Sydney

Breast Augmentation (Augmentation Mammoplasty)

Generally no. Breast augmentation performed to change the size or shape of normal breasts is classified as cosmetic surgery, so it does not attract a Medicare rebate, and private health funds will not contribute towards it. Because there is no MBS item number, hospital and theatre costs are not covered either. Medicare may apply in limited circumstances where there is a genuine medical indication, such as reconstruction following mastectomy or correction of a significant developmental abnormality. A/Prof Bish will tell you at your consultation whether any item number applies in your case.

Yes. A GP referral is required to see A/Prof Bish Soliman for any type of surgery. For cosmetic surgery it is also a regulatory requirement. Medical Board of Australia guidelines state that a patient must be referred before a cosmetic surgery consultation, and the doctor who writes the referral cannot be the surgeon who performs the procedure. Your GP can send the referral directly to the practice, and a referral form is available on the website.

Yes. Medical Board of Australia guidelines require a cooling-off period of at least seven days between giving informed consent and having cosmetic surgery. You will also have a minimum of two pre-operative consultations, and you cannot give consent until you have had an in-person consultation with A/Prof Bish himself rather than another member of the team. Patients under 18 have a three month cooling-off period and must be assessed by a GP, psychologist or psychiatrist beforehand. Screening for body dysmorphic disorder is a standard part of the process for all patients.

Breast augmentation with implants usually takes around 60 to 90 minutes, though this is longer if other procedures are performed at the same time. Most patients go home the same day. Some stay overnight so recovery can be monitored, which depends on your general health, the complexity of the surgery and how you feel afterwards. A/Prof Bish will tell you which to expect at your consultation, so you can arrange time off work and organise someone to drive you home.

Most patients return to desk-based work after about a week and avoid strenuous activity for six weeks. A supportive surgical bra is worn during this period. Expect tenderness, swelling and a tight sensation across the chest for the first fortnight, which settles gradually. Implants usually take around three months to settle into their final position, so the early result is not the final one. You will need someone to drive you home and to help around the house for the first few days. Recovery varies from person to person.

Yes. Breast augmentation leaves permanent scars. The incision is usually placed in the fold underneath the breast, where the scar sits in a natural crease and is generally covered by a bra or swimwear. Scars are pink or red at first and fade over 12 to 24 months, although they do not disappear completely. A/Prof Bish will give you scar care advice, which usually includes keeping the area out of the sun, using a topical scar treatment and keeping the incisions clean. Some people are more prone to thickened or keloid scarring than others.

The right implant depends on your chest measurements, how much breast tissue you already have and how much soft tissue cover is available, not on size alone. Round implants give more upper fullness, while teardrop implants give a more tapered shape. Most implants used in Australia today are silicone gel rather than saline. On surface texture, macro-textured and polyurethane coated implants are no longer available in Australia. Macro-textured implants were recalled and suspended during 2019 and cancelled from the Australian Register of Therapeutic Goods by October 2020, because of their association with BIA-ALCL, a rare cancer of the immune system that can develop in the tissue around an implant. Polyurethane coated implants were cancelled earlier, in 2016. A/Prof Bish will explain which implants he uses and the risks that come with them.

Breast implants are not lifetime devices, and most patients will need further surgery at some stage. There is no fixed expiry date, and the common belief that implants must be replaced every ten years is not accurate. Further surgery is usually prompted by a specific problem such as rupture, capsular contracture or a change in shape or position, and the likelihood of rupture increases as implants age. Regular implant checks help pick up changes before they cause symptoms.

Capsular contracture is the most common reason patients need further surgery after breast augmentation. The body forms a natural capsule of scar tissue around any implant. In some patients that capsule tightens and thickens, which can make the breast feel firm, look distorted or become uncomfortable. It can develop months or years after surgery. Mild cases are often just monitored. More significant cases usually need surgery to release or remove the capsule, with or without replacing the implant. It is not possible to predict in advance who will develop it.

Breast augmentation is less likely to affect breastfeeding than breast reduction, because the milk ducts and the nipple are usually left undisturbed, though it cannot be guaranteed. For breast screening, tell the radiographer that you have implants so additional implant displacement views can be taken, since implants can obscure part of the breast tissue on a standard mammogram. Mammograms remain appropriate for women with implants and you should continue routine screening. If you are planning to have children, mention it at your consultation so it can be taken into account.

It depends on where your nipple sits in relation to the fold beneath your breast. Implants add volume but do very little to lift a breast that has descended, so where there is significant sagging, implants on their own can make the breast look bottom-heavy rather than fuller. In that situation, a breast lift, either alone or combined with an implant, is usually the more suitable option. A/Prof Bish will assess and measure this at your consultation and explain what each approach would and would not achieve.

Because of their association with BIA-ALCL, a rare cancer of the immune system that can develop in the tissue around an implant. The Therapeutic Goods Administration began a post-market review of breast implants in April 2019. Allergan recalled its Biocell macro-textured implants and tissue expanders in August 2019, and in September 2019 the TGA suspended eight textured implant entries from the Australian Register of Therapeutic Goods. Those suspensions were converted to cancellations, with the final cancellations taking effect in October 2020. Polyurethane coated implants had already been cancelled from the register in 2016. Smooth and micro-textured implants remain available under strict conditions set by the TGA, which include reporting requirements and patient information obligations. The TGA does not recommend removing implants in patients who have no symptoms of BIA-ALCL.