The facts about breast enhancement
Dr Darryl Hodgkinson has over 25 years of experience as a plastic surgeon specialising in breast augmentation. Here he gives you the facts about breast enhancement.
'Breast augmentation can enhance a woman's figure and her self-esteem. To be content with her choice to have breast implants, however, she must know the facts and be realistic.'
FACT: You, the patient, need to be involved in the process.
It is very important for women considering breast enlargement to know as much as they can about the procedure. You need to be involved in the choice of implant most suitable for you. The type of implant and how it is inserted can affect not only the size and shape, but also projection, cleavage and movement.
FACT: You need to be realistic. This is surgery – it is an important decision which, if made responsibly, can enhance a patient’s appearance and confidence.
All surgery carries risks and patients need to be informed. Patients need to be prepared to cooperate with their surgeon both pre and post-operatively to ensure the best result possible from their surgery.
FACT: No single type of implant will solve every problem.
Every human body is a unique shape and size. No two women have the same sized chest wall, the same volume of muscle, projection and shape of chest-wall bone structure or skin elasticity. These components and more make up the basis for the surgeon’s evaluation of how to achieve the look the patient wants. A 350 cubic centimetre textured round gel on one woman will not look the same on another. The expertise of the surgeon and his team in assessing the patient and their desires leads to a choice from a myriad implant types and sizes.
FACT: The incision site can affect the position, cleavage and look of the result. No single incision site is correct for every woman or every type of implant.
Incisions can be made under the breast (in the inframammary fold), around the nipple, under the armpit or in the belly button to insert implants. Again, the woman’s actual chest wall in conjunction with her desired result can affect the decision of where to make the incision. As in all things with surgery, the experience of the surgeon is paramount in deciding not only which implant to use but how to insert it. Incision sizes also differ. The incisions for saline implants are smaller than for silicone and only saline implants can be inserted endoscopically through the navel.
FACT: No implant will last forever.
The average life of breast implants is between 10 and 15 years. Some patients are fortunate to have their implants last a long time and others a short time, but no implant will last a lifetime. It is also important for women to realise that their bodies change throughout their lives with the influence of hormones, pregnancies, menopause and weight gain, so the size of your original implants may be inappropriate for your changed shape. All surgeons should inform their patients that this is a procedure that will need to be repeated in the patient’s lifetime if the patient wants to retain the enhanced look achieved through surgery.
FACT: Breast, bra and implant sizes cannot be directly compared.
Correct sizing of patients is important because no two women are the same, no woman has the same sized breasts on both sides and no two bras are the same – but two implants by the same manufacturer will be the same size. We pride ourselves for our ability to also size a patient accurately for breast implants, not only by measurements but also by different ways of trialling different sized and shaped implants.
My clinic staff and I have a vast experience and a particular interest in the sizing. Generally speaking, unless the patient has a specific request, I choose a size with a patient that will achieve a C or C+ cup size in most bras. With all this effort and expertise, we find at our clinic that it is extremely rare for a patient not to be completely delighted with with the size and shape she achieves.
Implants – what you need to know
Latest Memory Gel implants prove their worth! There has been a big improvement in silicone gel technology. Having lived through the unfortunate experience of the old gel implants in the 1980s and their subsequent withdrawal from the market because of their 50 percent rate of capsular contraction or hardening of the breasts, I am pleased to see a study by United States surgeon Dr Mark Jule has shown that the new Memory Gel implant has not only a very low rate of capsular contracture and an extremely high satisfaction rate, but also a very low rupture rate.
These are not just personal opinions or observations but a proper prospective study in which the patient has the operation and then is followed very carefully for up to 40 months after the original operation. This is a meaningful study, whereas most studies are purely anecdotal and many doctors will say, ‘I never have any problems ’ or ,‘They never go hard,’ but do not follow up their patients. To be fair, following up patients who have undergone breast augmentation is difficult because many of them are young and highly mobile in our global society.
We are now stocking the new Memory Gel breast implants and although I maintain a loyalty to saline implants and have thousands of satisfied patients, I do think that in a thin woman there will be less palpability of the implant. In a study conducted by Israeli doctors on women over 15 years old, it was found that in normal women the amount of fullness of the upper part of the breast decreases and the fold underneath the breast slips down.
We know that there will be normal changes in the breasts over time, which can make the breast implant seem more palpable. In this particular case, a patient is more likely to be satisfied with a Memory Gel implant over time than a saline implant.
Silicone versus saline
While silicone and saline implants may both rupture, it is much easier to tell if a saline implant has broken because the implant deflates. It is a simpler procedure to replace a saline implant than a gel implant. Newer gel implants such as Memory Gel are cohesive, which means that if they break, the gel cannot migrate too far into your tissues. The problem with the gel that if it is does migrate into the tissues, it is akin to chewing gum getting stuck in carpet and is difficult to remove.
Saline implants remain popular at my practice for women who like a more subtle A or B to C cup result, usually in the 250 to 330cc range. These are often health conscious women who because of the silicone gel scare are not interested in having anything other than the most natural product (saline) in their body.
Saline implants are often chosen by models and dancers because of the ‘shimmy’ effect of the implant. The implant moves in a very natural way, going flat when you lie down and into a teardrop shape when you stand up. Cohesive gel implants, on the other hand, tend to have a fixed ‘headlight’ appearance. Most of the time, the implants are put in a partial subpectoral position or dual plane position, meaning that the implant is partly under the muscle at the top and is so completely covered by tissue, not giving the obvious subglandular appearance of Victoria Beckham.
I have been performing breast augmentation surgery for the last 30 years and in the thousands of patients for whom I have performed this procedure, I am convinced that in the majority of patients this operation gives probably as much satisfaction as any plastic or cosmetic surgical procedure. However, with caution, I realise that a small percentage of women will be dissatisfied with the procedure due to unfortunate complications. Fortunately, over the years, the implants have improved and ongoing developments and trials will continue to raise them to a higher standard.
Conquering our little imperfections
In the hands of an expert surgeon, women can have breast enhancement surgery and correct aesthetic issues of droop, asymmetry or chest wall deformities at the same time.
The most common problem seen by women seeking breast augmentation is droopy breasts. While many surgeons are tempted to simply place an implant in the breast, this will not correct the droop but draw attention to the compromised elasticity of the skin and position of the breast.
In this scenario a breast lift is performed at the same time the implant is inserted. The incision is made around the nipple to prevent scarring on the breast itself. Minimalincision breast lifting should only be performed by plastic cosmetic surgeons with specific experience and training in this procedure.
Breast asymmetry can be corrected at the same time breast enhancement takes place.
The harsh truth is that no woman is perfectly symmetrical. Many women, however, do not realise how common asymmetry is. As with all breast surgery, no one procedure suits every patient and this is also true for asymmetry as each breast must be treated individually to bring it into balance and harmony with its neighbour. It may be necessary to lift or reduce one breast while augmenting the other or lifting one and augmenting both – the solution depends on the individual’s situation and desired outcome.
Chest wall deformities
Chest wall deformities such as Poland’s syndrome, pectus excavatum, pectus carinatum and even scoliosis can affect the way breasts appear. It is important to address the issue of the chest wall if there is deformity at the same time as considering breast enhancement.
Surgeon profile – expertise is everything
Dr Hodgkinson learnt the skills of breast augmentation surgery in Newport Beach, California in the late 1970s after studying plastic surgery at the prestigious Mayo Clinic. He also worked with Dr Chuck Vinnik, a leading breast augmentation surgeon in Las Vegas, Nevada, as part of a special breast fellowship. During his career practising in the United States and Australia, Dr Hodgkinson has performed thousands of breast augmentation operations.
Dr Hodgkinson uses both saline and silicone implants through every type of incision. He is one of the pioneers of endoscopic trans-umbilical breast augmentation in Australia. Along with his experience and expertise, Dr Hodgkinson also brings a unique artistry and understanding of the female form to breast augmentation. His love of art and understanding of figurative representation help patients achieve the most appropriate result for what they want. ‘I look after every variety of patient wanting a ugmentation, from dancers to mums, models to executives, socialites to actors and pop stars,’ he says. His wide experience allows him to individualise results for each particular patient. Having used saline and silicone implants for nearly three decades, he understands the positive and negative aspects of each implant and can advise patients on the best implant size, shape and consistency for particular problems.
Dr Hodgkinson has written extensively on breast augmentation in surgical literature and is particularly interested in chest wall deformities, which are present in 10 percent of patients seeking breast augmentation. Ninety percent of patients presenting for breast augmentation also have some degree of asymmetry of the breasts; Dr Hodgkinson is particularly interested in this area and aims to correct these asymmetries as well as increase the size and beautify the breast. He has been invited to lecture other plastic surgeons around the world on breast surgery and was chosen to perform the live demonstration of breast augmentation surgery at the 2006 International Society of Aesthetic Plastic Surgery in Rio De Janeiro, Brazil, the largest ever congress on cosmetic plastic surgery. Patients come to Dr Hodgkinson for breast augmentation because of his expertise, experience, communication skills and ability to determine the appropriate procedure to give the best, long-lasting beautification of the female form.