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Breast Augmentation: what happens next?

Minimising long-term complications following breast enhancement is paramount, says Sydney plastic surgeon Dr Darryl Hodgkinson.

Breast augmentation has evolved over the past 50 years to become one of the most popular procedures

performed by cosmetic plastic surgeons. It is also an area of aesthetic surgery that attracts multiple opinions, in particular regarding implants.

Patients always ask me who is best at performing breast augmentations and my response, after performing more than 6,000 procedures, is that it is not who is the best at putting the breast implants in the patient but rather who is the best at taking care of the problems that can occur afterwards. Placing any foreign body in a person has potential complications, and the issues with breast implants become more obvious with time.

Early post-operative problems are not common; infection and haemorrhages are rare. The initial results often depend on the anatomy of the patient. Does she have symmetrical breasts? Are the nipples in a good position? Is the chest wall the same on both sides? What is the condition of the breast tissue? Does she have tuberous breasts, or ‘snoopy’, breasts? There are many different factors that contribute to the final result. No matter what the initial result is, the patient’s aesthetic form will likely be dramatically improved initially from the breast augmentation.

I believe what happens over time is the most critical aspect of breast augmentation surgery. With more than 30 years of experience performing this operation, I recognise that patients return to the doctor after several events: the natural ageing process, changes to a patient’s breast tissue, and ageing of the implant itself. Breaking this down further:

  1. Three to five percent of implants will fail in a five to 10 year period.
  2. The patient’s body will change – pregnancies, menopause, weight gain and hormone intake will all change the breast tissue and can make the breast implants inappropriate or redundant to the patient, so a re-operation is usually on the cards.
Before and after breast augmentation by 
Dr Hodgkinson using saline implants

 

One of the reasons I choose saline implants over silicone gel or polyurethane implants is that I’ve found very little follow-up is necessary with saline implants. Once the initial phase is over, usually at six weeks, I generally do not have to see a patient again, although I like to review them on a year-to-year basis and am available if they want a check-up or have a concern.

Before and after breast augmentation by 
Dr Hodgkinson using saline implants

 

If a saline implant fails, the only thing that happens is that it deflates. Any well-respected company such as Johnson & Johnson or Allergan will give the patient a new implant and the surgeon then replaces the broken one.

In comparison, with gel and polyurethane implants there are always questions about whether the gel is leaking and the implant is broken. The surveillance needed to ascertain this is much greater, often requiring x-ray scans and expensive MRI studies. So for the realistic patient, especially in the younger patient group, I advise them tochoose saline implants, if possible, as I believe this is the least complicated option.

Among my office staff, five women have had breast augmentations: two have had saline implants with no problems in 10 years and three of them have had gel implants, preferred by other surgeons, all with issues. Although this is a small select group, it does demonstrate that problems with saline implants are minimal longterm procedures whereas with gel implants, long-term problems seem to rise over time. We still use silicone and polyurethane implants but only in special cases, preferring to use saline implants. Two examples of saline implants are shown above.