The breast is a very important symbol of femininity and has a very strong association with self-image in self-esteem. While breasts of many different sizes are completely normal for different women, a breast that is perceived as small can have a significant psychological fallout for that woman.
Some women have small breasts from the outset of breast development. Other women will have a breast size they are comfortable with before pregnancy and then suffer from post lactational involution of the breast and will end with a breast size far smaller than their pre-pregnancy breast.
To consider breast enlargement is an extremely personal decision and there are a lot of people who feel free to offer an opinion. Very frequently, these people do not suffer from having a breast size that does not match their self-image. This problem is one that can only be understood by a woman in this position. This does not make the problem any less significant for those who suffer from it.
The commonest groups of women that consider breast augmentation are:
There are three primary implant types and these are silicone, saline or polyurethane coated silicone implants (commonly called Brazilian or even Brazilian furry implants). Silicone is like rubber in many respects, by changing its chemical structure it can be firm and pliable like a sheet of rubber or sticky and runny like honey. Saline implants are covered by an external silicone shell and are inflated with saltwater. Silicone implants have a similar external shell, however they are filled internally with silicone of a different structure so that it is soft and feels more natural than the firmer outer shell.
Older styles of implants had a very runny gel like honey. This type of implant is still used by some surgeons. When our doctor uses silicone implants he uses “cohesive gel” implants that have a similar consistency to the inside of a Turkish Delight rather than being runny like honey. This type of silicone implant has a more stable shape.
There have been several generations of silicone implants. The initial implants inserted in the seventies had a fairly firm/tough capsule. Many of these implants are still removed intact today.
The next generation of implant was made to be softer and had a much thinner capsule and a very fluid gel. These changes were an attempt at making an implant less apparent by being softer and harder to feel. Unfortunately these changes led to implants which fell apart to easily creating additional problems.
These implants were inserted through the eighties and the problems were twofold: the capsules were weak and deteriorated too rapidly over time and many had ruptured within 10 years. The gel inside was very fluid and once released was able to move through tissues in some patients. This meant that the body reacted to the silicone creating lumps and distortion around the released silicone. This is the cause of many of the problems displayed in the popular media regarding “breast implant disasters” during the 90s. As many as 70% of these implants required removal within 10 years.
The current range of breast implants that our doctor uses have a much more complex and tougher capsule that makes rupture less likely. Additionally this implant has a silicone gel which use “cohesive” or “form stable”. If the implant is cut the silicon tends to sit together like the inside of a Turkish delight rather than running freely like honey. This type of breast implant has been used since the early nineties. After almost 20 years of availability is still very uncommon for these implants to require removal for rupture and the overall reoperation rate is perhaps 5% to 10% (or 1% per year) over the same period of time.
The other issue to consider is whether silicone itself causes disease. In the early nineties silicone was removed from general availability in Australia and in the United States of America. It was felt that there may be an association between silicone implants and autoimmune diseases. During this period of time the majority of breast implants inserted were saline as these were not removed from availability. Although saline implants commonly created a very nice outcome there was an increased rate of visible rippling, sloshing and they did not feel as natural as silicone implants.
The problems with this generation of silicone implant led to the now infamous court cases against Dow Corning. The problem for Dow Corning was that they needed to demonstrate there was no association rather than the plaintiffs demonstrate that there was. This information did not exist at that point however there is now a vast body of evidence demonstrating no association between silicone and disease. As a result of this research demonstrating its safety, silicone breast implants were again approved by the Therapeutic Goods Association (TGA) in Australia for general use in 2001.
Now that silicone implants are again freely available, most surgeons have reverted to this type of implant as the outcome is more natural than with saline implants.
Polyurethane implants were first introduced in 1968 and there is more than 40 years experience with this type of implant. Silimed produces the current range of polyurethane implants utilised by Dr Magnusson and they have been producing these implants since 1983 (almost 30 years). The implant is presently made of a smooth capsule cohesive gel silicone implant with a layer of polyurethane foam vulcanised to its surface.
In the 1980s polyurethane implants were temporarily removed from the market due to concerns regarding a potential to increase the risk of cancer due to a potential breakdown product. 2,4 toluene diamond (TDA) was found in the urine of patients with polyurethane implants and this has been associated with cancer in high doses in rats but not humans. Further investigation demonstrated that the TDA was actually created due to the effect of high-dose hydrochloric acid exposure on harmless polymers in the handling of the urine sample and did not actually occur in the body. As a consequence of this association does not exist.
Subsequent approval for unrestricted use is in place in Europe, South America and the Therapeutic Goods Association in Australia has also now approved polyurethane implants. Furthermore the Canada health protection Branch and the FDA in America have indicated that there is no significant elevation of risk of cancer associated with polyurethane breast implants.
All breast implants regardless of manufacturing methods will need further surgery in due course. On average one in 100 implants will require a reoperation every year. This means a small number of patients will require further surgery in the first couple of years following a breast implant operation. The majority of patients won’t require a further procedure for many years.
About one in 10 patients will require further surgery by 10 years.
The scientific literature will show that there is no increase in infection rate or seromas with polyurethane implants compared with standard smooth or silicone implants.
Some patients would simply prefer to have a polyurethane implant inserted.
Some reoperations occur for reasons such as implant rotation or downward movement. Polyurethane implants are less likely to have these types of problem and therefore in patients where this is more likely a polyurethane implant may be beneficial. This is especially true for patients with a very short distance between the nipple and the fold underneath the breast where this fold needs to be lowered. This increases the possibility of downward implant migration and he’s a group of patients that may benefit from a polyurethane implant.
Polyurethane implants are also associated with a low rate of capsule formation. The rate of capsule formation with modern silicone implant varieties when surgery is performed by an experienced surgeon who performs this surgery regularly is much lower than with older varieties of implant. As a consequence the indication to use a polyurethane implant in the first instance is not clear-cut however using this type of implant is one of the considerations for patients with recurrent capsule formation.
The implant varieties used by Dr Magnusson are all approved by the TGA (Therapeutic Goods Association) of Australia. This is true for the silicone implant varieties (Allergan and Mentor) as well as the polyurethane implants (Silimed). This approval is based upon the availability of scientific evidence that these implants are safe.
There are generally two broad categories of implant shape: round and anatomical. Anatomical implants are generally based on a more natural breast shape having more projection “beneath the nipple”, and they don’t have a perfectly round circumference. In this way, they more closely match a natural breast shape.
The choice of a breast implant for each individual woman comes down to a number of factors. Firstly it is important to understand what the patient is trying to achieve in shape and size. There are also physical factors to consider such as the tightness of the breast skin, the amount of breast tissue present, the presence of breast ptosis (sag) and whether or not a woman has previously been pregnant or breast-fed. The individual choice for a patient cannot be generalised without a full discussion and physical examination.
Dr Magnusson uses both round and anatomical implants on the basis of these considerations.
In different women both choices will be appropriate. Women with a very small volume of breast tissue however are far more likely to require implants behind the muscle. Is also important to consider social factors such as occupation and hobbies. A woman with a very active lifestyle or an avid involvement in competitive sports may be better with implant above the muscle. In general though, most women will have an implant beneath the muscle. The individual choice for a patient cannot be generalised without discussion and examination.
It is important to understand that we are starting with your breast. We will be increasing the size of your breast and not providing you with someone else’s. As an example, two women with a similar breast size may have different chest shapes, a different amount of cleavage to commence with and different amounts of breast sag. Both these women may achieve an excellent outcome for them yet the final result will be individual.
The proportions of your current breast will dictate the maximum volume implants that Dr Magnusson will suggest. In general, a medium-size implant is going to give you a more natural result than a large implant beyond the maximum volume suggested for your breast dimensions. Breast implants don’t come as cup sizes. They are available as different volumes. The final aim of surgery is to create a general breast form rather than a specified cup size. It is important for you to set a goal for your final outcome as the combination of this goal and your examination by Dr Magnusson will set the course of your discussion with Dr Magnusson. During this discussion he will provide advice but you will ultimately choose your own implant size. Dr Magnusson will guide you with this selection.
For some women, especially following pregnancy/breast-feeding or significant weight loss, a breast implant alone will not achieve the desired result alone. In these women it may be necessary to consider a breast lift/mastopexy as well as an implant to increase size. If your nipple is pointing down and has fallen below the fold beneath your breast (intramammary fold), this increases the chance that you will require a breast lift to achieve the ideal outcome.
For the vast majority of women, choosing to have breast augmentation is considered a cosmetic procedure and has no assistance from Medicare or health funds. Small group of women with significant breast asymmetry (differences in size) will gain approval for the enlargement of one breast. Women who have had a mastectomy and require a breast enlargement on one side will also gain approval for enlargement of the affected breast. For further information about your own policy you should contact your health fund.