Breast Implants / Breast Augmentation

• A consultation (approximately one hour long) with Dr Georgina Konrat will include a comprehensive presentation of information about breast augmentation / breast enlargement surgery. She will listen carefully to your description of your reasons for wanting breast implants, and the results you want to achieve.
• Dr Konrat will ask important questions about you and your health (your medical history).
• Dr Konrat will examine your breasts, noting their size and shape, the quality of your skin and other physical details necessary to assist in the planning of your breast implant surgery.
• You will have the opportunity to have fun planning your post-surgery ‘look’ by putting on a special elastic bra (a ‘sizer’), and different sizes and styles of implants will be tried on to assess the style, size and shape that will achieve your ideals.
• You will be given an information kit to take home. We understand that you may not remember or understand everything you hear in the consultation, so we encourage you to make notes as soon as possible after the consultation, and call or email the clinic with any concerns or questions you may have about the surgery.
• At least one week prior to surgery, blood tests will be taken and pre-operative mammogram screening is recommended.
• In order to have the best healing result, Brisbane Cosmetic Clinic recommends:
• Eat a diet rich in vegetables, fish, fruit and salads;
• Commence taking Vitamin C and D, Zinc and Selenium.
• Drugs:
  • Do not take aspirin or anti-inflammatory drugs ten days before and ten days after your operation. These medicines can thin your blood and aggravate bruising or bleeding.
  • You must discuss any use of ‘leisure drugs’ with Dr Konrat at the time of your consultation, as these could also have an impact on the success of the surgery.
• If you smoke, you must cease for at least two weeks before and one month after your surgery.
• Pre-operative and post-operative instructions are provided in the brochure given at the time of the pre-operative appointment, or are sent to you once you have booked a date for your surgery.
• Brisbane Cosmetic Clinic staff are pleased to answer any questions after your consultation, and you are encouraged to return for a second consultation or ‘sizing’ any time you feel it would be useful.

The Operation

• Breast Implant surgery is done in an accredited and licensed Day Surgery Hospital under general anæsthetic.
• The procedure usually takes between one and two hours.
• Dr Konrat makes an incision in the agreed spot, elevates the breast tissues, surgically creating a pocket or space into which the implant of choice is placed. There are four options. At your consultation Dr Konrat will advise which incision choice will be right for you and discuss her reasons for her advice.
• 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 surgeon 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.
• 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.
• The coverings of the pocket are then closed with stitches and the skin stitched or sutured closed. The wound is covered with a small surgical dressing, which is left in place until your post-operative appointment.

Post-Operation

• A complete list of instructions will be given to you prior to your surgery. You will also be able to read about the post-operative period in the information brochure given to you at your first consultation.
• After a short recovery period, usually about two hours, you can go home. You must have a relative or friend drive you home from the hospital and you should under no circumstance take public transport. Be prepared to rest in bed for two hours after you get home, and it is best that you are not alone at home for the first 24 hours after surgery.
• You are likely to feel drowsy or even sleepy after the anæsthetic, but apart from this, if you feel fine, you can expect to be able to undertake normal light activity around the home on the evening of your surgery. You should eat lightly and drink to replenish your body fluids.
• You will be sent home with two small surgical tapes (like Band-Aids) over the stitches. They will remain in place until you return one week later for the removal of the stitches (which is not painful). During this week, you are able to shower, but not bath or swim. After showering, you should pat the tapes dry with a towel. After the stitches are removed, you will be given special tapes to apply to your scars for the next six weeks.
• There are usually no drains or bandages, but patients will have a special support bra, which will be worn for the first six weeks.
• If the implants are placed above the muscle, there is only moderate discomfort after the surgery, which is treated very well with over-the-counter pain relief medications. Mild pain relief medication is usually taken for the first two or three days.There is some swelling and occasionally some bruising immediately after the surgery.
• You do not need to sleep sitting up or lying on your back. Right from the first night, you are encouraged to sleep naturally, turning from side to side as normal. This helps the lymphatic system and veins drain away any swelling and bruising.
• Although you will recover within 24 hours, your breast surgery will take about six weeks to heal. By that time, swelling and bruising should have subsided completely, and your skin and breast tissues will have changed to accommodate your now larger breasts.
• New surgical tape will be placed over the scar and you will change the surgical tape over the wound once a week, each week for 6 weeks. This assists with healing and gives the best chance of the scar healing well.
• You will have post-operative checkups with Dr Konrat at one week, six weeks, 6 months.

• This can occur at any time, but seems to be more common in the first six months after surgery.
• It may occur on one or both sides, or not at all. The degree or severity of tightening might also be different on one side compared to the other.
• Although both breasts never match exactly, varying degrees of capsular contracture may mean that differences between the two breasts may be more noticeable.  This is sometimes able to be corrected, but may not be possible.

Possible Causes of Capsular Contracture (these are still very unclear, but the following are thought to put patients at higher risk):

• Infection or transient germ (bacterial) contamination. This could be a result of invasive dental cleaning or dental procedures, urinary tract infections, a previous history of mastitis, wound infection, or Streptococcal throat infection, to name a few.  At Brisbane Cosmetic Clinic, it is our policy to prescribe antibiotics for the first week post-op to minimise the chances of infection.
• Seroma: a collection of fluid that sometimes occurs following surgery. This is normal when in small amounts. The body normally produces fluid when it has been injured and is now healing. It only becomes a problem if you produce a large amount of fluid. This fluid is able to be easily drained and may require drainage a number of times before it settles and heals normally.
• Hæmatoma: a collection of blood or large bruises around the healing breast implant pocket. This can cause an inflammatory reaction. This is very rarely a problem, but if a large bruise occurs and there is a collection of blood larger than the size of the implant, then this may need drainage, which will require another visit to operating theatre.
• Smoking decreases the oxygen levels in the blood, which results in delayed healing, and possibly an inflammatory reaction. Brisbane Cosmetic Clinic recommends that, at the very least, you should not smoke for two weeks prior to, and one month after surgery.

Levels of Capsular Contracture (The Baker Grading System identifies four grades of Capsular Contraction):

• Baker Grade 1: Anyone with breast implants will have this level, since there is always capsule formation around an implant. The breast is normally soft, and looks natural.
• Baker Grade 2: The breast is a little firm, but appears natural.
• Baker Grade 3: The breast is firm and is beginning to appear distorted in shape.
• Baker Grade 4: The breast is hard, and has become quite distorted in shape. Pain or discomfort may be associated with this level of Capsular Contracture.

Treatment of Capsular Contracture

• Medical Treatment
  • Consult your doctor immediately you notice any firming of your breast. Intervention at this stage could slow or even halt the progress of Capsular Contracture. In particular, investigations for the presence of low-grade infection, signs of trauma, integrity of the implant is of special importance.
  • At Brisbane Cosmetic Clinic, we encourage our patients to assist the healing process by adopting a diet with a high nutrient density, and in addition, to take nutritional supplements such as anti-oxidants, Vitamins C and E, Omega Fatty Acids, Zinc and Selenium for at least two weeks prior to surgery.
• Surgical Treatment: Open Capsulotomy/Capsulectomy
  • This is the most successful treatment for Capsular Contracture.
  • The surgeon opens the existing pocket, removes the implant and either, completely removes the scar tissue, or releases the scar tissue formation in the fibrous capsule surrounding the breast implants. If implant replacement is desired, then new breast implants will be inserted into the pockets. It is thought that patients susceptible to developing capsular contracture have an increased risk of developing capsular contracture again.
  • A general anæsthetic or Twilight anæsthetic is required for this procedure.

Cancer

• Studies to date consistently conclude that breast implants are not associated with increased rates of breast cancer. There is, of course, ongoing research in this area, as these studies require many years of follow-up time to be fully conclusive. Women with breast implants should follow the same breast-screening guidelines as women without implants.
• BIA – ALCL: This is a very rare type of immune cancer and only occurs in patients who have either textured or polyurethane foam (“super furry Brazilians”) implants. Patients notice they have a very large swelling. The fluid from the swelling can be tested and, if positive, the breast implants are removed, along with the fibrous coating “capsule” around the implant. For more detailed information, click on the link and ask Dr Konrat about this at your consultation: https://www.tga.gov.au/alert/breast-implants.

Calcification

• Calcium deposits can form in the fibrous capsule tissue surrounding the implant and may cause pain and firmness.
• It is possible that calcifications may interfere with mammography, as these deposits need to be differentiated from calcium deposits that are a sign of breast cancer.

Changes in Nipple and Skin Sensation

• Some change in nipple sensation immediately after surgery is not unusual.
• After several months, most patients have normal or near normal sensation.
• Occasionally, partial or permanent loss of nipple and skin sensation or hypersensitivity may occur in one or both breasts.
• Changes in sensation may affect sexual response or the ability to feed a baby.

Risks Associated with Larger Implants

Many surgeons agree that a larger breast implant may carry an increased risk of complications.  Some of these risks include:

• Decreased nipple sensation
• Abnormal nipple position (too high or too low)
• Displacement of the breast shape medially or laterally (too close together or too far apart)
• Excessive ptosis (droop) over time
• Internal scarring (Capsular Contracture)
• Skin changes such as thinning, the extreme situation being skin loss and exposed implant requiring implant removal.
• Please refer back to ‘Choosing the Right Implant Size For You’ .

Wound Healing Problems or Tissue Necrosis

• Tissue Necrosis, or tissue breakdown, is the development of dead tissue around the implant. It will delay wound healing, may cause wound infection and may require surgical correction and/or implant removal.
• Some patients experience delayed healing, either of the surgical pocket in which the implant is placed, or of the incision itself, which may open from injury or infection. This can result in an unattractive scar or breast tissue loss.
• If the implant is exposed, further surgery will be required.
• Tissue Necrosis or tissue breakdown has been reported following the use of steroid drugs, chemotherapy, radiation to breast tissue, smoking, or excessive heat or cold therapy. Occasionally, it can occur without any identifiable cause, but this is very rare.

Visible Skin Wrinkling and Rippling

• This can occur when an implant pulls on the overlying tissues, or when the natural folds in the implant are visible through the skin due to certain movements.
• Choosing the correct implant for your particular body characteristics can significantly reduce the risk of visible rippling. Dr Konrat will provide very specific advice for your needs.

Implant Extrusion

• This is an exceedingly rare complication.
• If the skin or the breast tissue covering the implant is very thin and/or there is a problem with healing, the implant may break through the skin and become exposed.
• This will require the removal of the implant, as surgery to correct this condition can result in unacceptable scarring or breast tissue loss.

Chest Wall Deformity

• This is an extremely rare complication.
• The chest wall or underlying rib cage may appear deformed upon removal of implants.
• Chest wall deformity has been reported following the use of tissue expanders in conjunction with breast implants.
• The consequence of chest wall deformity is of unknown significance, but is not believed to produce any known health consequences.

Malposition

• Occasionally a breast implant may rotate or shift position after initial placement.
• This may cause discomfort and/or distortion in breast shape, and additional surgery may be required to correct this condition.
• Excessive sagging or stretching of the lower breast tissue may result in an implant that appears too low, or causes the nipple to point excessively upwards. This is sometimes called ‘bottoming out’.
• The implants can also shift toward the side, widening the apparent gap between the breasts.
• Contracture or tightening of the lower implant pocket may cause an upward displacement of the implant.

Asymmetry

• Most women’s breasts have at least some asymmetry. Significant asymmetry can be addressed by using implants of slightly different sizes.
• It is important to be aware that while this can result in an improvement in size difference, it could accentuate differences in nipple-areola angle and position.
• There is no way of accurately measuring breast size, apart from visually, so it is difficult to determine the difference in volume of an implant to correct size differences.

‘Snoopy’ Effect

• This phenomenon most often occurs when breast implants are placed underneath the pectoralis muscle. (Dr Konrat does not place implants under the pectoralis muscle.)
• It may not be noticeable in the first months or even years after surgery, but as the breast tissue and overlying skin stretches, for example, with pregnancy, breast-feeding or weight gain, the natural breast tissue can tend to ‘fall’ over the underlying implant.
• The effect can be magnified by placement of the breast implants under the muscle in women who already have a ptosis or an element of sag or droop.
• The implant remains firmly placed beneath the muscle, while the breast tissue and overlying skin fall further with age.
• This can only be corrected by removing the implants and replacing them sub-glandular (above the muscle).

Infection

• Infection following breast surgery is very unusual and statistically unlikely. If, however, it does occur, it is taken very seriously indeed, as infection around a breast implant is more difficult to treat than in normal body tissues. For this reason, Dr Konrat believes in taking a strongly preventative attitude to infection. Her directives regarding pre-operation health, and the post-operative course of antibiotics are designed to minimise still further the likelihood of any infection, and as a consequence, the possibility of capsular contraction.
• If, however, a diagnosis of a whole breast pocket infection is made, it is rare that further antibiotics alone will resolve the situation. If the infection does not respond to antibiotics, the implants may have to be removed. In this situation, the patient will need to remain on antibiotics for up to three months to ensure complete resolution of the initial infection. Once the infection is completely cleared up, new breast implants can usually be inserted several months later. Additional costs will be incurred in this situation.

Bleeding (Hæmatoma)

• Hæmatoma is a collection of blood that may occur around a breast implant following surgery. Due to the Rapid Recovery Technique used by Dr Konrat, she has not had a haematoma in 10 years. It is thought to occur in 2-4% of breast implant procedures. It will usually require a general anæsthetic and additional surgery to remove the hæmatoma and stop the bleeding. Commonly a Day Surgery fee and an Anesthetist’s fee will be charged, but there are no further surgical fees charged. Dr Konrat does not charge a surgical fee for revision surgery to correct an immediate post-operative complication.
• Hæmatoma may contribute to capsular contracture and infection.
• Aspirin, and most other anti-inflammatory medications, should not be taken for ten days before and after surgery, as their use may increase the risk of bleeding. Dr Konrat also prefers that you do not take any non-prescription ‘herbal’ remedies or dietary supplements prior to surgery, as these may increase the risk of surgical bleeding.
• After a few weeks, the risk of an early problem with bleeding is low. However, hæmatoma can occur at any time following an injury to the breast. If one or both breasts seem to increase in size quickly, this may be caused by hæmatoma. This rapid swelling is often associated with bruising and discomfort.

Seroma

• Seroma is the accumulation of fluid, in this case, around the implant, following surgery, trauma or vigorous exercise. Additional treatment may be necessary to drain the fluid accumulation.
• A seroma may contribute to infection, capsular contracture, and importantly should be sent to the laboratory for investigation to exclude BIA-ALCL.
• If one or both breasts increase in size over time, or if it seems that there is fluid around the implant, this may indicate a seroma, and you should consult your doctor.

Pain

• A significant number of women without implants experience breast pain at least once per month.
• Pain may develop or persist after breast implant surgery. Some women who did not have pain prior to surgery may have persistent pain after surgery.
• These pain symptoms are unpredictable and in some patients no cause can be found.

Mammography/ Breast Ultrasound

• Women with breast implants should have mammograms or ultrasounds as they normally would do for breast screening. You should inform the personnel that you have breast implants.
• The presence of breast implants may make screening mammography more difficult, as implants can partially block the ability to see all areas of the breast during a mammogram, thus possibly hiding disease.
• To ensure the most complete result from the mammogram, additional mammography views will be taken.
• Breast compression, which is part of the mammogram procedure, presents a risk of rupture of the scar around the implant or rupture of the implant itself, although this is rare. When it does occur, it is usually related to having a very firm internal scar, or capsule, around the implant.  However, this risk should not keep you from obtaining a mammogram when your doctor indicates this is appropriate.
• Ultrasound of the breast may be performed to aid in screening for breast cancer.

Risk to Offspring

The presence of a breast implant will have no effect on your ability to become pregnant, deliver a baby, or even breastfeed. Breast implants have not been shown to have an effect on children.

Risk of Breastfeeding

• Breast implants should not prevent you from breast-feeding.
• Choice of incision location could have an effect on your ability to breast-feed: an incision around the nipple could, theoretically, interfere with the breast ducts. While this is not necessarily the case, if you believe you may wish to breast-feed in the future, you should mention this to Dr Konrat when planning your surgery.

Breast and Nipple Piercing Procedures

• If you are thinking of having any body piercing to your breast region after having breast implants, you should consider the possibility that an infection could develop any time following this procedure.
• If an infection does occur, it is possible it could spread to the breast implant pocket.
• If this occurs, treatment, including antibiotics, possible removal of the implant or other surgery may be necessary. In this case, additional costs would be incurred.
• A breast infection with the presence of an implant is harder to treat than an infection in normal body tissues. If an infection does not respond to antibiotics, the breast implant may need to be removed.

GENERAL RISKS OF SURGERY

Because surgery is such a vital part of modern medicine, there is a tendency to forget that there are risks associated with every type of surgery. While these risks are small, every person undergoing surgery should be aware of the risks.

Wounds

All internal and external wounds need time to heal after surgery. Sutures and other material are used to hold wounds closed while they heal. For specific discussion possible complications with regard to breast surgery, click here

Infections

Despite taking precautions, infections can occur during and just after surgery. These may be general, such as pneumonia, or specific to breast surgery.  For a discussion of infection risks regarding breast surgery, click here. Because of their generally good health, breast implant patients usually have a lower risk of developing general infections such as pneumonia.

Pulmonary Risks

• Patients have a risk of forming a blood clot in the leg (deep vein thrombosis) that breaks off and gets stuck in the lung circulation (pulmonary embolism). This is minimised by the wearing of surgical ‘stockings’ during the surgery, and by getting the patient out of bed as soon as possible.
• You will also be encouraged to breathe deeply when you wake up from the anæsthetic, as this expands your lungs and helps ensure your blood oxygen levels are good.

Risks of Anæsthesia

As a rule, these risks are very low in cosmetic surgery patients, because the patients are generally in good health. Dr Konrat will take a full medical history, will order a number of tests prior to surgery and will make lifestyle recommendations to ensure your health is optimal before the surgery. This will minimise any general risks.

Mental Health disorders and Elective Surgery

• It is important that all patients seeking to undergo elective surgery have realistic expectations that focus on improvement rather than perfection.
• Complications or less than satisfactory results are sometimes unavoidable, may require additional surgery, and can be stressful.
• Please discuss openly with Dr Konrat in your consultation prior to surgery, any history of emotional depression or mental health disorders. If you are unsure whether a matter is relevant, please mention it anyway. Although many individuals may benefit psychologically from the results of elective cosmetic surgery, the effects on mental health can never be predicted and could possibly have a negative influence on emotional stability.