Breast Surgery Options for Every Patient

Breast augmentation is an operation performed to increase the size of the breasts and improve their shape. Breast augmentation surgery also increases the firmness of the breasts, leaving the patient with a more youthful appearance. Mild ptosis (drooping) of the breasts can also be corrected by lifting them into a more youthful position during breast augmentation. Our experienced plastic surgeon, Dr. Darrell Perkins, is dedicated to giving all of his patients the appearance they desire. He utilizes a variety of technologies and techniques combined with an aesthetic eye to provide patients from Sydney and across New South Wales with the most natural-looking breast augmentation results possible.

Just like our breast lift, reduction, and reconstruction procedures, breast augmentation at our practice is completely custom-tailored to the specific needs and goals of our patients. Patients who are interested in undergoing breast augmentation have a variety of options to choose from with respect to breast size, prosthesis position, and the types of incisions used during surgery. These decisions can be made during the initial breast augmentation consultation at our practice.

Breast Size

The desired size of breasts for a particular woman is a very individual thing. Because patients will desire a variety of different appearances, it is a very important thing to convey to the surgeon what you are trying to achieve in your breast augmentation surgery. Some patients at our practice wish for a very natural look, some patients wish to be more “out there”, and other patients wish to have a very full upper part of the breast to give them a very “buxom” look. The general goal of breast augmentation is to provide harmony and symmetry to a patient’s body, giving them a “wow factor” for their great figure while avoiding an obviously augmented appearance. Some patients, however, may desire that look, which is something that should be discussed with the surgeon.

There are technical factors which govern the appropriate size of the breast implants used during augmentation mammaplasty. There are many factors which go into deciding the appropriate size of prostheses for a particular patient, including the height of the patient, the width of the patient’s chest wall, the prominence of the ribs, and the amount of breast tissue the patient has to start off with. Another factor that comes into account is how much loose skin the patient has, which is greatly governed by whether the patient has had children in the past or not.

There is no right answer to what is the proper breast size. Technical considerations and personal preferences concerning the patient’s breast size usually guide the augmentation decision. In many ways, breast augmentation is also a fashion decision, and varies between patients of different ethnic groups as well as the times. Careful consideration of each patient’s particular circumstances and desires is very important to achieve a result that is pleasing to both the patient and the surgeon. Dr. Perkins can help patients make these important decisions during a breast augmentation consultation. Please contact our plastic surgery practice to schedule an appointment.

Breast Implant Position

During breast augmentation surgery, the implant is usually placed behind the breast tissue. However, the prosthesis may for various reasons also be placed behind the pectoralis muscle, which lies directly beneath the breast tissue (subpectoral position). Alternatively, the prosthesis may be placed on top of the pectoralis muscle (subglandular position). Subfascial breast augmentation involves placing the implant below the fascia, or the thick fibrous layer on top of the muscle.

There are pros and cons to all of these approaches depending on the particular circumstance of the patient. If the patient is extremely thin, the prosthesis must be placed underneath the pectoralis muscle to allow the muscle to hold the upper pole of the breast implant. This is the case if there is not enough breast tissue to adequately hide the upper pole of the prosthesis and stop it from being evident after breast augmentation surgery. There is also a thought that there may be a slightly lower incidence of capsular contraction when placing the prosthesis underneath the muscle. In this position, though, the muscle only partially covers the prosthesis as usually the inferior fibres of the pectoralis muscle have to be released to allow the prosthesis to come forward into the breast tissue.

Placing the prosthesis under the glandular tissue during breast augmentation is certainly less painful than in a subpectoral position. It does allow the breast to move more easily after augmentation as the pectoralis muscle is not pinning the implant down. This approach does, however, require enough tissue to cover the prosthesis, and placing the prosthesis in a subfascial plane does provide more tissue to hide the upper pole of the prosthesis.

In the situation where there is a mild to moderate degree of loose skin which must be filled out, the prosthesis will usually do this to a greater degree if placed in a subglandular position.

Ultimately, each breast augmentation patient at our practice must be assessed individually, and the appropriateness of placing in front or behind the muscle again depends on a variety of variables, including the size of the breast implant used as well as the amount of available breast envelope that will cover the actual prosthesis. Careful assessment of each individual is very important to achieve the desired effect.

Breast Augmentation Incision

There are a variety of incisions that can be used during the breast augmentation procedure at our Sydney practice. However, the type of incision favoured by Dr. Perkins for breast augmentation is via the inframammary fold. This type of incision usually forms an excellent scar that can be hidden well in a bikini. The scar, which is located in the fold underneath the breast, heals almost imperceptibly in the vast majority of patients and allows them to wear any type of swimwear or clothing almost immediately following surgery. The inframammary fold approach allows very accurate dissection of the pocket, which minimises pain and bleeding during breast augmentation surgery. It allows release of the inferior muscles and adjustment of the inframammary fold without complications.

Although transaxillary breast augmentation is performed at our practice, Dr. Perkins usually does not recommend it because it is more difficult to accurately release the interior pectoralis muscle and then position the prosthesis correctly, and it is also much easier to get an anatomical prosthesis malpositioned and rotated. Many surgeons who use this approach during breast augmentation drain the breast because it requires blunt dissection of the pocket with subsequent bleeding. Transaxillary breast augmentation also puts scars in the armpit, which are readily seen when the patient lifts her arms up until the scar fades. In addition, there have been some recent studies raising the possibility that transaxillary breast augmentation affects the drainage of the lymph from the breast and the lymph nodes, and subsequently affects diagnostic procedures associated with breast cancer.

With the use of a cohesive gel breast implant, incisions around or through the nipple have become somewhat obsolete because of the required length of the incision to get the cohesive gel prosthesis through the wound.

Learn More about Breast Augmentation

If you are interested in undergoing breast augmentation, our experienced plastic surgeon, Dr. Darrell Perkins, can help explain all of your options so that you can make the most educated decision about surgery. For more information, you can also visit our frequently asked questions section. Please contact our plastic surgery practice, serving patients from across Sydney and New South Wales, to schedule an initial breast augmentation consultation. We also offer a variety of other cosmetic procedures and treatments that allow us to give your body a complete transformation, including rhinoplasty, eyelid surgery, liposuction, and more.