Breast enlargement most frequently involves the insertion of a breast implant however Associate Prof Magnusson is increasingly using breast fat grafting for breast enlargement and shaping in combination with breast implants or on its own to enhance the breasts.

Breast implants:

Silicone or Saline

Associate Prof Magnusson uses silicone gel implants. Silicone breast implants feel more natural, have fewer aesthetic concerns such as rippling and last longer than saline implants (silicone outer layer filled with saltwater). The silicone implants he uses have cohesive gel, sometimes called gummy bear implants because of how the gel sticks together. Older generation silicone implants had a liquid silicone gel with a consistency more like honey. Cohesive gel implants tend to still stay together even with implant rupture and there is a reduction in problems such as silicone migration and extracapsular spread.

Different implant types have different risk profile and performance benefits. At your consultation implant selection is based on a discussion to balance these risks and benefits in reference to your individual requirements.

Implant Shape

Implants are either round or anatomical or teardrop shaped. For the majority of women, implant shape is not vital and different implants can be selected according to goals. High and extra high projection implants will always have the most significant difference in the shape of the upper pole when comparing round and shaped implants.

In some instances, a shaped implant may provide a specific advantage such as:

• Slim patient with a very small amount of breast tissue desiring a natural outcome
• High or extra-high projection implants with a large but natural shape
• Significant breast asymmetry or developmental deformity
• Women with a low nipple position may consider a shaped implant to give better support of the nipple to avoid additional mastopexy surgery
• Desiring a natural has she/he hasn’t she outcome

Breast reconstruction following mastectomy

Implant surface

Implants have either smooth or textured surfaces. Textured implants are considered to be more stable in position over time and less likely to migrate out of position which is one of the commonest reasons for re-operation following breast implants. All anatomical implants are textured to reduce the likelihood of implant rotation. Round implants can be either smooth or textured. In some circumstances, implant migration has a higher risk and textured implants will be considered and used more frequently. If the implant selected has a lower projection and smaller volume or size then implant texturing may be less effective and consequently a smooth implant will frequently be selected.

Circumstances where implant migration is more likely include:

• Loose breast tissue following pregnancies and weight fluctuations
• A mobile breast and infra-mammary fold which commonly follows significant weight loss
• Larger implants

Breast Implants vs Fat Grafting:

Breast implants allow us to achieve a substantial volume increase that can’t be achieved with fat grafting in a single episode. Breast implants do require monitoring and will eventually need to be replaced. Increasing breast size with fat grafting involves removing fat from other areas such as the tummy, love handles, waist and thighs by liposuction. This fat is then processed and returned to the breast.

Breast fat grafting will only allow us to achieve a more moderate increase in size but is especially useful to improve the shape and as part of a surgical plan for breast reconstruction for congenital breast deformities such as tuberous or constricted breasts and following breast cancer. Fat grafting can be used to achieve particular goals such as narrowing the cleavage and filling the upper part of the breast in particular when a shape improvement rather than significant volume change is desired. Fat grafting can be repeated at a later stage to obtain further volume change.

Associate Professor Magnusson regularly includes fat grafting as a component of explant surgery to maintain breast shape and uphold fullness while avoiding the need for further breast implants for some patients.

Breast implant considerations

• • Significant volume enhancement
  • Nicely shaped breast to start with requiring a volume increase
  • Breast implants are not life devices and will eventually require revision

Breast fat grafting considerations

• Abnormalities of breast shape such as tuberous or constricted breast
• As part of breast reconstruction following breast cancer treatment
• The goal is for significant shape change rather than substantial volume increase: regain upper pole fullness following pregnancy and to narrow the cleavage
• Fat grafting is frequently used by Associate Prof Magnusson as a component of explant surgery

Your consultation

The outcome of breast enlargement surgery can be something that patients find exciting and rewarding however it is always important to understand that this is real surgery with real risks and an anticipated recovery period. The outcome of surgery will depend upon the best plan being created, a technically well-performed procedure and a patient following the post-operative instructions to minimise the risk of problems.

To develop the best operative plan for you we will need to determine the optimal breast size according to what you already have and what you wish to achieve. We will need to determine the best incision and the best pocket for the implant as well as evaluating whether additional procedures such as a mastopexy authentic grafting may be required to maximise the outcome.

In addition to these elements relating to your breast, we will need to explore your medical history including prior breast surgery or problems with other operations.

Photographs are routinely taken prior to your consultation and form an integral part of your confidential medical record. Photographs make a very useful tool during the consultation to compare outcomes from other patients with achievable results for you. Photographs are not seen by others outside the clinical team under any circumstances without your express consent.

How is breast implant surgery planned?

Planning breast implant surgery is a fine balance between understanding what an individual woman wants to achieve, assessing what is already present and determining how best to achieve the goals.

Anatomical considerations:

• • Your height, weight and body shape
  • Comparison of one breast to the other
  • How wide and tall are your breasts
  • Where your breast is positioned on the chest wall in relation to your collarbone and bellybutton and how this balances with your shoulders, waist, hips and thighs
  • How much separation there is between the breasts (cleavage)
  • The shape of the upper pole of the breast
  • The shape of the lower pole of the breast and whether any part of the breast is overhanging the fold (inframammary fold/IMF) beneath the breast which is called breast ptosis
  • How much skin is below the nipple and how well defined the fold is beneath your breasts
  • The position of your nipple and whether it points up, forward or down
  • The distribution, volume and firmness of your breast tissue
  • The elasticity and strength of your breast skin

Goal considerations

• • Size
  • The shape of the upper pole of the breast
  • Cleavage
  • Nipple position
  • Lower pole overhang versus scarring if your breast has dropped

What is the goal after breast enlargement?

Everybody starts from a different platform, has different tissue qualities, different breast size and firmness, different history of pregnancy and weight change and has a different goal in mind. The plans for each woman will be bespoke.

A great deal is understood in relation to the ideal breast shape and beast proportions, however, size is a more personal consideration. After an assessment of your breasts, we will need to consider an individual plan that takes into account your anatomy and your goals.

• We want to look at the ratio between the amount of breast above and below the nipple (upper pole and lower pole): ideally about half way.
• We want to look at the nipple position and also whether it looks up, forward or down: ideally looking slightly upwards
• We will consider the slope and shape of the upper pole above the nipple and also the shape of the lower part of the breast and whether there is overhang or breast ptosis: the shape of the upper pole is individual and ideally, we will have no overhang below the nipple
• We need to consider what your goal is and whether your natural tissues in combination with a breast implant will allow us to adequately achieve that or whether additional procedures
• Do we need to consider fat grafting (to create a tighter cleavage, address developmental concerns such as tuberous breast, constricted breast or Poland’s syndrome, address size differences side to side)
• Do we need to consider a breast lift/mastopexy to improve the nipple position which may be too low or the shape of the lower pole which may be too droopy.

We need to consider your size goal in relation to all these other points and how an implant of that size is going to impact the outcome in general.

Will I need a lift?

This is a common question.

For most women, we are able to consider just an implant to obtain the best personal outcome. For some women we will need to consider repositioning a low nipple, tightening up a loose and droopy lower pole but these considerations require additional surgery and scarring with a breast lift.

HOME TEST: A good test you can perform at home to see whether or not you may need to consider a breast lift is to put your hands on your head in front of a mirror and if there is still some overhang below the fold then this is not likely to be fully corrected with an implant alone. A lower nipple position can be perfectly acceptable for some women especially if it looks forward or slightly up to avoid additional scarring.

The most important part of achieving your ideal outcome is to have a clear understanding of your goals which may include the acceptance of scars and then choosing an operative pathway that deals with each of these goals.

How is surgery performed?

All breast enlargement surgery performed by A/Prof Magnusson is undertaken in accredited hospitals with fully qualified anaesthetists in accordance with best practice.

All patients have surgery performed incorporating the 14 Point Plan to mitigate against bacterial contamination of the implant which is associated with significant complications such as infection, capsular contracture and evidence suggests it may be associated with breast implant associated-anaplastic blood cell lymphoma.

Surgery is performed under a full general anaesthetic. The most frequent incision is in the fold beneath the breast which is shown to be associated with lower bacterial contamination.

The implant pocket most frequently used is a dual plane submuscular pocket. There are some instances where an implant may be placed over the muscle such as some patients with tuberous breast deformity, to minimise the impact on the pectoralis major muscle or in some instances to create a more visible round shape to the breast at a patient’s request.

Surgery takes about one hour and a patient will then generally remain in the hospital during the initial part of the recovery as you wake from the anaesthetic for another two or three hours. This surgery it is almost always performed as a day case unless there are other procedures also being performed such as a tummy tuck or abdominoplasty.

Is breast implant surgery safe?

Breast implants have been used since the 1960s and have been under heavy scrutiny for much of this time. They are one of the most investigated medical devices by both regulators and practitioners. The implants that we use our advanced new technological discoveries and the surgical techniques for this procedure are also under continual refinement. The results we achieve now are more reliable and longer lasting than at any other stage in the history of breast implant use. Unfortunately, this does not mean there is an absence of risk.

Breast implants are not life devices and in due course will require revision. While the overwhelming majority of patients will have their implants for at least 10 years it is less likely to go beyond 15 years. There will however be a proportion of patients who require earlier surgery.

The reasons for re-operation on breast implants;

Breast tissue changes

Breast ptosis or droop is a natural change to the breast tissue with time that may impact your outcome from breast implant surgery.  Changes to the breast tissue will be the reason for reoperation for some patients rather than problems with their breast implants.

Problems with breast implants

Early reasons for re-operation may include infection or haematoma but these are very infrequent problems. Reasons for reoperation relating to breast implants further down the track after surgery will include implant migration/movement out of position, capsular contracture, breast asymmetry, scarring and eventual implant rupture. Implant rupture is very uncommon in the first 10 years following surgery.

Rare adverse events with breast implants

Breasts Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare form of non-Hodgkin’s lymphoma that can develop in the breast associated with breast implants. Tumour incidence varies with the type of implant chosen. The commonest presentation of this rare condition is a late, painless, swelling of one breast.

Associate Prof Magnusson performs research and has peer-reviewed publications in breast implant surgery including collaborative research into the rare problem of Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL), Breast Implant Illness (BII) and with the Australian Breast Device Registry. He has lectured on a wide variety of straightforward and complicated breast implant procedures at scientific meetings both in Australia and overseas. Your individual risks will be discussed fully during your consultation.

A/Prof Magnusson remains on top of the changes in the current knowledge relating to technique and safety with breast implant surgery. We are continuously striving to provide the safest environment using the most current techniques to create the safest, most reliable and enduring outcomes that we can.

Breast surgery forms the largest single part of Associate Prof Magnusson’s practice

• He performs all forms of breast surgery including primary cosmetic breast enlargement, breast asymmetry, congenital deformity like tuberous breast, augmentation mastopexy, revision augmentation/explant surgery and breast reconstruction for cosmetic and reconstructive problems.
• Associate Prof Magnusson uses fat grafting as an adjunct to breast surgery for many patients combined with mastopexy, implants and especially following explant surgery or as part of breast reconstruction
• He is a concept champion for the 14 Point Plan for safer breast implant surgery
• He is on an Expert Advisory Panel for breast implant surgery for the Australian Government’s Therapeutic Goods Association (TGA)He is a member of an international research group investigating Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL)
• He was run many meetings involving breast surgery education including his role as the scientific convener of the Breast Masters Symposium in Sydney, October 2018
• Associate Prof Magnusson is involved in research with and is a supporter of the Australian Breast Device Registry (ABDR)
• He has specifically researched and published on Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) and Breast Implant Illness (BII)
• He has delivered multiple talks on patient and implant selection, procedural planning and technique as well as many aspects of complex breast surgery at national and international scientific meetings

All of Dr Magnusson’s breast implant patients have surgery which incorporates the 14 point plan and are registered on the ABDR.