Breast augmentation surgery (breast implants)

Breast augmentation surgery

Breast augmentation is a type of cosmetic surgery in which implants are inserted beneath the breasts to enlarge them. It may also be performed for reconstructive reasons.

In reconstructive surgery, implants are used to:

• restore breast volume after weight reduction or pregnancy and breastfeeding
• even up asymmetric breasts
• reconstruct a breast after mastectomy (breast removal) or injury.

The implant type and size depend on several factors, such as how much bigger you want your breasts to be, your breast anatomy, skin thickness and elasticity, and body type.

Breast implant surgery is also known as augmentation mammoplasty, breast enlargement or a ‘boob job’.

If you are concerned about the way you look or are thinking about cosmetic treatments to boost your confidence, there are alternatives to cosmetic surgery. These may include other treatments, wearing padded bras or talking to a counsellor or psychologist to help you overcome your concerns about your appearance.

Changes to laws that affect cosmetic surgery

In 2018, amendments were made to the Health Services Act 1988 to regulate all surgery, including cosmetic surgery. The changes specified that:

• all surgery must be carried out in a registered private hospital or day procedure centre
• liposuction and anaesthesia, including intravenous sedation and anything more than a low dose of local anaesthetic, must be carried out in a registered private hospital or day procedure centre.

This means that it is now illegal for:

• any surgery (including cosmetic surgery) to be performed in facilities that are not registered with the Victorian Department of Health
• anaesthetic (other than low doses of local anaesthetic) to be administered in an unregistered facility.

How do I know if a facility or health service establishment is registered?

To find out if a facility is registered, you can:

• visit the Department of Health Private hospitals page and expand the ‘contact details for private hospitals’ link
• email the Department’s Private Hospitals Unit privatehospitals@health.vic.gov.au
• ask to see the facility’s certificate of registration (this is usually on display in an obvious place where consumers can see it easily).

You can also contact the unit to report suspected illegal activity or for further queries regarding liposuction, cosmetic surgery or anaesthesia in Victoria.

Things to consider before having breast augmentation surgery

Before you choose to have breast implant surgery, some of the important issues to keep in mind include:

• Breast augmentation does not correct droopy breasts. A breast lift (an operation to remove loose, excess skin that often involves shifting the nipple position as well) may also be required.
• Breast implants may affect your ability to breastfeed.
• Breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants. There is no consensus on the product life of breast implants once implanted. Studies show that the risk of problems increases about 8 to 10 years after surgery. You may require further surgery to replace one or both implants. Plan to have them changed every 10 years.
• Cosmetic surgery does not usually qualify for rebates from Medicare or private health insurance. Think about the financial cost.
• Smokers are at increased risk of complications. To decrease the risk of complications, and for your general health and wellbeing, try to quit smoking before having surgery.
• Consider asking another medical practitioner for a second opinion. It is important to have as much information as possible before deciding to have breast augmentation surgery.

Finding a qualified medical practitioner

Ask your GP for advice on a suitable and reputable medical practitioner and hospital where breast augmentations are performed.

At your first consultation, ask the medical practitioner about their training and experience.

This procedure should be done by a medical practitioner who has specialist training and has a lot of experience in breast augmentation surgery. Ask to see the practitioner’s certificates that show them to be qualified to perform this specialised surgery.

All doctors practising in Victoria must be registered with the Medical Board of Australia (the Board). Find out if your medical practitioner is registered with the Board by searching on the AHPRA website.

Your current medical status and breast augmentation surgery

If you are considering having breast augmentation surgery, you need to discuss your current medical status with your medical practitioner. This includes discussing:

• your physical health – including your past medical history, such as diseases, illnesses, surgeries, immunisations and current physical status, which will include your diet and exercise regime. This would be a good time for the medical practitioner to check your blood pressure, temperature, heart rate/rhythm, oxygen saturation and respiratory rate
• your mental health – any mental illnesses or issues and their treatments
• medications you are currently on, including vitamins and supplements
• past reactions to medications
• any allergies you have

As a result of this discussion, your medical practitioner will be able to assess the risks and possible complications of the surgery for you. They will also be able to tell you what preparations you will need to make to ensure your recovery from surgery is as smooth as possible.

Types of breast implants

The two main types of breast implant used in Australia are:

• saline implant – a silicone envelope filled with varying amounts of sterile salt water which is known as normal saline. This can affect the shape, firmness and feel of the breast. If the implant envelope leaks, a saline implant will collapse, and the saline will be absorbed and naturally expelled by the body
• silicone implant – a silicone envelope filled with an elastic gel that feels much like natural breast tissue. If the implant leaks, the gel may remain within the implant shell or it may escape into the scar capsule (area around the implant), or even into the breast tissue. This may cause no symptoms, or it may lead to pain or a change in breast shape or size. A leaking implant filled with silicone gel may not collapse.

Breast augmentation surgery – what happens during surgery

Breast augmentation surgery is usually performed under general anaesthetic, although some medical practitioners use a combination of local anaesthetic and sedation.

All surgery, including breast augmentation surgery, must be performed within licensed and accredited facilities. A registered anaesthetist must be present to treat you for any adverse reaction you may have to the anaesthetic. You can check if your anaesthetist is registered by searching on the AHPRA website.

Generally, breast augmentation involves:

• The medical practitioner makes an incision (cut). The location of the incision is decided with you beforehand and depends on factors such as your physical makeup and scarring tendency, and the type and size of implant. The incision may be in the armpit (transaxillary), in the crease beneath the breast (inframammary) or around the areola (periareolar).
• The medical practitioner makes a pocket, either behind the pectoral (chest) muscle or in front of the pectoral muscle beneath the breast tissue.
• The implant is inserted into the pocket. Sometimes, the implant is already filled at the time of insertion. In other cases, the empty implant is inserted and filled (with saline) through a thin tube until the desired size is reached.
• All incisions are stitched and dressings are applied.

Immediately after breast augmentation surgery

After breast augmentation surgery, you may expect:

• a drainage tube in the wound to help prevent fluid build-up
• bruising and swelling
• to be given antibiotics to prevent infection
• possible numbness
• pain and discomfort
• dressings or bandages.

Potential complications of breast augmentation surgery

All surgery carries some degree of risk. Some of the possible complications of breast augmentation surgery include:

• bleeding
• infection
• allergic reaction to suture materials, tape adhesive or other medical materials and topical lotions or ointments
• changes in breast and nipple sensation
• temporary or permanent areas of numbness
• wrinkling of the skin over the implant
• keloid, or lumpy scar tissue, which is raised and irregularly shaped. These scars may be inflamed and itchy
• capsular contracture, where firm scar tissue forms around the implant causing it to lose shape and softness
• inappropriate implant size
• implant rupture or deflation
• asymmetry (unevenness) of the breasts
• calcium deposits in the scar capsule around the implant
• granulomas, or lumps, in local lymph node tissue formed by leaking silicone
• breastfeeding difficulties, including reduced milk supply
• reduced effectiveness of breast cancer screening, as an implant may hide breast tissue (and tumours) during a mammogram
• movement of the implants from their original position
• further surgery to treat complications
• risks of anaesthesia including allergic reaction or potentially fatal cardiovascular complications such as heart attack
• a blood clot in the deep veins of the legs (deep vein thrombosis), which can move to the lungs (pulmonary embolus) or to the brain and may be life threatening.

This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. Speak to your medical practitioner for more information.

Self-care after breast augmentation surgery

Your medical practitioner will provide you with post-operative care instructions, such as:

• how to care for your surgical site(s) following surgery
• medications to apply or take orally to aid healing and reduce the risk of infection
• specific concerns to look for at the surgical site(s) or in your general health
• when to follow-up with your medical practitioner.

Australian Breast Device Registry and Breast Implant Registry

In May 2015, the ‘opt in’ Breast Implant Registry ceased to register new patients. However, the Australian Society of Plastic Surgeons has continued to maintain the Breast Implant Registry legacy data and to administer patient access to their data stored on the registry.

The Commonwealth-funded Australian Breast Device Registry (ABDR) superseded the Breast Implant Registry. It is run by Monash University and follows best practice in registry science. The ABDR aims to record and track all breast devices implanted in Australia, as well as any adverse events associated with those devices, to help medical practitioners improve their patient outcomes. For more information on how to participate, visit the Australian Breast Device Registry website.

Participating in the registry is important to help with your ongoing health and safety. Ask your medical practitioner for more information.

Long-term outlook after breast implant surgery

Careful review of scientific research conducted by independent groups has found no proven link between breast implants and autoimmune or other systemic diseases.

If you have silicone implants, you may need to visit your medical practitioner regularly to make sure the implants are functioning properly and not leaking. They may use an ultrasound or MRI to assess the condition of your breast implants.

Studies show that the risk of problems increases about 8 to 10 years after surgery. You may require further surgery to replace one or both implants. Plan to have them changed every 10 years.

Pregnancy, weight changes, ageing, menopause and gravity will influence the appearance of augmented breasts over the course of your lifetime. If you become dissatisfied with the appearance of your breasts after a period of years, you may choose to undergo a breast lift or implant exchange.

Alternatives to breast augmentation surgery

Alternatives to breast augmentation can include:

• breast lift surgery (also known as mastopexy)
• flap reconstruction after mastectomy – this involves surgery to create a breast from skin and tissue taken from elsewhere on the body
• wearing padded bras
• talking to a counsellor or psychologist – this may help you overcome your concerns about your appearance.

Where to get help

• Your GP (doctor)
• A psychologist, psychiatrist or counsellor
• Medical practitioner specially trained and experienced in performing breast augmentation surgery
• A second opinion from another medical practitioner specially trained and experienced in performing breast augmentation surgery
• Cosmetic surgery hub and hotline, Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 361 041
• Cosmetic surgery, Department of Health and Aged Care, Australian Government
• Private Hospitals Unit, Department of Health Email privatehospitals@health.vic.gov.au
• Australian Society of Plastic Surgeons Tel. (02) 9437 9200
• Royal Australasian College of SurgeonsTel. (03) 9249 1200
• Australian Breast Device Registry Tel. (03) 9903 0205
• Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 419 495
• Medical Device Incident Report Investigation SchemeTel. 1800 809 361.