POST PREGNANCY BREAST AUGMENTATION + MASTOPEXY

Breast augmentation, also known as augmentation mammoplasty, can be a cosmetic procedure or a reconstructive procedure in the case of breast reconstruction surgery. The procedure involves silicone implants being inserted beneath the breasts to increase the size of your breasts or increase breast volume that has been lost after weight reduction or pregnancy.

Breast augmentation can:

• Enlarge breasts
• Increase fullness and projection of your breasts
• Reduce breast symmetry
• Reconstruct a breast after mastectomy or injury

Over the years, factors such as pregnancy, nursing, and the force of gravity may change a woman’s breasts. As the skin loses its elasticity, the breasts often change shape and and become ptotic. Breast lift is a surgical procedure to raise and reshape ptotic breasts. Breast surgery is a deeply personal procedure and you should do it for yourself, not for anyone else.

People choose to undergo breast surgery to:

• Change the alignment of the nipple and breast or raise the nipple position in relation to the rest of the breast.
• Lift ptotic (sagging) breasts
• Change breast shape
• Change the size and/or shape of the areola.

Breast enlargement and lift surgery can bring physical changes, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr Sharp.

If your breasts have lost volume — for example, after pregnancy — breast implants inserted in conjunction with a breast lift can increase both their size and position on the chest.

The best candidates for breast augmentation are women who are seeking aesthetic changes, but not perfection. If you’re physically healthy and realistic in your expectations, you may be a good candidate.

How to maintain your results

Following your post-operative instructions and wearing your support garments are integral in the early stages of healing. Good nutrition and maintaining a healthy body weight are integral to obtaining and maintaining optimal long-term results.

Pictured, right: before and 4 months after breast augmentation and mastopexy surgery with Dr Sharp. Please note this patient’s scarring is still in the early stages of the 24 month scar maturation process.

The surgical procedure

There are two main components of your breast lift and augmentation procedure. Whether you have them done at the same time, or staged over two operations, the following details the process involved:

Your breast lift procedure can be achieved through a variety of incision patterns and techniques. The appropriate technique for you will be determined based on:

• Breast size and shape
• The size and position of your areolas
• The degree of breast ptosis (sagging)
• Skin quality and elasticity as well as the amount of extra skin

Step 1 – Anaesthesia

Mastopexy surgery is performed under a general anaesthetic with a specialist anaesthetist meaning you will be asleep during surgery.

Step 2 – The incision

There are three common incision patterns:

• Around the areola
• Around the areola and vertically down from the areola to the breast crease
• Around the areola, vertically down from the breast crease and horizontally along the breast crease

Step 3 – Reshaping your breasts

The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.

If you’re having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.

Step 4 – Closing the incisions

If you are having an augmentation is a second separate procedure, at this point in your mastopexy, all of your incision sites will be closed. Some incision lines resulting from breast lift are placed in the natural breast contours; however, others are visible on the breast surface. Incision lines are permanent, but in most cases will fade and significantly improve over time.

Sutures are layered deep within the breast tissue to create and support the breasts. Sutures, skin adhesives and/or surgical tape may be used to close the skin.

If you are having an immediate augmentation, the incision under the breast (inframammary) is left open at this point to facilitate the next step.

The breast augmentation component of this procedure involves the following further steps:

Step 5 – Inserting and placing the breast implant

Using the existing inframammary incision, a pocket is created for the insertion of the breast implant. The location of the pocket can be either:

• Sub-muscular: Under the pectoral muscle
• Sub-glandular: Directly behind the breast tissue, over the pectoral muscle
• Dual Plane: placement partially beneath the pectoralis muscle and partially beneath the mammary gland

Step 6 – Closing the incisions

Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive or surgical tape to the skin. A small thin drainage tube may be left in the breast pocket to assist with drainage of any blood or fluid post-operatively.

Seeing the results

The results of mastopexy and breast augmentation are obscured in the early stages by bruising and swelling. Deep swelling can take several months to subside, with the breast taking up to another 6 months to ‘settle’ into its future shape.

The best candidates for breast augmentation and lift surgery are women who are looking for change, not perfection. If you’re physically healthy and realistic in your expectations, you may be a good candidate. Before you decide on breast lift and augmentation surgery, there are some important issues to keep in mind:

• Surgeons generally recommend waiting until breast development, child birth and breastfeeding have stopped before undertaking breast lift surgery
• Breast surgery can change your appearance, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr Sharp.

A breast lift may be a good option for you if:

• You are physically healthy
• You have realistic expectations
• Your breasts vary in size or shape
• One or both breasts failed to develop
• Your breasts have lost their shape and fullness
• When unsupported, your nipples sit below the breast crease
• Your nipples and areolas point downward
• You have stretched skin and enlarged areolas
• One breast is lower than the other
• Remember that the shape and size of your breasts before surgery will influence the surgical procedure and the outcome.

Some women seek mastopexy and augmentation because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you’re planning to have more children, it may be a good idea to postpone your breast lift. Pregnancy is likely to stretch your breasts again and offset the results of the procedure.

Any breast surgery is a very personal process and you should do it for yourself, not for someone else

Breast lift and augmentation surgery is safe and performed frequently by plastic surgeons in Brisbane, carrying very low mortality and morbidity rates when performed in accredited facilities by specialist plastic surgeons.

However it is a major procedure – and therefore, choosing the right surgeon is of utmost importance. Both breast reduction and breast augmentation surgeries should be performed by a qualified plastic surgeon who is registered as a Fellow of the Royal Australasian College of Surgeons. You can confirm your surgeon’s credentials here

Dr David Sharp is a qualified plastic surgeon with a special interest in reconstructive and cosmetic plastic surgery. His personalised approach means that you receive plenty of preoperative time with him to discuss your specific objectives and any questions.

It’s normal to feel both nervous, and an excited sense of anticipation when planning your breast  surgery. Dr Sharp takes the time to ensure you have as many consultations as you require, to ensure your treatment is customised to suit your body and expectations – and address any concerns you may have.

If you have just had a baby and are considering this surgery, it’s important to give your body plenty of nurturing, patience and time to slowly find its equilibrium after birth and breastfeeding. Most women’s bodies do not return to their pre-pregnancy shape.

The last thing a new mum needs is external pressures to return to your post-baby shape, so give yourself time and self-love.

Once you have recovered from child birth, if you love your newfound form, that’s great!

If you would prefer it to be more similar to your appearance pre-baby, that’s okay too – but make sure you are doing it for yourself.

Dr Sharp has a special interest in post-pregnancy surgery. Click here to read more about tummy tuck (abdominoplasty) and breast surgery options.

Breast lifts and augmentations are performed under a full general anaesthetic. A specifically selected range of medications are administered during the surgery to ensure your post-operative comfort. Dr Sharp works with an experienced team of anesthetists.

Types of breast implants used by Dr Sharp

Silicone implants

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. A leaking implant filled with silicone gel may not collapse.

Round breast implants

Round breast implants have a tendency to make breasts appear fuller. Higher profile options can achieve even more projection. Because round implants are the same shape all over, there is less concern about them rotating out of place.

Anatomical breast implants

Anatomical (or tear drop) breast implants’ main characteristics are a flatter upper breast pole and a fuller lower breast curve. An appearance that usually is associated with a youthful natural-looking female breast appearance. These are usually micro or nano textured.

Smooth breast implants

Smooth breast implants do not have a textured surface. These implants can move with the breast implant pocket, which may give more natural movement and avoid shape change if your chest muscles are very active. Smooth implants are round and may have a more visibly augmented result and some palpable or visible rippling. Smooth implants do not carry a risk of BIA-ALCL.

Textured breast implants

Textured breast implants develop scar tissue to stick to the implant, making them less likely to move around inside of the breast and get repositioned. Texturing offers some advantage in diminishing the risk of a tight scar capsule, but carry risks of biofilm and BIA-ALCL; although these risks are very low and mitigated by the Macquarie University 14 Point Pledge followed by Dr Sharp.

Potential costs include:

• Dr Sharp’s fee
• Anaesthetist fee
• Assistant’s fee
• Theatre costs
• Support garments

Depending on your suitability, Dr Sharp may be able to offer this surgery either as an inpatient, or as a day case in an accredited private hospital. The cost of your hospital component of the procedure will vary accordingly.

Breast augmentation and lift for cosmetic reasons is not covered by most private health insurers. 

After your consultation with Dr Sharp, if there’s a possibility that your surgery meets Medicare’s MBS Item Number criteria, you will be provided with an item number, We recommend you contact your health insurance provider and ask them if you are covered for plastic surgery, particularly siting the item number provided.

It is important to understand that, in the case of complications or revision surgery, the cost of your breast augmentation and lift might extend to future surgical procedures and hospitalisations. We encourage patients to think about how they would fund further treatment beyond the immediate costs expected.

Breast augmentation and mastopexy recovery

During your pre-operative consultations, Dr Sharp will give you specific information regarding what to expect during your individual recovery period that will help you prepare for the best possible post-operative experience, particularly regarding:

• Post-operative care; in hospital (inpatient) or at home (day surgery)
• Medication and pain relief
• Dressings/tapes after surgery
• Stitches and excision wounds
• Symptoms of complications; what’s normal, and what to look out for
• Resuming normal activity / work

You will also be given a number for our 24/7 post-operative care service.

During your breast augmentation and lift recovery, you will be taken into a recovery area to be closely monitored following surgery. If you are having the procedure as a day case, you will be discharged home; ensure you have a trusted person to collect you from the hospital and stay with you for at least 24 hours after surgery. If you are an inpatient, you will be discharged from recovery to the ward.

After your procedure, tape will be applied to the incisions. You will go home wearing a special post-operative support bra, which we supply to minimise swelling and support your breasts as they heal.

You will also go home from hospital with post operative instructions, our after hours contact number and a complimentary bag which contains post op support products to help optimise your healing. 

Your dressings will be checked and changed on day 7 after your procedure. A thin layer of tape will be over the incision wounds; these should remain in place to support your incisions for several weeks, so please don’t remove these until nurse indicates.

Continue to use your post-operative bra for at least 6 weeks after your procedure.

If your breast skin is very dry following surgery, you can apply a natural moisturiser such as bio-oil or coconut oil several times a day. Be careful not to tug at your skin in the process, and keep the moisturiser away from the suture areas. Your post op support bag will include a silicone gel which can be massaged into your incision lines once your tape is ready to come off.

You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides. In some patients, however, it may last a year or more, and occasionally it may be permanent.

Dr Sharp will give you detailed instructions for resuming your normal activities; this is generally safe after about 6 weeks. After that, you can resume these activities slowly. 

Healing is a gradual process. Although you may be up and about in a day or two, don’t plan on returning to work for 2 weeks, depending on how you feel. Avoid lifting anything (even light objects) for 6 weeks. If you have any unusual symptoms, don’t hesitate to call Dr Sharp’s rooms.

You will likely experience soreness and swelling for a few weeks, and twinges of pain or pulling feelings for months after the surgery. Your final results will be visible after approximately 12 months, as your implants can take time to settle and internal scarring requires time (24 months).

Returning to exercise after breast augmentation and lift surgery

After 6 weeks you can gradually return to normal gym activities, adding small 2kg increments of weights and increasing length and intensity of your workout based on how body responds. Ease back if pain, swelling or any distortion is noticed. After 6 weeks you can start jogging and gentle swimming short distances – again, gradually increasing pace and distance using a supportive sports bra. Leave hard running or any sprinting to 12 weeks post op.

Breast augmentation patients who have a prosthesis in place may not be able to do regular pectoral workouts without discomfort in their breast, or shape distortion. You may need to avoid bench press, dips and flies altogether (now and in the future) if you find that these cause your PO results to change; this just requires close monitoring in the months after resuming activity. This is also something to consider if you are having a breast augmentation and mastopexy and participate in body building or use your pectoral muscle intensively in your job. Talk to Dr Sharp about this prior to your surgery as there are some considerations he can make in implant position and implant selection when planning your procedure if this is the case. It may be a trade off between having the look you desire, and the function you require.

Breast augmentation and mastopexy results + expectations

Good pre and postoperative health is an essential component of achieving a pleasing result, as is following postoperative instructions closely. It is important that the surgical incisions are not subjected to excessive force, swelling, abrasion or motion during the healing period.

Over time, post-surgical swelling will resolve and with good scar care, incision lines will be less prominent. Post operative blues are normal, but these fluctuations should stabilise as you recover from surgery. The outcome of your breast augmentation and lift will gradually appear over the next 6-12 months as breast shape and position continue to settle.

Dr Sharp will take every effort to make your scars as inconspicuous as possible. Still, it’s important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading. Fortunately, the scars can usually be placed so that you can wear most clothing and swimwear without incisions being detected. Scarring, internal and external, will take 24 months to mature and it is important to think about how you will feel about your scarring during this period, especially if you are genetically prone to poor scarring.

Scar development is impacted by factors such as genetics, skin condition, health (non smoking), good nutrition, taping and massage and minimising exertion and strain on incisions during the recovery period; things that patients can actively control with diligent adherence to postoperative instructions. 

If you are concerned about scarring, speak to us about the therapies available to reduce the appearance of scars.

Your satisfaction with a breast lift and augmentation is likely to be greater if you understand the procedure thoroughly, follow postoperative instructions and if your expectations are realistic. You’ll be able to retain your new look longer if you:

• Maintain your weight
• Keep a healthy lifestyle

Breast surgery should be undertaken after child bearing is completed. Changes that occur in the breasts during pregnancy can minimise or reverse the changes a breast lift provides.

Likewise, significant weight loss after breast surgery can impact results.

Surgery will not stop the ageing process, nor the effects of gravity.

Provided you generally maintain your operative weight, wear a supportive bra and don’t sustain injuries or undergo further breast surgery, your results should last many years.

Pregnancy and substantial weight gain are the two most common reasons why breast augmentation and lift results don’t last. Implants do not last forever and may need replacing in the future.

What is a complication?

Surgery aims to create improvements. Where a patient achieves an improvement, but does not perceive it to be enough of an improvement, this is not considered a surgical ‘complication’. Read more about the classification of complications here.

A surgical complication is an unexpected deviation from the normal surgical course.  For example, not liking your postoperative breast size is not a complication, but wound dehiscence or an infection around your implant is a complication.

Possible complications of surgery in general include:

• Acute medical event such as stoke, heart attack, pneumonia
• The need for revision or further surgery
• Pain which does not respond to pain relief
• Nerve damage, causing altered sensation or loss of sensation – temporary or permanent
• Haematoma (collection of blood), oedema (collection of fluid) and abscess
• Deep vein thrombosis (DVT) or pulmonary embolisms (PE)
• Damage or or loss of loose teeth during placement of anaesthetic apparatus
• Sore throat, swelling or discomfort following placement of breathing tubes during anaesthetic
• Breathing difficulties following anaesthetic
• Allergic reaction to medication
• Allergic reaction to sutures, dressings, tapes or intraoperative solutions
• Heavy bleeding from the wound, which may require further surgery
• Poor or slow skin healing, wound infection, breakdown or necrosis (skin death)
• Wound dehiscence (incision separation)
• Adverse scarring
• Psychological impact of surgery, recovery or altered appearance
• Death

Possible breast augmentation/lift specific surgery risks include:

• Changes in nipple or breast sensation, which most patients experience to some degree; mostly temporary but may be permanent
• Poor scarring of skin
• Malposition of the implant
• Implant leakage or rupture
• The formation of tight scar tissue around the implant (capsular contracture) is a common experience for women with long term implants
• Wrinkling of the skin over the implant
• Implant rippling, which most patients experience to some degree especially if they do not have much fat or breast tissue covering the implant
• Pain, which may persist
• Possibility of revisional surgery
• Areola enlargement
• Migration or altered position of implant
• Contour deformities
• Aesthetic concerns, such as asymmetry
• BIA-ALCL and breast implant illness, which are two rare conditions; please explore these in detail, in the linked articles, which are dedicated to these topics

Complications can occur despite the patient and surgeon’s best efforts to avoid them – so it is important to consider how they may impact you physically, emotionally and financially if they do arise.

Dr Sharp and his team manage known risks with the upmost care to further reduce the likelihood of them occurring. In the event they do occur, most can be treated with prompt intervention.

Everyone’s body responds differently to surgery. In some cases, post-operative revision surgery might be required.

How do we reduce the chance of complications occurring?

• We select healthy candidates for surgery – that means physically and mentally, they are in the best possible condition to undergo their procedure
• Dr Sharp is a specialist plastic surgeon, which means he has the appropriate training and qualifications to perform breast augmentation surgery
• We operate in accredited facilities with a specialist anaesthetist present

Some factors, such as weight, lifestyle or health problems can increase the chance of a complication occurring. Dr Sharp will take time to learn about your potential risk factors during your pre-operative consultations, and will determine if they are relevant to your surgery.

Women should not be made to feel pressure to change their bodies – and nor should they be made feel guilty or selfish for wanting to make changes to their bodies.

Provided they are making an educated, considered decision, we think most mothers have earned the right to do what they want with their bodies, whatever that means to them. And for the majority of women, that means doing nothing.

Reasons why women may choose not to have breast lift (mastopexy), breast augmentation or abdominoplasty after pregnancy include:

• They are pleased with the way their body looks and they don’t have a desire to change it 
• It is too costly, or they may not be able to afford potential ongoing costs, such as implant revision or placement in the future if the need arises 
• They are unsure whether their result would meet their expectations 
• They are concerned about the potential risks and complications inherent with surgery
• They are worried about the limitations of the recovery period, especially when this may require other people to help carry their share of family or household duties for an extended period.
• They are not physically or mentally in a suitable position right now to have surgery
• They cannot take time off work 
• Their concerns about the other unknowns of surgery (variable results, delayed healing etc) outweigh the benefits.

And here are some of the reasons why women might choose to have breast lift (mastopexy), breast augmentation or abdominoplasty after pregnancy:

• Improvement in quality of life, in the case of them needing a medically-required procedure, especially women living with chronic skin issues, back pain, hernias and core strength issues. Research has proven that procedures such as abdominoplasty, which can improve core strength and pelvic floor weakness, may improve women’s quality of life, sexual function and pleasure.
• They seek the skin reduction and physical changes that breast augmentation, breast lift and tummy tuck surgery provides.
• They had good core muscle strength and pelvic floor control before having babies; but have been unable to restore it with exercise, physiotherapy and a healthy lifestyle
• They already have good self esteem; their identity and self image is not dependent on having surgery; they feel comfortable with their motivations.
• It is something they have thought about, and researched, for some time. They have given great consideration as to the benefits and risks – and what they want do with their own body.