Now you’ve probably heard, or read on the internet that you always get a more natural result if the implant goes behind the muscle. This is usually true, but not always true. There are some situations where we really can’t put the implants behind the muscle. A typical example would be a lady who’s had children and breastfed, and has got somewhat droopy breasts. There are some situations where we would actually need to do a lift, but if I decide that we can get away without doing a lift, I may nevertheless recommend that the implant go in front of the muscle, directly behind the breast tissue. As you can imagine, post breastfeeding breasts tend to be very mobile. They go a long way up and down, and they can move sideways. They’re kind of loose, and you can well imagine that if we sit an implant on the chest wall, that’s in a fixed position. The breast tissue is going to is still be mobile on that, if the implant is behind the muscle because the implant and the breast tissue are not in direct contact. So in that situation, when you do have a very mobile breast tissue, you might find that the breast tissue hangs off the implant when you’re leaning forward. When you lie back to go to sleep, the breast tissue sloshes to the size of the implant, and so on and so forth. Even when you’re just standing up normally, the breast tissue can hang off the end of the implant and we actually have a name for that. It’s a terrible name. We call it the Snoopy dog deformity. It’s not good. We find that if we get the implant size, diameter, and overall dimensions correct and put it in front of the muscle because the implant is now in direct contact with breast tissue, it’s going to control the breast tissue much better, and you won’t get those problems.
Let me talk to you a bit about implant selection in breast augmentation. We have a number of different types of implant available, and a number of different brands. As you probably all know, the main two varieties are ones with saline fill and those with silicone gel fill. I’m a big fan of the silicone implants. I don’t really like using saline. I don’t think it gives as natural a result. Silicone gel is a very safe, biologically inert product. The companies that make breast implants have been improving their procedures over a number of decades in order to achieve a product which is minimally invasive and minimally damaging to human tissue. I’m confident in the implants that we use now. I mainly use Mentor brand implants. I think it’s an excellent company, and they have a very good product. Once we’ve made that decision, we also have to think about the size. We have to think about whether we’re going to use round or teardrop implants. We have to think about whether we’re going to use smooth or textured implants. That refers to the surface treatment of the implant. There is actually a third variety of implant that uses a polyurethane microfoam coating on the outside. These are commonly known as the Furry Brazilian implants because the first company to offer this product were actually a Brazilian manufacturer. How do we go about selecting implants? It’s a very complex thing. I go very much by the measurements that I’ve taken at the time of the consultation and the examination. The measurements will give me a very good idea about the base diameter of the implant. Now, I’m going to show you what I mean by that. Let me just grab an implant. Okay. Here’s our basic implant. This is actually a teardrop, as you can see, it has that teardrop shape. It’s not round, but it does have a round base. This width from here to here is the base diameter. This is really the single-most important thing to get right in breast augmentation is the base diameter […]
I’d like to talk to you a little bit about my approach to breast augmentation. This is a procedure which might seem fairly straightforward. It’s a procedure that’s obviously done an enormous amount in the Western world and in Australia. In many respects, it is a straightforward procedure, but certainly, the planning of the procedure is extremely important, and it’s easy to get it wrong. I think that the initial consultation is a really important part of this. I always listen very carefully to what my patients are asking for, and I’m going to try and give that to them if I possibly can. If I can’t give them exactly what they want, then I’m going to explain why and I’m going to propose what I can do for them, and explain exactly why I think that’s the right way to go. Part of this is listening carefully as I said to what the patient’s desires are, but it’s also very important to do a full, careful physical examination, taking a lot of measurements, and we then need to refer back to our breast implant catalogues to make sure that we pick the exact right implant.