Silicone gel filled breast implants for cosmetic breast augmentation surgery.  Manufactured in the UK by Nagor and distributed under license in Australia by Surgiplas, silicone breast implants have been used for cosmetic enhancement since the early 1960’s and are the most intensively studied medical device in the world. 

All of my breast augmentation patients stay overnight and this is for safety reasons. A small proportion of patients can develop a bleed (haematoma) in the breast following surgery which needs to be addressed quickly.  During my last audit study I found that risk to be <4%, and all of these bleeds occurred within 6 hours of  surgery. Therefore, where possible, we schedule  our augment patients first thing in the morning and then, by keeping them in hospital overnight, we ensure that any breast bleed  is very unlikely to go undetected. 

I also review my augment patients the morning after surgery.  In that way I can be sure that I’ve answered any questions prior to your departure from hospital and ensured that you go home pain free.

My team and I focus on educating my patients.  We provide as many appointments as requested with my nursing team and with me to ensure that all your questions are answered prior to your procedure.

We encourage patients to do their own research prior to coming to their consultations. 

I undertake a lot of clinical research and am widely published in breast related procedures. With your consent, we collect and audit data anonymously from patient procedures which assists in making the surgical choices that I present to you. 

Make an appointment for a consultation to see Dr Tim at his practice in Berwick.

We ask you to fill out a practice registration form prior to the consultation which we email to you when you make your appointment.  Dr Tim encourages you to bring your partner, mother or other family member or friend – two heads often hear and remember more than one, particularly if you are nervous. 

During your consultation, Tim will need to know your full medical history.  What is discussed during this time is outlined in our section ‘Your Consultation’. 

You meet with one of our nursing team. They will prepare a detailed quote of the estimated fees for the procedure. They will also provide you with some written information which covers some of the general points in the consultation, and can be useful if you have further questions. 

The nurse will also start the process of breast implant sizing based on Tim’s recommendations and your expectations.  We have collected information from over 600 patients regarding their satisfaction with our breast sizing system, and will happily share this with you to help you make a decision.  You’re welcome to return to the practice to be comfortable that you have chosen the correct sized implant for you. 

Detecting a ruptured shell of a cohesive gel breast implant is a difficult problem, and the question of whether screening is necessary is a difficult one. 

MRI scans currently provide the best accuracy when looking for rupture.  Ultrasound tests are not useful unless combined with an MRI, and would not be an investigation of choice. 

However, if your breasts are asymptomatic (ie, not changed significantly since your month surgical review (the chances of an MRI scan picking up a ‘rupture’ when there isn’t one (a false positive) are significantly less than if you have noticed a chance in the shape of your breast. 

Current studies indicate that it is rare for an implant to rupture before 10 years, suggesting that an MRI scan before that time in unlikely to be useful, as well as costly (currently around $300 out of pocket not covered by health funds.) 

Cohesive gel breast implants (cogel) are more like a jelly bean than a syrup when ruptured.  The gel, rarely, if ever spreads outside the capsule that has formed around the implant during the first three months following surgery.  It requires considerable force to disrupt that capsule, a ruptured cohesive gel implant pose little risk to your health, and is not absorbed to any significant degree by the body. 

Based on these facts, Tim recommends the following; 

• Visit Tim should your breasts change shape significantly following your surgery,
• Consideration of an MRI scan if your implants have been present for more than 10 year

Tim is happy to see you at any time following your breast implant (breast augmentation, breast enhancement) surgery should you have any concerns or if you would prefer, will review you on an annual basis. 

Breast cup sizes (A, B, C, D etc.) are not standard between bra manufacturers, and speaking about a breast size in terms of these letters is misleading.  Quite often one company’s C cup is another one’s D or E. 

When choosing an implants size, the aim is to bring the body into proportion to give a pleasing overall figure.  The ratio of the shoulders, to the hips, to the waist and thighs are all taken into account, in addition to the width of the chest wall.  During your consultation, Tim will measure the width of your breast so that he can begin to choose an implant which would be anatomically appropriate for your physique.  In his last research paper, the average width of a breast was 12.3cm, but obviously this varies depending on stature. 

Implants come in different shapes for any given vole, known as the profile.  A lower profile implant will be flat and wide compared with a high-profile implant.  Generally speaking, a higher profile will provide more lift in a breast, and produce a fuller cleavage. 

In addition, Tim measures the thickness of tissue at the edge of your breast bone (sternum) to decide how much soft tissue is available to cover the implant and camouflage the edge where it sits on the chest wall.  If you are very slender and use a higher profile implant, it will tend to produce a very obvious ‘fake’ look.  Similarly, if you have thick soft tissue and desire a generous cleavage, a high-profile implant is required to produce this effect.  In most cases, you will need to take advise from Tim as to what he feels will work for you. 

Once the width of your breast and profile has been decided, there a limited number of implants that will be anatomically appropriate for your body shape.  The choice of the implant is then a matter of personal taste, which is undertaken by placing the sized implants in a bra.  We ask you to assess your complete figure rather than breast size when doing this exercise.  It is often helpful to try on several occasions. 

You will be able to appreciate that a given volume implant can produce many different breast sizes and shapes in different people depending on their body composition.  It is a mistake to try and compare your implant size with something that a friend may have had during her surgery, or to try and equate a volume with a bra size. 

Over the last 8 years, Tim has collected data regarding women’s expectations of their breast size following breast implant surgery.  We have a data base of over 500 patients, who have given feedback as to whether we have advised them appropriately.  80% believe that they have made the correct choice and would not change the size of their implants.  15% wished to be bigger.  5% wished to be smaller, but looking at these patients, they are all clinically underweight (BMI less than 19).  On the basis of these figures: If you have a normal BMI and listen to our advise, you will most likely be content with your choice of implant.  However, if you are unsure, pick the bigger implant as a significant number of patients at 3 months post-surgery wish they had done so.  The chance of you picking an implant which you consider too large is unlikely unless you are underweight. 

Tim’s data was published in the Aesthetic Surgery Journal in 2014, and has been recently rated as one of the top three most authoritative articles concerning breast implant choice in the world. 

The choice of a breast implant size is a process that you will go through once Tim and his team take hundreds of women through the journey, and we would ask you to listen to the feedback that they have received from previous patients.

The implants which Tim uses are made by Nagor, an English company which has manufactured breast implants for over 35 years. 

The product is designed, developed and manufactured in facilities compliant with the ISO 13485 standards and requirements demanded for class III sterile breast implant medical devices.  Nagor’s products are manufactured under a quality management system in accordance with ISO and EN requirements and have CE mark certification. 

Nagor provides patients with the Nagor Enhance Warranty, which applies to all Nagor silicone filled breast implants.  Click here for more information regarding this warranty. 

In addition, Tim provides reduced costs in the event of you requiring revision surgery under the Nagor Enhance Warranty.  Should you have private health insurance, the costs of the surgery for implant rupture or capsular hardening are usually covered (depending on your policy).

Dr Tim only operates at St John of God Hospital, Berwick. This hospital is accredited, and has excellent, modern operating and inpatient facilities.  Dr Tim works with the same nursing team each week, both in the operating room and on the ward. These teams have developed their own expertise in caring for breast augmentation patients over the last 10 years. 

All breast augmentation patients stay overnight.  This is for safety. A small proportion of patients can develop a bleed in the breast following an operation, which needs to be dealt with quickly.  During our last audit study, we found that risk to be less than 4%, and all of these bleeds occurred within 6 hours of the surgical procedure.  By ensuring that implant procedures are undertaken first thing in the morning and keeping patient’s overnight, we ensure that a breast bleed (haematoma) is very unlikely to go undetected. 

Tim also wishes to review is breast augmentation patient the morning after surgery.  That way we can make sure that you go home pain free, not feeling sick and having had all of your questions answered prior to departure. 

One of the commonest questions I get asked, is regarding the plane in which a breast implant is placed.  

I find it helps patients to visualise this as follows:  Imagine that an implant is a golf ball. If you place a golf ball under a sheet, it will have a very obvious appearance, with a distinct junction where it sits on the bed. Now imagine that this golf ball is placed under a doona; it will look very different and it won’t be as visible. 

Placement of breast implants is very similar. In thin people, think 'sheets', there is very little soft tissue to cover the implant, and the junction between the implant and the chest wall will be very obvious. This is a result that most patients want to avoid. In these individuals, an implant might need to be covered in some muscle, which essentially converts a 'sheet' into a ‘doona’. 

However, if a person is carrying some extra weight,  think ‘doona’, then placing an implant behind the muscle is effectively adding a second ‘doona’ on to what is already and adequately padded bed. The shape of the implant will be lost in the extra covering, and consequently the breast will not have a good appearance.  

The decision I have to make, when examining a patient is where does a ‘doona’ stop and a ‘sheet’ start? I examined this issue in a 2012 peer reviewed publication by examining data from 329 patients following breast augmentation. When you have your initial consultation with me, I will measure the thickness of tissue over your breast with a series of measurements, including a body fat caliper. My data suggests that a ‘sheet’ begins and a ‘doona’ stops when there is less than 20mm of soft tissue measurable with the caliper. A subsequent piece of research I’ve undertaken has discovered that individuals who have a BMI in the normal range (19-25), statistically have the same amount of soft tissue at the side of the breast bone and that it is always at least 20mm. 

Placement of an implant behind the pectoralis major muscle is not a procedure that should be undertaken lightly. It involves dividing the muscle from the sternum over the lower portion to allow it to drape over the implant. In athletic women, this procedure has been shown to reduce the performance of certain exercises such as pushups, bench press and inclined flies. The procedure is also associated with a prolonged recovery before return to normal exercise.  

Even in woman who only undertake moderate exercise, the constant action of the pectoralis muscle tends to cause it to displace over time, with one author suggesting that majority of sub muscular implants require revision by 7 years post-surgery. 

Most women notice that when they move their shoulders following sub muscular breast augmentation, their breast move and distort to a varying degree. This is called animation, and is a normal, but often unwanted consequence of placing an implant under the pectoral muscle.  

For lean individuals, Tim has been at the forefront of publishing data concerning placement of the implant in the sub-fascial plane. His 2012 publication on the subject was recognised by his colleagues in Australasia as the best peer reviewed cosmetic surgery paper in the Aesthetic Surgery Journal, and was awarded the prestigious ISAPS Prize. It represents a comprehensive experience of one of the largest series of sub fascial breast augmentations in the world. 

The pectoral fascia is a very thin fibrous layer that covers the part of the muscle which contracts. If you take the time to look at a steak, it is the white glistening layer that covers the meaty fibres. Whilst the layer is very thin, it is immensely strong and inelastic such that placing an implant behind this fascial layer will compress the upper portion of the device and blunt the junction between the implant and the chest wall. By using this type of sub-fascial breast augmentation, Tim is happy to undertake breast augmentation in very lean individuals where there is only 12mm of soft tissue measurable by the caliper. His publications and ongoing audits have demonstrated that using this assessment system for deciding how an implant should be placed provides a very high degree of patient satisfaction, with low complication rates (rippling in <4%, revision surgery in 0.25%) 

So, in response to the question “Does Dr Brown place implants in front of or behind the muscle?” the answer is “it depends on the individual undergoing surgery, there body measurements and lifestyle.” For that reason, we recommend a consultation with Dr Brown so he can advise which procedure is the correct choice for you 

Once you have made the decision to have a breast augmentation, the most important choice often relates to the size of the implant. We often have a situation where Dr Brown has recommended a certain size and style of implant only for you to discuss this choice with a friend, who tells you it is a dreadful mistake and that they know better! 

In this situation the best advice we can give you is this: don’t discuss your implant volumes with people who offer an unqualified opinion, and return to discuss your concerns with Dr Brown and his staff, who has been dealing with these issues for 20 years.  

When Dr Brown undertakes his initial clinical examination, he records a number of measurements concerning the dimensions of your breast. Importantly he measures the width of the breast, how much soft tissue covers the breast and the amount of droop. All of these measurements assist in providing options that would fit your anatomy, after which you can choose which implant feels appropriate for you. Dr Brown’s clinical nurse educators Tracey and Colleen and  are very experienced is assisting patients to make these decisions, and it is not unusual for patients to visit several times before making their choice.  

The base width of the implant should match the width of the breast, after the soft tissue covering has been considered. Pick an implant that is too narrow, and the breasts will look widely spaced; pick one that is too wide, and your figure will appear top heavy. This measurement alone will dictate to a very great degree the volume of breast implant that can be used. 

Implants have different degrees of “steepness” or profiles, varying from very flat to quite ball-like. 

Once Dr Brown has undertaken your implant surgery, he is happy to see and advise you, even if it is a number of years later. 

We need to assist you in choosing the correct profile for the suggested breast width. If you think of an implant as a pole in a circus tent, the higher the pole, the more lift will occur, and the greater the shape of the tent or breast. 

Often patients who have had children have a degree of droop in their breast, and often picking a higher profile implant will produce sufficient lift to produce a pleasing breast shape without having to resort to further surgery. 

Another consideration when choosing a profile is the amount of soft tissue that covers the breast. I want you to imagine that an implant is a golf ball. If you place a golf ball under a sheet, it will have a very obvious appearance, with a very distinct junction where it sits on the bed. Now imagine that the same golf ball is placed under a doona. Obviously, it will look very different, and it will hardly be visible at all. 

Depending on the “look” you are trying to achieve, Dr Brown will make a suggestion as to which profile might be appropriate for you.  

We also look at your overall body shape, paying particular attention to the ratio of shoulders to bust to hips to waist. The aim is to produce a silhouette that is “in proportion”.  

The process of sizing is not an exact science, and whilst guidance can be obtained from the measurements, there is a degree of judgement borne from experience that is required. However, it should be possible to examine the relationship between our sizing system and patient satisfaction with their surgical outcome. Consequently, earlier this year Dr Brown published a large statistical study in Aesthetic Plastic Surgery Journal, which looks at whether or not patients are happy with the choices he assists then in making, and tries to identify groups of individuals who have specific issues relating to breast implant sizing. 

Mr. Brown has demonstrated that for his breast augmentation patients, only 3.4% considered that their implants were too large. All these patients were classified as clinically underweight, with BMI less than 19. 20% of patients thought that their implants were too small, and the remaining 76% were happy with the choices that they had made. What does that mean for you? If you are not underweight, and you take on board our advice, you have a very high chance of being happy with the implant size that you have picked. If in doubt about your choice, pick the bigger of the suggested implants, as statistically it is very unlikely you will regret it. One in five women who choose a smaller implant in the range that we suggest, subsequently return and tell us that they wish they had chose the larger implant. This is particularly true for patients with broad breasts (greater than 13 cm wide), as our data suggests that they are 9 times more likely to wish they had picked the larger size! 

One of the commonest fears is that patients worry they will look to busty; however the study demonstrates that the commonest outcome is that they don’t feel quite busty enough. 

One last comment about bra sizes – they don’t exist! Each manufacturer has their own system of sizing bras, and there is no international standard sizing system as there is for shoes. Mr. Brown does not, and cannot guarantee a particular bra size, and strongly believes that it is irrelevant. Provided you are happy with your figure, what does the letter on the bra label matter? It would be like going to an open home clutching a number six and telling the real estate agent that you “need one of these”. As long as you are happy with your figure, finding clothes to fit you properly is a secondary issue. If your figure is in proportion, it should be straight forward and present little difficulty. Mr. Brown suggests that you don’t buy bras until at least 6 weeks after your surgery, as his measurements have demonstrated that size and shape can continue to alter for that length of time following surgery. 

So, in response to the question “Why are my implants so much bigger than my friends?” the answer is, because you are different from your friend. And will you look ridiculous? Our peer reviewed and published data suggests that will not happen, providing you take advice from Mr. Brown and his nurse educators Tracey and Joanne when choosing your breast implant size. 

The short answer is that your  implant will not change, but your body will. During pregnancy, your breasts get bigger as the glandular tissue increases in size. The skin envelope stretches to accommodate the new growth. 

High levels of pregnancy hormones can cause stretch marks, which are really small tears in the elastic layer or dermis. Unfortunately, these are permanent, and no amount of magic creams or lasers will get rid of them. 

I published a paper in 1999 which measured the shape of women’s breasts and examined the issue of breast feeding. I found that it was being pregnant rather than breast feeding which was responsible for alterations in breast shape. 

It is impossible to predict how your breast shape will change following child birth and whether or not subsequent pregnancies will further alter the shape. 

Your implant is not affected by either pregnancy or breastfeeding and will not alter your ability to breastfeed. 

There are very rare studies that have shown that getting pregnant following implant surgery can cause the following issues:  

• An increased risk in late capsular hardening
• Fluid collection around the implant (seroma)
• Infection of the implant following mastitis

However, the most common issue following completion of a family is an increase in the droop in the breast. Often weight has increased, and what might have been an appropriate implant prior to children, is now too small. In these patients changing the implant, sometimes with an associated breast lift, can be beneficial. 

That is a very difficult question to answer, as “normal” varies so much. These are the common questions we get asked:  

When can I drive?             I prefer that you don’t drive for one or possibly two weeks. It is not that you cannot control the vehicle, but should you make a sudden stop, the seat belt can cause damage.  

When can I go back to work?        Obviously, it depends on your occupation. My advice is for desk based jobs, allow at least 7 working days rest. Physical jobs will require much longer (refer to the section on exercise after breast augmentation). Generally, if it hurts, don’t do it! Also remember it is not what you do at work, but also the getting up, getting ready and travelling there which can be just as exhausting.  

When can I have sex?      When you feel like it! Obviously if your breasts are tender, your partner needs to be aware and careful. 

Do I need to stop drinking alcohol before and after breast implant surgery? No, you don’t. 

When can I start my vitamins and supplements after surgery? Generally, two weeks, but if in doubt please ask. 

When can I buy a bra?     You will notice that your breast shape changes a lot in the first 6 weeks following breast implant surgery. If you have had children, generally your breast shape has settled completely at this time, and buying a bra should be OK. Patients who haven’t had children should wait until 3 months. We recommend that if you decide to wear under wired bras for the first three months, you should apply a few layers of tape to the scars to prevent them from being irritated by the bra. It is worth getting fitted professionally for a bra to ascertain your correct size for a particular brand. Tracey offers this service, and also can arrange for you to purchase Intimo bras if you wish.