FAQ Breast Implants

The 10 things to find out about during your breast implant consultation

Does your doctor carry out many of these procedures?	Just as you would like the obstetrician delivering your baby to be delivery many babies every month, your breast surgeon should also be doing many procedures every month. I suggest that at least 10 would be reasonable
Is the procedure done in a registered facility?	Whilst some doctor’s rooms can be quite sophisticated, having the procedure in a registered facility ensures maximum comfort and safety. Typically, in a registered facility, you will have an anaesthetist, anaesthetic nurse, scrub nurse, scout nurse, and your surgeon. If your doctor does not use the right facility, possibly to cut costs, then safety, comfort, recovery etc may be compromised.
Does your doctor have a special interest or skill, for example in using tear-shaped implants ?	Implants come in different shapes, sizes, and with different coatings – eg smooth or textured. Even the gel can vary from soft to firm. The surgical technique is very different for tear-shaped implants, compared to round implants.
All breast implant surgeries can have complications	some soon after surgery, and some delayed. Ask your doctor what his or her complication rate is, especially with capsule contraction. Ask what the policy is for the management of, and costs associated with these potential problems.
What size implant is best for your body?	Whilst you may have your own ideas about breast size, the dimensions of your body, more specifically the width of the rib cage underneath the breast, are the main determinants of the size implant you can have. For example if you are a size 10 in clothes, the “base width” may be between 10 and 11 cm. Therefore, the width of the implant selected must be compatible with those measurements. Otherwise, if the implant is too wide, you will be pre-disposed to rippling, implant failure, and other problems.
Silicone gel or Saline?	Very few surgeons now use saline filled implants. They do not feel as natural, and tend to ripple when inflated. Also, some studies show a significant leakage and failure rate after just a few years. The safety issues with silicone gel have been resolved, and they are fully approved by the health authorities all over the world. They feel much better, and are more reliable. Many of the manufacturers back their implants with lifetime guarantees.
Round or shaped?	If you want the most natural look, then the tear-shaped implants are usually the best choice. Sometimes the surgeon can use what we call an 85% fill round gel implant – this can also give a very natural shape. Where you want a lot of fullness in the upper breast, then a round implant should be used. Both shapes will improve your cleavage.
Behind or in front of muscle?	In my opinion, the muscle should be left alone if there is enough tissue coverage over the upper part of the breast - otherwise the edge of the implant may be visible. If you can pinch up 2 or 3cm of tissue in that area, your implant can safely be placed in front of the muscle. Some surgeons automatically advise that the implant should go behind the muscle, without even assessing your tissues. One of the reasons may be that creating the pocket behind the muscle is much easier for the surgeon, and takes less time. If a saline implant is being inserted, then because of the inherent issues (ripples etc) then this should be placed behind the muscle. Also, if a round implant is being used, then going behind the muscle, which only gives extra coverage over the top half of the implant, can create a more natural shape – but why not use a shaped implant in front of the muscle, and save all the extra trauma, discomfort, and adverse effects on muscle function. If you are into fitness and gym, you should avoid the retro-pectoral position if at all possible.
Location of Scar	Implants can be inserted below the natural breast, through the nipple, through the navel and through the under arm. It is important that you discuss this with your surgeon. My preference whenever possible is beneath the breast as this causes the minimum interference with the body and the scar is concealed within a natural fold.
What is the cost and what is included?	What follow up will be needed after the surgery and is this included in the cost. Will a garment, medications and after care be included? What costs will be involved in the event of complications?

Dr Simon Rosenbaum

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