Breast augmentation is the most popular cosmetic surgery operation performed throughout the world today. The reason for this is that the results are the best that they have ever been, the costs are more affordable and the complications are very low.

Breast augmentation is not a very complicated operation and hence every type of doctor performs them. The results vary widely. The nuances of this operation is what turns the results from mediocre to exceptional and there are a lot of nuances and pitfalls in this operation. Breast augmentation with implants is being challenged by breast augmentation with fat grafting. At present I believe that breast augmentation with implants is more predictable and less expensive.

The advantages with fat is that there is no potential for long term capsular contracture. In exceptionally thin people there would be less implants show and no visible implant rippling. There is only one problem is that very thin people do not have any fat for grafting and so unfortunately they are stuck with implants.

When it comes to choosing the style of implant I am a big fan of anatomical implants for many reasons. I still do round implant breast augmentations if requested but I believe there are a lot of myths about round implants that will provide you with more upper pole fullness. One can get as much or even more upper pole fullness with anatomical implants.

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Choosing a longer implant in the anatomical range will give you more filling than in the round implant as one can still choose a narrow base width implant but a higher length of implant. With a round implant you can only go higher if you go wider. The high profile round implants will generally give you a shelf or more sudden upper pole takeoff but not necessary a fuller upper pole than an anatomical implant. There are numerous other reasons that I can give about why I choose anatomical implants over round implants.

If the patient has perfect breasts both round and anatomical implants will give a good result. The moment you want to impart some shape to the breasts that is where the anatomical implant is vastly superior.

I prefer an infra-mammary crease scar over axillary or peri-areolar scars. The infra-mammary crease scar is the most direct approach and one can adjust the pocket a lot more easily. In my 19 years of practice I can honestly say that I have never had an issue or problem with this infra-mammary crease scar and saying never in any type of surgery is not done lightly.

Now to the pocket. I much prefer a sub-mammary pocket if at all possible. The only exception is where a patient is thin and does not have enough soft tissue cover over the upper pole and medially. In this case I feel that a sub-pectoral pocket is advisable.

I do not honestly believe that one can tell the difference between a sub-mammary and sub-pectoral pocket by looking at pictures. Both look quite natural. I feel that the submammary pocket is less invasive and that there is no animation of the breast when tensing the pec-major muscles. Animation is where if one contracts the pec major muscle there is movement of the breast. Normal breasts do not have animation. When contracting the pec major muscle and the breasts move the implant is definitely a sub-pectoral implant.

Choosing the correct size implant is also very important. The width of the implant is the most important parmater of the implant. The width of the implant in relation to the chest is what will give the operation a natural look.

The operation is fairly quick taking about one to one hour fifteen to complete. I prefer doing the operation under general anaesthetic and as a day only procedure. I believe drains are important for draining the pocket. These usually stay in an average of three days. I use a sports bra post-operatively which should be worn for approximately one month.

Vectra Machine

This machine is a three dimensional graphic/computerised simulation device that allows the patient to see what she might expect from the different implants. It is a tool and has its own limitations but it does give patients a good idea of breast size and differences of the different implants when choosing different shapes and sizes. It makes the decision making for patients a lot easier.

Photographs and simulations are available at your initial consultation.

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