Breast Augmentation / Breast Implants

Some women who desire a breast augmentation procedure start with so little of their own tissue (AA -AAA cup), that their chest can be referred to as a ‘blank palette’!

Dr Miroshnik usually recommends the use of anatomical, memory gel implants in these circumstances combined with a dual-plane, submuscular placement which maximises muscle coverage in order to conceal implant edges. If there is available fat for harvest, it is almost always used by Dr Miroshnik for grafting to further conceal the result.

Hybrid breast augmentation refers  to the addition of fat grafting to a breast augmentation procedure. In this way, the augmented breast is not only composed of new implant but also by a variable proportion of ones own fat.

Fat for grafting into the breast is best taken from the lower abdomen or inner thighs. These two areas of fat harvest have proven to be the most successful in this procedure and Dr Miroshnik will assess these donor sites for suitability during your consultation.

In combination with gel implants, fat is particularly useful in highlighting and blending in areas such as the cleavage, decolletage, lower pole of the breast and outer pole. It is also useful for concealing bony irregularities and implant characteristics in those with little native breast tissue.

A small amount of breast asymmetry is a normal finding, and one which most women would accept.

Large differences in breast size, shape or position however, can be quite visible and throw off the balance of the female form. 

Breast asymmetry correction may involve lifting, adding or subtracting volume from one or both breasts in the hope of restoring balance and symmetry between the two breasts. Adding volume may also involve fat grafting.

For more information on breast symmetry correction, please click here: Breast Asymmetry

Tuberous (also known as ‘snoopy’, ‘tubular’ or constricted) breasts are breasts that are misshaped, having grown in an unusual way due to the presence of a constricting ring of tissue at their base.

The constriction leads to deficient horizontal +/- vertical development of the breast and may lead to areolar enlargement. The condition itself is often inherited and usually affects the breasts asymmetrically, the estimated incidence being approximately 5% of the female population.

Unlike regular breast reshaping/augmentation, with tuberous breasts, it is important to release the constricting ring of tissue as well as redistribute the existing breast tissue in a way that promotes better breast shape and associated implant coverage.

Mild cases of tuberous breasts are suitable for standard breast augmentation surgery and fat grafting. Moderate to severe cases however, will require more complex techniques involving periareolar or vertical incisions and may require more than one surgery.

For more information on breast augmentation procedures for tuberous type breasts, please click here: Tuberous Breast Correction 

Problems with breast augmentation may occur as a result of poor planning, poor surgery or simply as a result of the way scarring and healing has occurred in the individual patient. All implants themselves are not lifetime devices and will eventually need to be updated and replaced – the usual recommended time being 10-15 years after the primary operation.

Dr Miroshnik treats patients from all over the country who have had their breast augmentation surgery performed elsewhere. The assessment process and the technical aspects of the corrective surgery itself are usually many times more complicated than primary (or first-time) breast augmentation. For this reason, secondary (or corrective) plastic surgery is frequently more expensive and takes longer. It is often, however, at least partially health fund rebatable if there are problems with the device itself such as rupture.

To learn more about corrective breast augmentation surgery, please visit this page: Breast Implant Revision/Correction 

An ‘internal bra’ is either a barbed stitch or mesh which is used to support the lower pole of the implant in the breast pocket. It is a useful technique performed by Dr Miroshnik to allow for extra reinforcement of the infra-mammary fold (IMF) and in doing so stops implant migration downwards.

This is particularly useful in this day and age as many women choose not to wear bras with certain clothes after their augmentation procedure. In this setting, an internal bra helps stop implant migration inferiorly and the phenomenon of  ‘bottoming out’ as well as ‘lateralisation’. 

Dr Miroshnik uses the same anaesthetists and dedicated team of nurses for all his surgeries. Most procedures are performed as day-only procedures using a fast recovery general anaesthetic. Most patients are back to office based duties within 7-10 days and are doing light exercises within the first 2 weeks.

For more information on the recovery/risks associated with surgery please visit our recovery page.

Dr Miroshnik works with all types, shapes and styles of breast implants with all the major breast implant manufacturers of the world.

The two very broad categories of implant shape are round and anatomic (teardrop), which are detailed below. Many women, who are considering breast augmentation surgery already have some sort of preference in mind when it comes to these shapes. It is important, however, to remember though that the way these shaped implants are used, and in particular their placement, will affect the way they look in any individual. The amount and quality of pre-existing breast tissue is also very important in the look that these two implant types can achieve. Dr Miroshnik will guide you to the type and style of implant that will work best for you and your body during your consultation.

Round Implants have a circular base and therefore a height and width that are equal. They also add volume equally to all parts of the breast. Round implants vary in their surface and the type of gel fill they have. Some round base implants contain particularly soft/malleable gel that is designed to look like a teardrop implant under the influence of gravity. More information about implant types and available options for surgery will be available at your consultation.

Anatomic (or teardrop) implants have a shape that is made to look more like a real breast. They are more customisable than round implants as their width doesn’t have to equal their height. They are an excellent choice in those with very little breast tissue to start with, those with breasts that are somewhat droopy and those with tuberous or misshaped breasts. They generally allow for more customisation than round implants as a lot more shapes and sizes are available to choose from and suit your anatomical needs. More information about implant types and available options for surgery will be available at your consultation.

During your consultation, Dr Miroshnik will suggest sizes that match the type of result you would like to achieve with your augmentation. Many women have a cup size in mind when considering breast enhancement, whereas others are happy to be guided by Dr Miroshnik.

The ideal sized implant is determined by considering the width of your chest, the amount of skin and quality of skin you have available as well as the type of result you would like to achieve.

Dr Miroshnik will use sizers to allow you to assess the look and feel of various implants that he may use. In some cases of asymmetry, two different sized implants are sometimes needed as well as the use of fat grafting for optimal outcomes.

Today, the best breast implant manufacturers in the world supply a variety of silicone gel fills. All silicone gel inside these implants holds its shape to some extent like jelly (jello) or gummy bear lollies. However the gel itself does vary on how firm it is to the touch and its shape-holding qualities.

In general, the firmer a gel is the better shape holding characteristics it has, whereas the softer it is the less shape holding capacity it has.

You may see terms such as ‘memory shape’ , ‘memory gel’, or ‘highly cohesive gel’ used to describe implants that are filled with silicone gel that has high shape retaining properties. In fact, most of the anatomical implants have a highly cohesive gel with maximum shape holding capacity.

Dr Miroshnik has a vast experience with the use of highly cohesive gel implants and will let you know if they are your best choice during your consultation.

Further developing the dual-plane method, Dr Miroshnik moves the muscle in such a way as to create volume in areas where it is most needed and hide volume where it is less needed. Customising the exact position of the pectoralis muscle in not only its vertical position but also its angulation allows for even more precise control of breast shape. Dr Miroshnik has pioneered this method of dual plane positioning and lectures about this to other plastic surgeons world-wide.