Dr Raja Sawhney specialises in breast sculpting. He has extensive experience in breast surgery especially breast reconstruction for breast cancer and congenital breast deformities including asymmetries, underdeveloped and overdeveloped breasts, tuberous breast deformities and male breasts/Gynaecomastia. He is the Clinical Director of the Department of Plastic & Reconstructive Surgery of the Gold Coast and Robina Hospitals where he performs a large workload of breast reconstruction for breast cancer patients and other breast deformities.
Using liposuction, fat is removed from unwanted areas. The common sites for this are the tummy and love handles or inner and outer thighs. This fat is then prepared for transfer and injected around the breast mound. This fat then takes on new blood supply in the breasts to become living fat again.
At your first consultation, Dr Sawhney will use 3-D Vectra imaging and a sizing kit to show you what you would look like with different volumes of augmentation. This will help you decide on how much volume you want to be added to your breasts. Depending on this, Dr Sawhney will advise you on how many fat grafts would be required to achieve this. He will give you time to contemplate these options. At your second consultation, you can repeat the exercises with the sizing kit and Vectra 3-D imaging before deciding on volume and method you want to use ie Implant or Fat transfer or both.
It is important to know that after any breast surgery the breasts do swell and results take 2-3 months to settle. Swelling and bruising tends to be more prominent after fat transfer and it is important to keep this is in mind: as this resolves the breast will shrink in size to your stable result.
This is a common plastic surgery procedure and patients who request them include patients who are underdeveloped, those who have lost volume after childbirth or weight loss, and those who simply desire more volume in their breasts. Though the majority of women have minor volume differences in their breasts, patients with significant differences may also request an augmentation of one or both breasts to enhance as well as symmetrise their breasts.
Breast implants are also used for breast reconstruction after breast cancer and for congenital deformities such as tuberous breasts. All of these patients have different considerations and implications for achieving desired results.
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The scar tends to heal well and is well hidden in the fold below the breast. In the instance of a bad scar, it is easily revised without significant deformity to breast tissue. The incision is typically 4-6cm, depending on size and type of implant. Textured and more cohesive “form stable” gel implants require slightly longer incisions.
The scar tends to heal extremely well and camouflage better than all approaches. However, if a tethered or complicated scar occurs it tends to tether through the breast tissue causing noticeable deformity which can be troublesome to improve and difficult to fix.
The scar is meant to hide in hairy skin of the armpit but most patients requesting this incision to avoid a scar in the fold below the breast or around the areola do not have lengthy hair growth in the armpit to camouflage the scar. It is a useable incision for the right patient and can give good results.
Large weight gain can enlarge the breasts significantly and cause the surrounding skin to stretch and thin. Subsequent weight loss will usually cause breast volume loss but leave stretched skin that is thin, with overall breast droop. This situation commonly requires both augmentation and breast lift procedures to restore breast shape.
Patients with mild and moderate weight changes may be able to achieve good breast shape with breast implants alone. Weight loss after breast and other procedures can alter the results achieved. At your first consultation, Dr Raja will assess your needs and form a tailored approach to achieve your goals.
No procedure is booked through the Sculpted Clinic before a thorough assessment is made and pros and cons of all options are openly discussed with our patients. It is imperative to Dr Raja Sawhney that his patients feel well informed and have realistic expectations. Some of the pertinent decisions in breast augmentation that he will discuss at the first consultation are:
If you’re ready to come in and see Dr Raja Sawhney, book in your comprehensive and confidential appointment today.
Shape – Tear drop (Anatomical, Natural) or Round
Round implants are cheaper than naturally shaped ones but often not best suited for optimal results, especially if one is looking for a natural look. Simple physics dictates that round implants have the same width and height. Thus, if a patient has a similar breast width and height she may be a good candidate for a round implant. If however, breast width is wider than the height there are two alternatives – choose an implant with diameter to match the height or width. In matching the height, the implant might not be wide enough for good shape.
If using the width, you may need to lower the fold below the breast or the implant will sit too high. Lowering the fold is not straight forward and runs the risk of a double bubble deformity where the original fold forms a tight band over the lower part of the implant. If the fold is poorly defined lowering by 1-2cm is readily achievable without double bubble deformities.
Similarly, if a patient has a long narrow chest then a round implant matched to the width will give poor upper breast fill and shape with less cleavage, whereas an implant matched to the height will protrude in front of the arms. Anatomical implants often give a more natural slope to the upper breast especially out of a bra. Push up bras can be used to create more cleavage as desired within a bra.
Anatomical implants can however rotate whereas if a round implant rotates its shape does not differ (unless it flips back to front). Thus, pockets formed for anatomical implants need to be more precise to avoid rotation. Round implants give more upper pole/breast fullness, which may be desired.
This works well in patients with good amount of breast tissue in the upper pole to start with. However, if the patient’s upper breast tissue is thin the upper edge of the implant can be quite obvious and “fake” looking. Suffice to say, if a patient has similar height and width of their breast and good thickness of breast tissue in the upper pole a round implant can give pleasing results and avoid the risk of rotation.
The other exception is where previous round implants have been used or a mega-pocket technique utilised where replacement with anything, but round implants will lead to higher risk of rotation unless a new controlled pocket is formed.
At Sculpted Clinic we use 3D imaging with Vectra to show patients a simulation of what they may look like with a breast augmentation. You can choose different styles and sizes to help decide with Dr Raja’s guidance what implant and look you prefer. Please note that Vectra creates simulations as a guide and is not a guarantee of an outcome.
Textured or Smooth
All implants have a silicone outer shell that may be textured or smooth. The texturing is done in an attempt to allow tissue attachment and ingrowth to hold position better. All tear drop/natural/anatomical implants are textured.
There is good literature to show that texturing decreases rates of capsular contracture. This decrease is significant when implants are placed behind the breast and in front of the muscle. Behind the muscle, the effect of texturing in lowering capsular contracture rates is less obvious but present in the literature. Textured implants do require slightly longer incisions for placement, especially the more cohesive “form stable” implants.
Brazilian implants have a special coating of polyurethane and have been shown in some studies to be associated with lower rates of capsular contracture. Some surgeons experience that they tend to adhere firmly to surrounding tissues and feel firmer than many other available implants. Dr Raja does not routinely use Brazilian implants but will consider using them for patients with recurrent capsular contracture or where tissue adherence is desirable e.g. revision surgery where implant position was lost or on patient request.
An older technique of inserting implants was to make a large pocket and put round smooth implants in. The patient would then massage and move the implants around to stop adherence and decrease chances of capsular contracture by virtue of the fact that the capsule would have to constrict a lot before deforming the implant. In the appropriate setting and certainly in many revision cases this may prove a useful technique to revert to. One major problem with this technique is that when the patient lies down the implants drift into the armpits, lose projection and appear less perky. Dr Raja has revised patients with this problem to textured implants in new controlled pockets.
Silicone or Saline Filled
As mentioned above, all implants have a silicone shell. They may be filled with sterile saline (salt water) or silicone in a gel form. The advantage of using saline-filled implants is that if they rupture or leak the saline will be absorbed into the patient’s tissues without harm, leaving a deflated implant.
Older silicone gel implants had runny thin gel in them with thin outer shells which allowed the gel to leak into breast tissue or move around other parts especially if the shell ruptured for any reason. Newer cohesive gel implants have gel that is firmer and even after breaking may stay together like a cut piece of Turkish delight. Thus, shape is not necessarily lost immediately on rupture, nor is leak and dissemination into breast tissue and elsewhere e.g. armpits.
The most obvious advantage is that silicone implants feel softer and more breast tissue like than saline filled implants which tend to feel firmer and rigid. Secondly, especially if under-filled, the implant shell can indent and ripple leading to an uneven feel to touch and even visible rippling if covered with thin breast tissue.
If done in one sitting, your procedure will take two to three hours to perform. If done separately, each procedure will usually take one to two hours.
Not all women can breastfeed, even without surgery and of those who can a significant proportion need to supplement it with commercial formulas. After breast reduction surgery, approximately one-third of patients can breastfeed sufficiently and one-third can breast feed but only partially and need to supplement this with formula. The remaining one-third cannot breastfeed at all. The size of reduction and residual breast volume may have some effect on your chance of being able to sufficiently breastfeed.
This surgery is performed on an outpatient basis, requires a general anaesthetic and takes about two to three hours to complete. To correct the breasts, soft implants are placed inside the breast pocket. However, in some instances, before both breasts can look the same, tissue expanders will need to be inserted to increase the size of the breast pocket. This needs to be done gradually, which means several procedures may be required. The type of incision that’s used and where the implants are placed will be discussed during your initial consultation. Once the implants are inserted, the incisions are closed and a dressing is applied. Patients are then moved to a recovery room for several hours.
Generally, after any breast procedure, we recommend from two days, up to one week off work depending on your procedure and work. You should avoid lifting significant weight or manual work for two to three weeks while your wounds are healing.
You may choose to have multiple sequential fat transfers at least three months apart to allow time for the previous graft to settle in. Alternatively, you may choose to combine the fat transfer with a small implant to attain the overall enlargement you want. The benefit of this over breast implants alone is that the Implant will be smaller and there will be more of your own tissue/fat over the top of it so you are less likely to feel the Implant and your breasts will feel more natural.
The obvious third option is to opt to have breast implants alone. If you have very small breasts or have an athletic body habitus having large Implants placed can mean that you can feel the implants through the skin easily. Implants alone in this setting can often have poor cover of your own tissue, especially in the upper part of the breast making it obvious that you have breast implants. Fat transfer can make your breasts look more naturally large and feel softer like your own fat elsewhere, which of course is exactly what it is. Autologous fat transfer is not a substitute for breast implants. The two work in very different ways and both have their pros and cons.
Patients won’t need to spend a night in hospital but they will need someone to drive them home due to the effects of the general anaesthetic. Bruising, discomfort, swelling and some numbness is common after a breast lift but these effects will subside within a week or two. Patients will need to spend at least a week at home before they can return to work and most of their usual routine. Any exercise or strenuous activities can only be resumed six weeks after your breast lift. Patients are required to wear a compression garment for six weeks to reduce breast swelling and accelerate healing. If drains are placed under the skin after surgery, you will need to see Dr Sawhney several days after your surgery to have them removed. It’s important to care for your incision sites to avoid infection and other complications. Dr Sawhney will inform you of all potential risks and complications so that you know what to expect after your breast lift.
If you have two very differently sized, shaped, or positioned breasts, you will well understand some of the challenges it presents. From bras which never fit you properly, to problems with clothing not fitting you correctly on one side and even embarrassment, these are very real problems which as many as one in every two women experience.