skin around the implant case to ripple, making the implant look obvious.

Smooth or Textured – All implants have a silicone coating on the outside. You can choose whether this outer shell is textured or smooth. A textured implant has a slightly rough surface, is thicker than the surface of a smooth implant, and can be more easily felt through the skin. Smooth implants are made with a shiny polished surface, which is a lot thinner than that of a textured implant.

The reason for the two different implant surfaces is to prevent the implant from rotating. Sometimes smooth-surfaced implants, especially round ones, can turn after they are placed. Theoretically, the textured implants ‘stick’ to the muscle or tissue and don’t move.

Your choice of implants needs to take into consideration your frame, the size of your chest wall and what implant shape and size you’ve chosen. Whether you choose textured or smooth as well as the kind of implant you have should be discussed with your surgeon.

Size – Size is a major decision for you. An implant that is too large for your frame will make you look top heavy and unnatural, and can, in some cases, cause neck and back pain from the weight. Too small an implant may be barely noticeable. Often surgeons provide their patients with a number of sample implants. Inserted in a bra, the implants can let you try on new breasts before having the procedure.

Shape – The two main implant shapes are either circular (round) or oval (teardrop or anatomic). Teardrop implants mimic the natural shape of the breast, with greater fullness towards the bottom. Round implants are perfectly round hemispheres with the entire material of the implant distributed evenly. Both of these implants have a flat base.

Profile – You can also choose low, medium or high profile implants. For any given size a low profile implant will have a greater diameter and lower projection than a high profile implant. The medium implant will be somewhere in between. Which profile type is best for you depends on your chest-wall shape and size, as well as your choice of implant size.

Implant shape and profile is something that can be discussed in more detail with your surgeon. It’s also a good idea to have a look at before and after photographs to get an idea of what these different shapes can look like after surgery. A high profile implant, for instance, will give you cleavage at a higher point on your chest than a low profile implant.

Under or Over the Muscle (placement) – A breast implant can be placed either under the pectoral muscle or over it. There are pros and cons to each choice. Your decision will depend on the type of implant you’ve chosen as well as the amount of breast tissue you have. Women who are slim and have a small amount of breast tissue are sometimes advised to have the implant placed under the muscle so it isn’t visible after surgery.

There is a slight difference in pain and recovery time between implants placed under or over the muscle. Under the muscle tends to be mildly more painful and requires a few days additional recovery time immediately post surgery. Both options should be discussed with your surgeon.

Dual plane placement

There is also something called dual-plane placement of breast implants. According to Dr Michael Miroshnik this is the “goldilocks” solution to implant placement where some of the implant is below the muscle and some of the implant is not. Dr Miroshnik says this type of placement allows the breast shape to be more customised to the individual patient by carefully placing a different amount of the implant under the muscle depending on her unique anatomy and desired look.

Incision Location – Your surgeon can make the incision to insert implants in four different places. The choice usually comes down to personal preference, but one important factor must be considered carefully: scarring. If you are a person who scars easily, the smallest and least visible location is best.

The four incision locations are:

• Around the bottom of the areola, where dark and light skin tissue meet (periareolar).
• In the armpit crease (transaxillary), ensuring absolutely no scarring on the breast itself.
• In the crease at the very base of the breast where it meets the chest (inframammary).
• Through the navel (transumbilical or TUBA), in which an incision is made in the belly button and an endoscope is used to push the implants up to the chest area. This scar is almost undetectable.

At present, the most common place for incisions is at the very base of the breast where it meets the chest.

How to Prepare for Breast Augmentation Surgery

There are things you can do leading up to any kind of surgery – getting enough rest, eating well, positive visualisation – that can contribute to a positive outcome. Click here to read the full list.

Your surgeon will likely provide you with a list of do’s and don’ts. Here are things specific to breast implant surgery you should consider:

• Put everything you will need (food, clean clothes, TV remote) in easy reach and below chest level at home, so you don’t have to raise your arms to get at them.
• Load up your bed with pillows. You will need to sleep in an elevated position for about a week following surgery. A wedge might help elevate your shoulders and head without flexing your neck.
• Speak to your surgeon about taking an anti-nausea medication prior to surgery if you think you might be sensitive to general anaesthesia or antibiotics.
• Your surgeon will advise you to wear a tight-fitting top or compression garment to support your chest for about 4 weeks following surgery. Your surgeon may provide this garment. If not, buy one or two fitted sports bras before surgery. Make sure these bras have as few joined seams and attachments as possible, as you’ll be wearing them 24/7 for a few weeks following surgery and don’t want to be uncomfortable, especially during sleep.
• Arrange for someone to pick you up and take you home after surgery. If possible, have someone stay with you for at least a night.

What Happens During Breast Augmentation

After you and your surgeon have decided on implant type, texture, size, shape, profile and incision location, you are ready to book in for the procedure. The operation will take approximately 1 hour and is performed in a hospital or approved day hospital under general anaesthesia.

Most breast augmentations are performed on an outpatient basis, which means you will probably be ready to go home a couple of hours after you’ve recovered from the effects of anaesthesia. When you wake up in the post-operative recovery room, your new breasts will be tightly bandaged and you will be wearing a post-surgical garment or the sports bar you’ve previously bought.

You will likely feel a bit tired and woozy. Even if you feel alert, you should not attempt to drive a car.

What to Expect After Breast Augmentation Mammoplasty

You will be able to return to most normal activities between one and two weeks after breast implant surgery. Those two weeks can be challenging, but what you do during that time can have a tremendous impact on the outcome of your procedure.

Your surgeon will provide you with after-care instructions, which you should follow to the letter to ensure optimal results. You may also be given a script for pain medication to help with any discomfort. A simple over-the-counter pain medication such as Panadol is often sufficient for the first week following surgery.

Here are other things that are a natural, to-be-expected part of breast augmentation mammoplasty:

• Bruising around your breasts should resolve in around 7 days. Your breasts may feel hard and a little high on your chest at first, but they will soften and settle into a lower position over the next few weeks.
• Chest pain should diminish as your muscles stretch.
• Lack of mobility, no arm strength and the inability to lift yourself out of bed under your own steam can last for two or three days after under-muscle breast implant surgery.
• You may also experience some pain in your arms and back. This is mostly because you will naturally want to hunch your back following surgery and your sleeping position will be different to normal. This, too, will diminish over time. Some short exercises, such as moving your arms around in a circular motion away from the body and raising and lowering your shoulders, should help with the discomfort. Do these exercises slowly to ensure you don’t stress your chest as it heals.
• Itching around the incision location is common after surgery. It will resolve as you heal.
• Your scars may take a full year to fully diminish or disappear. Be sure to follow your surgeon’s instructions on scar-healing treatments.

4 Things You Can Do to Speed Recovery after Breast Augmentation

1. Ice the chest area to reduce inflammation and swelling. A bag of frozen peas makes an excellent ice pack.
2. Don’t peek. Even though you desperately want to look at your new breasts, resist the urge and keep your bandages on until you next see your surgeon. You don’t want to get an infection by exposing the wound area.
3. Use a skin cream prescribed by your surgeon to help with swelling, redness, and discoloration.
4. Protect sensitive nipples by wearing a nursing pad.

Possible Risks and Complications Associated with Breast Augmentation

As with any surgical procedure, there are risks involved in breast augmentation. You should be fully aware of these before you consider surgery. The best way to reduce risk is to find a fully qualified surgeon with formal training in breast augmentation who has performed the procedure many times.

Make sure you familiarise yourself with the list of complications that could arise as a result of any surgery. Specific complications that may occur after breast augmentation surgery:

• Loss of nipple sensation as a result of cut or stretched nerves in and around the nipple area, especially if the incision is made on or near the areola. This risk is fairly low, but is worth taking into account.
• Capsular contracture can occur as a result of the body’s natural response to foreign materials. When a foreign object (i.e. a breast implant) is inserted, the body forms a lining around it and is programmed to shrink this lining the same way it does with scar tissue. As this happens the implants are squeezed and tightened within their cavity, which can cause them to feel hard. Sometimes the breast implants will need to be removed altogether as a result of extreme capsular contracture.

Many surgeons comment that implants that are too big can result in capsular contracture. Follow your surgeon’s advice on optimal size when choosing implants.

In severe cases of capsular contracture, implants can sometimes rupture or shift. Trauma to the breast area and injuries sustained from surgical instruments can also cause rupturing or shifting.

• Breast implants can wear out, and a rupture could occur after a long period of time.
• The implant can ripple against the tissue or muscle after it has settled into place. Textured implants are more likely than smooth ones to ripple, as the implant can ‘stick’ to the muscle of the breast wall.

Implants can sometimes interfere with the detection of suspicious lumps and lesions in the breast. Tell your radiologist about the implants before a mammogram or exam, so that he or she can push the implant away from the breast tissue and gain a better view.

The Facts About Breast Augmentation

Breast implants, like any other device, have a limited life span. It is impossible to know exactly how long an implant will last, but they usually last between 10 and 20 years.

It is obvious when a saline implant needs replacing, because once the outer shell has broken the saline starts to leak and the breast looks deflated. It is more difficult to tell when silicone implants need replacing, and for this reason it is advisable to have occasional MRI scans to establish if there have been any ruptures. Generally though, silicone implants have a history of lasting longer than saline.

Some women decide after having breast augmentation that they don’t like the feel or size of their implants. Breast implants can be removed whenever you choose. Occasionally, women who have large implants removed will have a degree of chest wall deformity and tissue loss. Sagging may also occur after the removal of implants and a breast lift may be required.

Breast augmentation has no effect on breastfeeding. The milk glands in the breast tissue determine how much milk a mother will produce, and implants don’t interfere with the function of milk glands.

The Average Cost of Breast Augmentation

Surgeon, anaesthetist and hospital costs will vary, but a breast augmentation procedure usually costs somewhere between $10,000 and $15,000 (AUD).

You should expect the costs to be higher if you are having combined procedures at the same time.

Read our article What Does Breast Augmentation Cost in Australia for more detailed information on all costs associated with breast augmentation in different locations around Australia..

Of course, for an exact price, this will depend heavily on the surgeon. You can generally obtain an all inclusive price by calling or emailing the practice, but it is possible this figure is not accurate as some women require a breast lift instead of, or together with implants which can greatly increase the price. Together with your surgeon you can discuss surgery specifics and obtain a personalised price estimate.

This information is correct as of 2019.