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:
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.
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.
Most patients having breast enlargement will have breast implants. In some instances we will use autologous fact grafting in combination with implants or on its own for breast enlargement and breast shaping.
Dr Magnusson uses silicone breast implants that have cohesive gels with both smooth and textured surfaces for different patients. Different implants have different performance benefits and risk profiles and an individual implant selection will be made for each patient according to the breast tissue that they already have and the goals they have with respect to size and shape. Your individual implant selection will be rationalised and explained for you including any additional options that may apply.
Silicone breast implants are one of the most investigated medical devices in history.
Breast implant surgery is a real operation with risks and breast implants aren’t life devices so eventually they will need to be be removed. The overwhelming majority of patients will go at least 10 years with their implants but fewer patients will still have the implants at 15 years.
Bacteria are associated with risks and complications relating to breast implant surgery particularly along the lines of infection, capsular contracture and also BIA-ALCL. Dr Magnusson is a champion of the 14 point plan which are a series of operative steps designed to mitigate against bacteria at the time of breast implant surgery.
Breast implants have been examined for a potential association with connective tissue or rheumatic diseases for a condition called Breast Implant Illness and this led to a moratorium on the use of breast implants in the 1990s but no association was found. After 40 years of investigation by regulators, health departments, immunologists, rheumatologists, epidemiologists and surgeons there is still no definitive evidence that there is an association between silicone and these conditions. Nevertheless there are patients who don’t sit comfortably with their breast implants and do feel better when they are removed although most patients are highly satisfied with their outcomes.
Despite a lack of association between silicone breast implants and BII between silicone breast implants and BII Dr Magnusson does have an open mind and is involved in collaborative research involving patients who feel they may have symptoms of this type.
Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare association with breast implants that most frequently presents as swelling of the breast. In the early stage of this disease the removal of the implant and the capsule that the body forms around it is curative with no requirement for chemotherapy or radiotherapy.
Dr Magnusson is involved in international collaborative research with several publications on BIA-ALCL and is one of the joint leads for research and management advice on a multidisciplinary task force for this condition in Australia and New Zealand. He is also sits on a Therapeutic Goods Administration (TGA) Expert Advisory Panel for this condition.
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.