Over the past 20 years I have performed more than a thousand breast implant procedures and it is a procedure which interests me greatly. My special interest over this time has been in perfecting techniques which achieve a completely natural result. I believe that augmentation mammaplasty should provide patients with breasts of a natural size and shape, without any evidence to suggest that they are the result of surgery.

Augmentation mammaplasty is performed for women of all ages but the ideal candidate for this procedure is a younger women of normal build, or older women who have not had a pregnancy.

For these patients the placement of the incision is especially important. It should not be on the breast, but in the hair-bearing skin of the armpit, because this means the scar will be undetectable once it heals. Incisions on the breast produce scarring because the increased breast size causes the skin to tighten, stretching the scar and leading to a visible result.

I strongly recommend the round, low profile type of smooth surface silicone gel implants, not saline implants. The main problem with saline implants is that they do not feel like breasts, they feel more like hot water bottles under the skin. The second problem is that they are prone to developing leaks. This does not pose a health risk, but the unexpected overnight deflation of a breast is a profound disappointment and requires additional surgery to replace the faulty implant.

The new silicone gel implants, which have been used in Australia for over five years, feel so soft and natural as to be completely undetectable in 95% of patients. While these are still breast implants and therefore not perfect, they are clearly the best implants ever to date.

The placement of the implant in relation to the pectoral muscle is an important consideration (see illustration). Traditionally, implants have been placed directly behind the breast tissue (subglandular) but in front of the pectoral muscle. This is technically simpler surgery, so more appealing for the less experienced surgeon, but there are serious limitations from this placement. The key problem is that implants in front of the pectoral muscle are more prone to the development of scar tissue, which grows around the implant in a condition known as 'capsular contracture'. Capsular contracture has traditionally been a problem of breast implant surgery, and tends to worsen during pregnancy, possibly as a result of the bacteria which proliferate in the breast tissue around the breast ducts.

Breast implant placed in front of the pectoral muscle	Breast implant placed behind the pectoral muscle

Placing the implant behind the pectoral muscle has many advantages. Firstly, the implants are less prone to capsular contraction as there is a natural gliding plane between the muscles which allows movement in the space in which the implant is placed. Also, there is less chance of capsular contraction developing during pregnancy, possibly because the pectoral muscle provides a barrier between the implant and the breast tissue.

The second important advantage is that the edge of the implant is less detectable when placed behind the pectoral muscle. Further, placing the implants in a larger cavity like this contributes to a natural, soft feel and allows natural movement. The breast assumes a normal, tear-drop shape and then moves to the side when the woman is lying down, just like a natural breast.

Photograph of a woman five years after breast implant surgery, showing natural softness which is demonstrated by squeezing the breast implant. The breasts respond in a soft manner because they are free of restriction by capsular contracture.

Using the current implants and techniques, 95% of all breast implant surgery patients have breasts which are soft and natural looking with natural movement. These breasts are quite different to those featured in some sections of the media and also to those created from saline implants seen on some American women. Augmentation mammaplasty offers a discrete and attractive solution for most women which enhances the overall appearance of their figure.

Women with a very thin chest wall, asymmetry of the chest or breasts, minimal breast tissue, sagging breasts from previous pregnancies or severe weight loss face different issue from those discussed above. More information about this is available from our Patient Information Notes.

If you would like more information on breast augmentation please click here to email the surgery and request our Patient Information Notes, Augmentation Mammaplasty.