Breast Augmentation

The decision to have breast implants is not a minor one.  The first consultation about breast augmentation can take up to an hour.  Here are the issues that you need to think about and that will be discussed at the consultation:

The practicalities of the operation:

  • Implant shape: round or “teardrop”
  • Implant size:   I often suggest that you make cloth bags and fill them with a measured amount (in mls) of rice and put these inside a (nonpadded) bra.  While this is not much use for shape it can give an exact idea of volume.  It is particularly useful, if your breasts are not the same size, for estimating the size difference.
  • Implant position:   The pocket created to contain the implant is always completely behind the breast but its upper part can additionally be behind the pectoral muscle.   While the latter option is anatomically incorrect, it is often the best option if you are slim as it camouflages the upper edge of the implant.
  • Site of inicision:  My practice is confined to making the incision in the groove beneath the breast (about 6cm long).  Other possibilities are around the areola and in the armpit, neither of which I have ever used.
  • Implant surface: Textured or smooth.  I generally use implants with a textured surface.  These were thought to have a lower risk of capsular contracture (see below) than smooth surfaced implants but there is debate about the whether there is really any difference.
  • Breast position:  If your breasts have drooped sufficiently that the nipples are below the level of the groove beneath the breast, then breast augmentation without a breast lift (mastopexy) is unlikely to be satisfactory

The “silicone controversy”:  This swept the world in the first half of the 1990s.  The accusation that silicone gel implants were related to autoimmune disease had faded away by the end of the decade.  Saline-filled iimplants are aesthetically inferior to silicone gel implants.  I have not used saline-filled implants for more than 10 years.


  • Numbness:  Loss of nipple sensation is possible with this operation but very uncommon.  More common but of less concern is numbness of some skin immediately above the scar in the groove beneath the breast.
  • Bleeding: I like you to stay overnight to check that this hasn’t happened. If you bleed into the pocket containing the implant it means a return to the operating theatre.
  • Infection: Intraoperative antibiotics are used and as with all operations careful sterile precautions are taken.  So infection in the pocket containing the implant is very uncommon which is fortunate as if it happens there is no option but to remove the implant, let everything settle down and insert a new implant some months later.  An expensive excercise!  
  • Asymmetry:  If asymmetry exists before the operation I will point this out to you as it will persist afterward – although some correction may be possible by using implants of different size or shape on the two sides.  Asymmetrical placement of the implants would require re-operation.  This being the case I strive mightily to avoid this!
  • Capsular contracture:  When any foreign material finds its way into the body, one of three things may happen: it may get infected and the body tries to “spit it out” (see above);  it may be irritant and stimulate a non-infective inflammatory reaction; if non-irritant it may cause a “quiet” production of scar tissue to “wall it off” from the surrounding tissues.  It it this last process that happens with breast implants. The implant capsule becomes surrounded by a scar tissue capsule.  Unfortunately this tissue capsule in some cases is not as “quiet” as ideal.  The tissue capsule can thicken and clasp the implant enough to cause crinkles in the implant capsule which you may be able to feel around the edges.  If this happens at all it is often minor – not enough to want re-operation.    However it is possible to develop a capsular contracture  severe enough to make the breast feel unnaturally firm and alter its shape.  In that situation there is a difficult decision to be made: reoperation for capsular contracture doesn’t necessarily prevent it from happening again.
  • The virtual certainty of needing a further operation at some time in the future – if only to remove them later in your life.
  • see risks common to all operations


  • I don’t usually use drains after a breast augmentation operation but I like you to stay overnight in hospital.
  • The whole of your breasts will be taped with paper tape.  You can shower immediately with the tape on.
  • If the implant pockets are not under the pectoral muscle you will have considerably less pain than if they are.  If they are submuscular it will hurt to move your arms for a few days and you are likely to need 7-14 days off depending on the nature of your work.
  • I like to check you at 3 to 4 days and remove the tapes, leaving just a small tape on the incisions.  You can wear a stretch bra at that stage.
  • Check again at 2 weeks.  Stitches are buried and absorbable – nothing to remove.

Note a source of dissatisfaction to be aware of.  Day 2: Shock! Looks too big.    Day 5: Used to the new size and happy with it.  But some of this size is swelling.  Day 21: Swelling has settled – you wish you were the size you were on day 5!  Moral: while I’m not an advocate for very big implants, don’t choose too small.

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