Breast Enlargement • Breast Implants

Your breasts help define your shape as a woman. It is natural to want to be happy with this area of your body.

• Are your breasts smaller than you would like?
• Are your breasts asymmetrical (one larger than the other), or not quite the shape or size you would like them to be?
• Have your breasts lost their shape and fullness following pregnancy and breast-feeding?
• Or have you lost significant volume and shape following weight-loss?

If you answered ‘yes’ to any of these questions, and you want to improve the way you feel about your body, you may be a candidate for breast enlargement surgery with breast implants. This decision is a very personal one: only you can decide what is right for you.

Breast enlargement not only increases the size of the breasts, it can also be used to address problems of shape to give a more natural form, or to help restore natural fullness lost due to breast-feeding or loss of weight.

• Dr Konrat uses  high-tech, ‘shaped’ (anatomical) breast implants made by reputable global manufacturers. All implants have Australian Therapeutic Goods approval.
• Shaped implants can look more natural. There is a range of styles and profiles making breast implant surgery possible for women with any shape or style of breast.
• They feel softer, because Dr Konrat places them under the breast tissues and not UNDER the muscles.
• They are more ‘mobile’ (not locked down under the muscle where they have limited movement). All movements using the Pectoralis muscles can be performed without affecting the breast implants. Return to exercise and full muscle function is possible earlier after surgery.
• Using ‘shaped’ (anatomical) breast implants placed OVER the muscle, it is possible to achieve reasonable results in one breast augmentation surgery in women with varying presentations (such as tuberous breasts, women with lean body mass and unable to gain weight and asymmetrical breasts and many more).

Very lean, athletic woman using ‘shaped’ breast implants placed OVER the muscle.

Tuberous breasts.

Correction of breast size asymmetry

This patient has had correction of asymmetrical breast size. One breast failed to grow at puberty while the other grew to a small A cup natural size. Different sized and different profiled breast implants were used to achieve a close symmetry.

Saline or Silicone?

Dr Konrat only uses the very latest, approved cohesive silicone gel breast implants. The information below is designed to inform you about the latest breast implants being used in Brisbane by Dr Konrat today.

Modern silicone implants are filled with cohesive silicone gel. They feel very similar to natural breasts. Even though silicone implants look and feel better, women are still anxious about their safety record, so it is important to get the facts straight. There are two main differences between the silicone implant of today and the silicone implants used in the past.

Firstly, the covering or shell is much stronger and therefore much less likely to leak. Secondly, the gel inside is no longer liquid. All the silicone implants we use contain a cohesive gel, which has the consistency of Turkish Delight. Even if the covering ruptures, this gel should not leak out.  It was claimed that silicone in the body might cause disease. This has been completely disproved by numerous studies comparing women with silicone implants and women with no implants at all. There is no difference in the disease rates between these two groups.

Size?

Implants are sized by their volume and measured in ml, grams or cc’s. The right size of implant for you depends on the final size you wish to be and the size and shape of your existing breasts. Sizing can be estimated by placing a dummy implant in a crop top or sports bra during the consultation. This method is not exact but can give a very good idea of the size one is hoping to achieve.

It is worth knowing that many patients, during the consultation, worry about ‘going too big’, but if a patient regrets her choice of size after surgery, she almost always wishes she had chosen larger implants. Therefore if you cannot choose between two sizes, it is probably better to go for the larger implants.

Before Your Breast Enlargement Surgery in Brisbane

• You need to re-read all of your instructions allowing enough time to call us for any clarification prior to your breast augmentation surgery in Brisbane. Phone: 07 3391 5710
• Nothing to eat or drink (no sips of water) from midnight before surgery. Anything by mouth could cancel or postpone your surgery.
• Prescriptions: have your scripts filled prior to surgery
• Constipation: we recommend Guardian Flakes, from Coles/Woolworths.
• NO ASPIRIN, IBUPROFEN OR MEDICATION CONTAINING Anti-inflammatories.
• No vitamin E internally (pill) or externally (on the skin) should be used a minimum of seven days prior to surgery.
• Arnica tablets (naturopathic remedy that may help to minimize bruising and swelling) can be taken. Two tablets three times per day sucked or chewed (not swallowed) for seven days prior to surgery and seven days after surgery.
• Any tablets that you are taking should be reported to the doctor and then taken as instructed.
• No alcohol should be taken within 48 hours prior to surgery. Alcohol impairs clotting.
• If you smoke we recommend that you stop. Nicotine markedly impairs the healing process by encouraging infection and poor circulation.
• The morning or evening prior to your surgery you are requested to wash your hair and take a shower.
• Arrange for transportation to and from the hospital. Perhaps include a pillow and blanket in the car for your comfort post operatively.
• Arrange for someone to stay with you at home for 24 hours after your surgery.
• If you experience any signs or symptoms of illness from this day until your operation, you need to call us. Early treatment could prevent postponing your surgery.
• Remove nail polish, contact lenses, jewellery and make-up
• Bring loose fitting, front opening and comfortable clothing to wear home.

Breast Implant / Breast Enlargement Surgery

General anaesthetic

This surgery is performed under general anaesthetic in a Brisbane day surgery hospital and is performed by a specialist anaesthetist.

Day surgery or hospital stay

Dr Konrat performs all her breast implant surgery in a licensed accredited day surgery hospital in Brisbane. The surgery is performed as a day procedure. You will need a responsible adult to take you home from hospital and care for you for the first 24 hours.

Day of Surgery

No food or liquids from midnight the evening before your surgery.

Dr Konrat will meet you to review your surgery. She will be able to address any of your concerns. Your consent forms are signed at this time.

After you have been admitted to the Day Surgery Hospital, your anaesthetist will consult with you prior to your surgery. Please advise him/her of any medical conditions or tablets you may be taking or any allergies you are aware of.

It is important to wear comfortable clothes, preferably something that buttons down the front.

Please remove your nail polish, contact lenses and do not wear jewellery and ensure you do not bring valuables with you to hospital.

Incision site

Dr Konrat’s approach is via a tiny incision in either the existing fold beneath the breast, or in what will become the new fold beneath the breast. This is called the infra-mammary fold, or crease.

The Technique

Brisbane Cosmetic Clinic uses the Rapid Recovery Technique for breast enlargement surgery. Initially described by the famous Texan surgeon Dr Tebbetts, it has now been adopted by many doctors performing breast implant surgery. This is the only technique used by Dr Konrat for breast implant surgery.

The Rapid Recovery Technique is important because:

• Less than 1ml of blood is lost during surgery and the surgical pocket (where the implants are inserted) is kept clean and dry. This means less inflammation, swelling and pain, so there is no need for long acting local anesthetics, pain pumps or strong pain relief medication.
• A special anaesthetic is used so the patient wakes feeling alert and well. 98% of patients are ready to be discharged home within 2½ hours of surgery. Most patients feel well enough to be up and about that evening.
• All patients are able to return to all activities of daily living within 24 hours – except of course, strenuous aerobic exercise or activities requiring lifting weights above the head. No bandages, strapping, drains or compression belts are needed. Patients go home with a small bandaid over the incision line (which is in the crease below the breasts), and are dressed in a supportive sports bra for comfort.

Placement of implants

Working from the inside out, on top of the ribs are the chest muscles or ‘pecs’, then on top of the Pectoralis muscles are the breast tissues and skin. Implants can be placed either under the chest muscles, partially under the chest muscles (dual plane) or on top of the chest muscles (directly under the skin and breast tissues).

Dr Konrat almost always places breast implants just under the breast tissues. This creates the most natural look and feel. It also prevents a condition forming called ‘Snoopy Effect’ or Waterfall effect. This is where the breasts drop over the rigid submuscular implant as a result of pregnancy, breast-feeding, weight loss, or simply because of thin inelastic skin and breast tissues, which sag with age and gravity. Placing the implant under the breast tissues also allows the patient to perform all physical activities without the chest muscles pulling or squeezing over the breast implant causing visible temporary deformity across the breast and breast implant. When the implant is on top of the chest muscles, the implant is sometimes described as being ‘subglandular’ or under the breast tissues. Since in both cases the implant is behind the breast tissue, there is no interference with subsequent breast-feeding.

There are advantages and disadvantages with both placement sites. For example, an implant in the front of the muscle can rarely result in visible rippling. Rarely the outline of the implant may be seen at the top of the implant if the skin on the chest is very thin and inelastic. If the patient has very thin skin or has a very thin chest, then fat harvesting from another part of the body, and grafting of the harvested fat to the chest to thicken the skin and tissues is recommended.  This particular technique gives beautiful natural results and greatly reduces the risks of implant show and visible rippling.

An implant placed over the muscle will generally have a more gradual ‘take off’ at the top edge of the implant, giving a smoother silhouette and minimising the very round, or tennis ball appearance.

However, women who have moderate to severe breast ptosis or droop, will not be good candidates for breast implants and may need to have a breast lift, which is called, ‘Mastopexy’. It is possible to have breast implants once the breasts have been lifted.

After Breast Implant Surgery at Brisbane Cosmetic Clinic

After the surgery, your breasts may feel bruised, swollen or tender. All of the bruising and swelling can take up to 4 weeks or more to resolve. DO NOT BE UNDULY WORRIED ABOUT THIS.

Panadol/Panadeine may be prescribed for post-operative pain. It is important to take the tablets with food and plenty of water.

You will also be prescribed a course of antibiotics.  Please ensure you finish the course.

Please sleep on your side and turn from side to side. You are not required to sleep sitting up or on your back.

A small water resistant dressing will cover the wound under your breast.  Please do not remove it until you see the nurse/doctor at your first post operative checkup.  You can get this wet and shower as normal the day after surgery but you may not swim, spa, bath or submerge for one month following the procedure.

Please pat your dressings dry with a towel. Do not blow dry.

On day 7, any remaining stitches will be removed if required.  You will be given special surgical tapes to be worn over the suture line that requires changing once a week for 6 weeks, for healing purposes.  Any questions in regards to when you can resume physical exercise, housework etc will be answered at this appointment.

You may experience numbness in some areas of the breast.  This may take several weeks or even up to 9 or 12 months to return to normal.

If there is excessive bruising, bleeding, swelling or pain unrelieved by medication, please call Dr Konrat at the clinic on 07 3391 5710 or on the after hours mobile phone: 0468 476 451.

You will be given a prescription for antibiotics. Should you visit the dentist to have your teeth cleaned or require a dental procedure, please commence antibiotics the morning of your visit to the dentist and continue the antibiotics as prescribed the day of your visit to the dentist. This is thought to reduce your risks of developing capsular contraction, especially during the first two years following your surgery.

Please use a sugar-free antiseptic mouthwash each day when cleaning and flossing your teeth. This is thought to reduce your risks of developing capsular contraction.

If you have any questions pre or post surgery, we welcome the opportunity to assist and are available to support your needs every step of the way.

There are many brands of breast implants, and each brand has several style options. Dr Georgina Konrat can explain the difference between the brands and styles and help you make an informed decision about what is the right fit for you.

Beware of cheap implants! A significantly lower cost of surgery can sometimes mean that cheaper or outdated styles of implants are being used. Round breast implants are cheaper than anatomical implants. Breast implants should come with a high level of guarantee.

Remember that cheap is not best, especially when it comes to surgery on your own body!

NOT ALL SURGEONS ARE TRAINED AND QUALIFIED OR EXPERIENCED IN BREAST IMPLANT SURGERY

Ask your doctor if he/she is experienced and qualified in breast implant surgery. Being a surgeon does not automatically give you expertise in breast implant surgery. Ask your Doctor not only about their qualifications, but more importantly about their experience in performing breast implant surgery.

The patients above have ‘under the muscle’ breast implants. Sagging of breasts over the implant is called ‘Snoopy’ or ‘waterfall’ effect, and occurs after surgery. Occasionally Snoopy occurs quickly, and at other times occurs after pregnancy, breast feeding, weight gain or weight loss.

How does this happen?

The ‘under the muscle’ breast implant stays securely in position under the muscle, while over time, the skin and breast tissues stretch and gradually fall over the top of the stabilised breast implant. The photos show the under the muscle implant high on the chest wall and the sagging breast tissues hanging below the bottom of the ‘under the muscle’ breast implant.

When the breast implant is placed ABOVE the muscle, this does not occur.

Why do surgeons place the implant under the muscle?

The main reason is to add a little more coverage over the upper and inner parts of the breast implant so that the edges of the implant cannot be seen. It is also thought to reduce the possibility of seeing rippling of the breast implant. However, rippling may be seen either under or over the muscle, depending on a number of factors.

Dr Konrat places all breast implants OVER the muscle and has never had a case of visible rippling using high quality breast implants.

Can Snoopy Effect be fixed?

There are two main surgical procedures to correct the Snoopy Effect.

• The first is to have a breast lift or Mastopexy. This will correct the deformity initially, but with time the breasts may sag again and a further revision surgery may be needed.
• A more definitive surgical technique to correct SNOOPY EFFECT is to remove the breast implants from under the muscle, and create a new space OVER the muscle and place the same or new breast implants in the new space or anatomical plane. You may or may not need to have a breast lift as well. This technique gives a more permanent result.

The patient below declined to have a breast lift and was happy to have her implants removed from under the muscle and re-positioned OVER the muscle and was happy with the results. See photos below.

So, we’ve talked about why Dr Konrat places breast implants OVER the muscle. Now lets talk about why she uses ’shaped’ (anatomical) breast implants.

All surgery, including cosmetic surgery, carries risks. Although the vast majority of breast implant patients do not suffer complications, you should not undergo breast augmentation surgery without understanding the risks involved. There are two types of risk; those that apply to any kind of operation such as bleeding, anaesthetic risk and wound infection; and those that apply only to breast implant surgery. Once you have read this information, you should discuss any concerns with Dr Konrat. The following explains some but not all of the risks specifically associated with breast implant surgery.

Rippling – Visible rippling can occur rarely in the very thin patient. This is when the natural folds in the implant are visible through the skin. It is often possible to feel these folds in certain positions, but rarely they are visible.

Leakage – For routine breast augmentation or enlargement, Dr Konrat only uses high quality, cohesive silicone gel implants.

Implant Infection – An infection inside where the breast implant is placed will require removal of both implants and a settling down period of about three months before the implants are able to be replaced. The patient will need to be on antibiotics for the duration of that period. Provided there are no signs of residual infection, the implants may then be re-implanted. The final result should not be affected. Even if only one implant becomes infected, it is the policy that both implants be removed to achieve the best aesthetic outcome at the time of re-implantation and to reduce the risk of an infection occurring in the other breast.

Capsular Contraction – For reasons that are not known, the tissues which form around the implant, and which are normally not visible or palpable (able to be felt) can shrink making the implant feel hard. A mild degree of this would probably be accepted by most patients, but in severe cases where the fibrous tissue surrounding the implant feels rock hard, revision surgery will be needed. The overall risk of problematic capsular contracture with textured implants is usually quoted at less than 3%. There are many theories as to the cause of capsular contraction and this will be discussed during your consultation. The most common suspected cause of capsular contraction is infection: minor infection or ‘bacteremia’ that occurs following a dental clean or a dental procedure, a bladder infection or repeated urine infections or repeated bouts of tonsillitis, for example. After breast augmentation surgery, Dr Konrat recommends an antiseptic mouthwash to be used daily after cleaning and flossing teeth and the use of preventative antibiotics the day of a dental clean or treatment.

Cancer – There is no increase in the risk of death from breast cancer in women with any kind of breast implant. Indeed, studies have shown a reduced risk of breast cancer in women with silicone implants. Breast self examination and mammograms can be performed effectively in women with implants.

Sensation Changes – Temporary sensation changes in the breast skin and/or the nipples are common after breast implant surgery. In the vast majority of patients, sensation will return to normal over a period of months, but may take up to 18 months. There is a small risk of permanent loss of sensation, which could involve the nipple.