Breast Enlargement / Breast Implant Surgery

Choosing Your Implants

The shape, profile and volume of your implants should be selected based on discussion and close consultation with Dr Konrat.

You should first establish very clear goals for your breast size and shape. This is critical to achieving the best outcome from your surgery.

Implant sizes range from 120 gm to 900 gm. Shapes are either round or 'tear-drop'.

After surgery, a silicone gel implant cannot be adjusted. If you wish to have different sized implants, this will mean a second operation and additional costs.

Your choice, therefore, needs to be realistic, made in the context of the best outcome, not just for the present, but also for the rest of your life.

• The shape and size of your breasts change over time.
• Breasts tend to sag, droop and lose their volume with the passage of time. Pregnancy, breast-feeding and weight gain or loss can all affect the size and volume of your breasts.
• Your expectations of the ideal breast size and shape can vary, depending on your stage of life, so that what you desire now may be unsuitable in twenty years` time. You can either choose for the present with the expectation of needing further surgery to change your implants later in life, or you can choose the best compromise for the long term.

Dr Konrat believes is it very important to 'play' with potential shapes and sizes, by working with the special elastic bra ('sizer') and inserting various sizes and styles of implants until you achieve your ideal 'look'.

Replacement

• If, after the swelling has resolved, you decide your implants are too big or too small, you may decide you want to have the implants replaced with a larger or smaller size.
• The cost of replacement will be similar to that of the original surgery.

All About Cohesive Silicone Gel Breast Implants

Dr Konrat believes that because every woman is different, it's important for patients to have access to the widest possible range of implants. She has samples of all the available implants, all of which are officially approved by the TGA (Therapeutic Goods Association of Australia). Because individual requirements have such a strong impact on the choice of implant, Dr Konrat will conduct a thorough examination before recommending the best implant for your body shape, type and your desired result. This enables doctor and patient together to choose the right implant for the best result.

Implant Surface: Smooth or Textured

• Smooth implants move freely in the surgical pocket and their shells are thinner. They can be inserted through a smaller incision and there is generally less of a problem with rippling, unless a woman has a very thin upper body.
• Textured implants were originally designed to prevent Capsular Contracture (there is still some debate as to whether they achieve this). Overlying tissue grows towards the implant and 'grabs' the textured surface, to prevent the implant moving freely in the pocket. Rippling on the skin surface can occur if the tissues and the implant move in different directions.

Implant Shape: Round or Shaped/Anatomical/Tear-drop

• Shaped implants (sometimes called anatomical or 'tear-drop' implants) are fuller at the base than the top. This mimics the natural shape of a woman's breast by providing more fullness in the bottom half of the breast whilst still ensuring that the whole breast has a full volume natural look.
• There can be specific technical reasons for using this type of implant, and Dr Konrat will discuss this fully with you at your consultation if you are a candidate for this type of implant.
• Shaped implants can turn or flip in the pocket (surgical cavity), so they usually have a textured or micro-polyurethane outer cover to help maintain their position. (The 'super-furry Brazilian' implant is one of the most advanced of this technology.) For most women, these implants give a much more natural look than the round implants.

Implant Profile/Projection

• This describes how far the implant projects from the chest wall.
• Implants come in many profile styles. The reason why one implant profile style will be chosen over another will depend on your body shape (e.g., size and width of rib cage, how far apart your breasts are), the current shape and size of your breasts, and the final shape you want to achieve.
  • Low profile is wider in its diameter and flatter in how far it projects from the chest.
  • Moderate profile provides the most usual combination of width and height.
  • High and Ultra-high profiles describe how far the implant makes your breasts 'stick out' in front. Rather like a hill that is narrow around the base but very steep and high. Compare that with a hill that takes a long time to walk around the base and has a very gentle slope and is not very high.

Implant Size

This is probably the most important decision you personally have to make: while Dr Konrat can advise you and help you to visualise the final results, you must make the final decision on the size of implant.

Here are some facts to think about:

• The most common reason for women with breast implants to request replacement surgery is dissatisfaction with their breast size (either too big or too small).
• Your breast size looks more natural when it is in proportion to your overall body shape and size.
• You should attend your first consultation with Dr Konrat with a good idea of your desired size in mind. Dr Konrat will use 'sizers' to demonstrate as closely as possible the final result using a variety of implant sizes and styles.
• Because this is such an important decision, you will be invited to visit the surgery for re-sizing as many times as you wish prior to your surgery, to ensure you are comfortable with your choice.
• The final implant size is also impacted by a number of factors such as tissue thickness, breast volume, nipple sensation, familial traits of large or droopy breasts, and anatomy with size from inframammary fold to nipple and chest width. Dr Konrat will discuss this in detail with you.

The size of your breasts after surgery depends on a number of factors:

• The size and fullness of your breasts before surgery
• The length of your body from shoulder to waist
• The width of your chest
• The width of your breasts at their base
• Chest shape
• Your height without shoes

Incision

An incision is made to create a surgical pocket in which to place the implant. It can be made in any one of the following places:

• Infra-mammary fold (crease under the breast): this is Dr Konrat's preferred incision as it hides the scar well. It also provides the easiest and safest approach for the doctor and is the one most commonly used. Experience has proved that the lowest rate of complications is associated with this type of access.
• Peri-aerolar (around the pigmented or coloured area of the nipple): this leaves a very thin scar on the edge of the nipple, which is always visible. The biggest risk of this type of incision is loss of sensation in the nipple.
• Axillae (underarm): This is most often used when the implant is placed under the muscle, but it can be used for over the muscle implants as well. There is an increased risk of asymmetrical placement of the implants and riding or descending of the implants, as well as an obvious scar under the arm.
• The width of your breasts at their base
• Through the Navel: Due to the risks and complications involved and the need for the use of saline-filled implants, Dr Konrat does not use this approach.

At your consultation Dr Konrat will advise which incision choice will be right for you and discuss her reasons for her advice.

Implant Placement

There are three options for the placement of the implant:

• Sub-muscular completely under the pectoralis muscle:
  • This may give less interference with mammography examination of the breasts;
  • It can result in less obvious implants in women with very little breast tissue, or who are very thin; however, with the choice of the right implants, even very thin women can have their breast implants placed under the breast tissue (sub-glandular) with success;
  • Tensing the chest muscles can pull across the top of the implants causing a visible change in the shape of the breasts, particularly when exercising the upper body;
  • Weight gain or loss, or breast changes associated with pregnancy or breast-feeding may lead to 'sagging' of the breast tissue over the implants, causing a 'snoopy' effect.
• Partially sub-muscular ' a combination of sub-muscular and sub-glandular for specific circumstances. Dr Konrat will discuss this in detail at your consultation if it is a viable option for you;
• Sub-glandular ' on top of the pectoralis muscle, but under the breast tissue:
  • This provides the most distinct cleavage line, with the fall and drape of the breast likely to appear more natural in most women;
  • In some very thin women there may be a risk of 'rippling' with sub-glandular placement, but this can usually be avoided with the right choice of implants;
  • Sub-glandular may make surgery and recovery times shorter; it is definitely much less painful (because there is no need to cut through the muscle), and it may be easier for access if re-operation is ever required.

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