Breast Enlargement (Augmentation)

Breast implants can go hard due to what is called “capsular contracture”.  A capsule is caused by a build-up of scar tissue around the implant. This hardening is more common with the silicone filled breast implants, especially when they are positioned behind in front of the chest muscle.  The risk of capsular contracture increases with time.

Whilst some of the newer textured implants claim to have a reduced rate of capsular contracture, they too are not without their problems as textured implants have been implicated in concerns about ALCL (Anaplastic large-cell lymphoma).

The most common incision sites are under the breast, around the nipple or in the armpit. Breast implants have also been described as being inserted endoscopically through the navel (saline only). 

The choice of incision site needs to be discussed with your surgeon as just with the type of implant.  All incision sites have certain advantages and disadvantages. The preferred incision for Dr Lotz is in the crease under the breast, as this offers the best visualization and the scar hides nicely in the fold.

While the armpit avoids any potential scarring on or around the breast, it makes if very difficult to accurately place the implant, and has a high revision rate. Incisions around the nipple have a higher risk of issues with loss in nipple sensation. It also risks contamination of the implant from touching the breast tissue when it is inserted, which increases the risk of ALCL.

Both the type and size of breast implant that are appropriate for you depends not only on the shape and size you wish to achieve but need to be measured against your existing breasts and your chest wall to determine what will work best to give you the result you desire. Breast implants come in many shapes and sizes, all of which are factors in the ultimate shape and look.

There are several factors that determine the best implant placement. For women who are very thin, generally placing silicone gel filled breast implants partly under the chest muscles is often a better choice to avoid implant show through the skin. Implants under the muscle have a lower risk of capsular contracture (hardening over time).

An implant placed in front the muscle is a little less painful initially, and allows better filling of the loose skin if needed. However, you need to make sure you have enough breast tissue or you risk visibility of the implant edge.

I use Mentor, textured, silicone gel filled implants, as they have been in use for many years and have a proven safety record. They have a very low risk of ALCL compared to other implants, and I find the gel gives a very natural feel.

This will be discussed in your consultation. Round implants will give more fullness to the upper part of the breast than anatomical implants. If you have no breast tissue at all, the final breast shape will be determined by the implant, so a tear drop (anatomical) implant will give the most natural result.

With careful selection of implant size and shape a natural look can be achieved, but this needs to also be looked at with respect to your body shape and how much breast tissue you already have.

Breast implant associated ALCL (anaplastic large cell lymphoma) is a cancer of the immune system caused by breast implants. It is generally found in fluid collection in between the implant and capsule, and usually presents as a swelling of the breast. It occurs in association predominantly with textured breast implants with a rate between 1 in 2200 and 1 in 86000 (American Society of Plastic Surgeons, October 2019). The average time from surgery to diagnosis is 8 years. Removal of the implant and the capsule is required and it usually has a good prognosis. As of March 2020, only 4 women in Australia have died from this in the last 10 years.

Dr Lotz uses predominantly Mentor implants which have a relatively low risk of ALCL.

Silicone breast implants have come a long way.  The implants are now filled with a highly viscous grade of silicone get that is similar in texture to ‘Turkish Delight’. This substance is more easily contained and removed should the implant rupture and leak.  Because no implant will last forever and because small defects in implants may be undetectable for an unspecified period of time, it is recommended that women have regular annual check-ups.  Any hardening, suspicions or irregular ultrasounds should be followed by an MRI for a definitive diagnosis.  The average life span of all implants averages approximately 10 years and this need for further surgery should be factored into the decisions to have breast implants.

Getting natural looking breasts with breast implants is possible.  If a natural look is what is desired, then it is possible for an experienced breast surgeon working with the patient desires to choose the size, shape and position correctly and create a natural breast shape that is in balance with your body. 

Most patients can return-to-work in one to two weeks after breast augmentation surgery. The time required may depend on how physically demanding the patient’s job is. Most patients will be back at office work in about a week, whilst more involved work may require 10-14 days off. Patients should avoid any strenuous activity for a month, but gentle exercise can be resumed after a couple of weeks. You will be back to full activity 6 weeks after the breast augmentation surgery.

Following your initial consultation with Dr Lotz, you will be provided with a detailed, personalised quotation which explains all the relevant costs pertaining to the breast enlargement procedure including all surgeon, anaesthetist and hospital costs.