Breast Augmentation Sydney

Cosmetic Concerns Procedure Information Implants Risks & Complications ALCL Procedure FAQs Procedure Pricing

Breast augmentation, or enlargement, is one of the most popular cosmetic surgery procedures among women. Whether you want to increase the size of your breasts or improve their shape, breast augmentation can help.

Women seek breast augmentation for a variety of reasons but common to all is to regain or improve confidence. Breast augmentation (or ‘boob job’) is a surgical procedure that involves using implants to improve the size and shape of your breasts. The implants are usually made of cohesive silicone gel surrounded by a silicone shell. During the procedure, an incision is made under the breast, and a pocket is created under the muscle (generally) and the implant inserted. The size and shape of the implant is usually selected during your preoperative consultation.

Main Reasons for
Breast Augmentation

Improve the size of a breast that already has good shape
Improve cleavage and upper pole fullness
Improve the size of breasts that did not develop during puberty
Restore breast volume and shape after breast feeding or significant weight loss – this sometimes needs to be combined with a breast lift (mastopexy).
Correct breast asymmetry
Correct tuberous breast deformity

Recovery from Breast Augmentation Surgery

We recommend patients of breast augmentation surgery to avoid getting any incisions wet for the first 72 hours. To avoid this using a damp sponge gently around the body will keep you feeling clean without any risk.

If you’re thinking ‘how long do I need to take off work’, the answer is that it depends on each patient’s ability to heal. We always recommend that you plan to be away from work for at least 1 week which will give you the time your incisions need to heal so that you can move around with minimal discomfort. Any extra time that you’re able to take will be beneficial. You should not do any strenuous or heavy listing for around 6-8 weeks, so speak to Dr Aggarwal and your employer if this will be difficult.

Most patients can drive again after one week. If you feel the need to use opioid medication to reduce discomfort, don’t drive until you can stop taking these medications.

Seeing Results!

You will notice a change in your breast immediately after surgery, the complete results of your breast augmentation will take some time. After surgery there will be some swelling that will take several weeks to subside completely. Your implants will also take some time to settle into their optimal position and it’s rare that both implants will do this at the same time, so be aware one implant may drop before the other.

It’s important to take care of your incisions and follow Dr Aggarwal’s post-operative instructions closely so that you can enjoy complete results after about three months.

Dr Aggarwal

Dr Aggarwal is a well regarded, respected, highly skilled and experienced Specialist Plastic Surgeon. Graduating at the top of his class throughout his training, Dr Aggarwal has completed fellowship training at some of the world’s most prestigious reconstructive and cosmetic plastic surgery institutions in Canada and the USA. He continues to publish research is prestigious plastic surgery journals, and is actively involved in the training of future plastic surgeons.

What sets Dr Aggarwal apart from others is his personal, affable and warm nature. Not only does he pay attention to detail, to producing natural, beautiful results but he ensures that the patient’s journey is just as special as their outcome. Dr Aggarwal looks after patients at one of Sydney’s most prestigious public hospital campuses (POWH/SCH/RHW), and operates privately on Sydney’s North Shore. Dr Aggarwal has treated thousands of patients throughout Sydney and beyond who have achieved outstanding results under his care.

Procedure Snapshot

Anaesthetic: GA by accredited anaesthetist
Time: 1-2 hours
Duration of stay: Day Surgery (or overnight if requested)
Recovery: Most people can do most things at the end of the first week. Upper body exercise is disallowed for 6 weeks and strenuous exercise for 3 months. Avoid swimming in a pool or beach for 2 weeks.

Medicare/Health Fund Rebate: No
Hospital: Offered at Hunters Hill Private, Sydney Adventist Hospital
Results: One of the most satisfying procedures for patients but it is important to note that results vary from patient to patient largely due to variation in anatomy and breast size and asymmetry prior to surgery.

Cosmetic Concerns

“I want to look natural, and don’t want anyone to notice I have had a breast augmentation”

This is the most common request for patients who come to us for breast augmentation. Women wanting this look want to restore the breast volume and shape that may have been lost after breast feeding or loss of weight.
Depending on your breast size and soft tissue thickness most women wanting this look will benefit from either anatomical/ tear drop implants or Motiva Ergonomix implants in a Mini or Demi profile.

“I want people to notice that I have had a breast augmentation” or prefer an enhanced look

This request is often by women who desire more cleavage or want upper pole fullness.
Depending on your existing breast size and shape this look may be possible with moderate to high profile round implants or anatomical/tear-drop implants

“I want to be as large as possible”

Women have commonly read about patents having breast augmentation and regretting that they did not go bigger. However we have not found this to be true in our practice, and many patients we see from elsewhere regret being too big, and wish for smaller implants.
The size of breast implants needs to be selected with some degree of caution as the larger the size of the implant the greater the long term consequences – larger implants lead to thinning or atrophy of the overlying breast tissue creating new problems such as implant palpability and rippling. Larger implants are also heavier and the effects of gravity can lead to abnormal position over time – such as them descending over time or displacing laterally.
During your consultation Dr Aggarwal will take measurements of your breast and chest, to determine the ideal size of breast implant that will achieve your goals.

“I have slightly asymmetrical breasts – what will breast augmentation do to this?”

Small degrees of asymmetry exist in virtually every women and these will be unchanged by breast augmentation, and sometimes can become slightly more exaggerated especially slight differences in nipple position between the two breasts.
Dr Aggarwal will always try to correct asymmetry where possible and this will be discussed during your preoperative consultation. For example slight breast size differences may be addressed by asymmetrical implant sizes and differences in nipple position may require a lift on one or both sides (see Breast Lift with Implants)

Procedure Information

The procedure is always performed under general anaesthesia given by an accredited anaesthetist in a fully accredited and licensed facility (usually Hunters Hill Private or the SAN). The procedure takes one to two hours and most patients will be discharged the same day (some elect to stay overnight however).

Mammogram and Ultrasound

Before any surgery on your breast Dr Aggarwal will refer you for a mammogram and ultrasound to ensure the breast is clear of any pathology.

Incision location

A small inconspicuous incision is made to access the area under the breast where a pocket is created for the breast implant

Inframammary

This incision is placed in the fold under the breast and is the most common incision used by Dr Aggarwal for breast augmentation
This incision allows the best access to create the pocket for the breast implant and best control of long term shape of the breast
It also allows the cleanest access for implant placement preventing long term contamination of the implant which can contribute to risk of capsular contracture

Peri-areolar

This incision is placed around the nipple and areola
It is less often used by Dr Aggarwal as the risk of contamination of the breast implant is higher
However it can be the preferred approach in some patients, especially with tuberous breast (or ‘snoopy’ breast) deformity where the breast gland must be reshaped to drape over the implant, the nipple may need to be elevated, and the areola may need to be reduced in size (see Tuberous Breast Deformity)

Trans-axillary or trans-umbilical

These incisions are placed in the armpit and around the belly button respectively.
These incisions are almost never used by Dr Aggarwal as they are less suitable for silicone implants, and offer less control of pocket creation for the breast implant and therefore less control of the breast shape.

Pocket placement

Breast implants may be placed in a subglandular or submuscular pocket.

Subglandular

This is where the implant is placed above the muscle but under the breast gland
This pocket is less commonly used as it offers less coverage of the implant by soft tissues and therefore the implant may be more visible
However in certain patients it has several advantages such as:
- Better cleavage in patients with good soft tissue cover, and already reasonable breast size and shape this
- Less risk of lateral displacement of the implant
- reduced animation (i.e. movement of the implant with muscle contraction)
- faster recovery
- improved shape and better control of gland reshaping in patients with tuberous breast (also known as snoopy or constricted breast)

Submuscular

This is where the implant is placed under the muscle and the breast gland
Submuscular or subpectoral pocket placement allows the following advantages:
- additional coverage of the implant imparting a more natural look to the result especially the upper pole
- offers reduced rates of capsular contracture long term
- less risk of the implant migrating downward (or inferiorly) as the pectoralis major and pectoralis minor muscles sandwich the implant, maintaining its position as they contract during routine muscle activity.
- easier to image the breast tissue using mammography

Dual Plane Technique

Dr Aggarwal routinely employs this technique as it offers the best of both submuscular and subglandular placement
This is where the muscle is partially divided so that the upper part of the implant is under the muscle (therefore imparting a more natural look to the upper pole of the breast) and the inferior part of the implant is in direct contact with the gland (and therefore imparting greater shape to the rest of the breast).
In some women dual plane technique along with slightly larger anatomical implants can avoid the need for a breast lift with breast augmentation.

After your breast augmentation surgery

Dr Aggarwal will place waterproof dressings over the incisions. You will also be placed in a surgical bra that you must wear for the first 6-8 weeks. This helps to reduce swelling, pain and discomfort as well as controlling the position of the implants in the early post-operative period as the area heals.
You will be able to get the area wet after 72 hours and go back into the surgical bra after your shower. You will not be allowed to swim in a pool or beach for at least 2 weeks after surgery.
You will be given a script for antibiotics by Dr Aggarwal which you must continue until the box runs out
You will also be given pain relief medications although most patients only report minor amounts of post-operative pain that is responsive to simple oral analgesia.
You will not be allowed to go back home on your own – you must have someone accompany you home, and it is best to have someone look after you for the first few days as you recover. You should not drive for at least 24 hours after having an anaesthetic nor operate heavy machinery.
While most sedentary activities can be resumed in the first week, you must not do any exercise for the first few days after surgery that could raise your blood pressure. You will also not be allowed to do any heavy lifting or upper body exercises for the first 6-8 weeks.
Dr Aggarwal will see you a week after your procedure to inspect how the wound is healing. You will be given instructions how to look after the wound as it continues to heal. You will be able to ask questions about what you can and cannot do. Generally we will see you at 1 week, 3 weeks, 6 weeks, 3 month, 6 months and 1 year post surgery.

Implants

Dr Aggarwal only use the highest quality implants from the leading manufacturers (Mentor or Motiva) who back their implants with lifetime guarantees. At Mode Plastic Surgery we will never employ cut price or cheap implants that have not had the most rigorous testing or safety profile

Silicone “Gummy Bear” Implants

Modern breast augmentation uses current generation of silicone implants which have advanced significantly since being introduced decades ago. Unlike older generation implants, modern silicone implants are form stable/highly cohesive meaning that:

They offer greater stability of breast shape
If they rupture, the silicone retains its shape much like a ‘gummy bear’. It is therefore rare for even the breast to change its shape in the event of a rupture usually being detected on breast imaging.
Modern silicone implants have a tough outer shell which has very low rupture rates.
There is much lower incidence of gel bleed/ silicone seepage

It was older generation silicone implants that had less cohesive silicone so if the implant ruptured the silicone could leak into the breast tissue, form silicone cysts, and migrate to the axilla (arm pit). This does not usually happen with modern generation implants.

Implant Shape

Round Implants

These are used in women who:

Already have an excellent shape to their breast with reasonable tissue thickness
Do not require the shape of a tear-drop implant to produce an excellent shape
There is a concern that the implant could rotate
These implants are available in less firmer gels and can therefore feel softer to touch. However due to the softer gel, they can be more prone to rippling which can be visible and palpable in patients with thin overlying tissues.
Round implants come in different projections.
Have concern surrounding ALCL
Dr Aggarwal uses round implants from Motiva and Mentor.

Anatomical Implants

Anatomical or ‘tear drop’ implants are fuller at the bottom than the top resembling the shape of a native breast. These are useful in women who:

Have less thickness to their tissues and therefore less likely to hide the underlying implant shape
Desire a more natural looking result
Have a shape to their chest requiring difference in width and height of the implant (as anatomical implants come in different widths and heights)
Have tuberous breasts, or significant breast asymmetry
Have a degree of droop (ptosis) to their breast and want to avoid a breast lift

Anatomical implants are always textured though the degree of texturing varies between different implant manufacturers. At Mode, we utilise anatomical implants from Mentor (CPG).

Smooth or textured?

Smooth implants

In Dr Aggarwal’s practice smooth implants are less commonly used as they have less stability of position and are more prone to implant malposition especially down and out when placed in a subpectoral/submuscular position.

However their benefits can include:

Lowest Risk of ALCL
May be possible to insert these via a smaller incision

Textured

Textured devices are more commonly used because as the tissue heals around the implant it produces a Velcro effect with the implant surface adding to maintenance of implant position.

Benefits of textured implants include:

Better maintenance of implant position
Lower capsular contracture rate especially in the subglandular position
Option to use anatomical implants with firmer gel consistency offering better maintenance of long term shape, and less rippling

The degree of texturing of implants varies and can be described as:

Macrotexturing: this is a very coarse texture imparted to the device during manufacturing. It was thought that texturing was a big reason why textured implants had reduced capsular contracture rates (see capsular contracture in complications) in breast augmentation. However this has lost favour recently whereby macrotextured implants from multiple manufacturers (eg. Allergan) have been associated with higher rates of ALCL.
Microtexturing: this is degree of texturing that is much finer than macrotexturing. We regularly use implants from Mentor which offer microtexturing. Mentor implants are available in smooth and round, and we employ them for both reconstructive and cosmetic breast surgery. Microtextured implants have a much lower rate of ALCL (see ALCL tab).
Nanotexturing: with increased innovation and research around ALCL, a new category of texturing has been recently developed. This texturing is so fine that the implant almost resembles a smooth implant whilst still offering the benefits of texturing. It is thought that given the reduced association of microtexturing with ALCL that these implants will have an even lower risk of such issues. Dr Aggarwal uses implants from Motiva which feature nanotexturing.

Saline Implants

Saline implants were popular overseas especially in North America as that continent went through a period of not using silicone implants.
In Australia these are rarely used as they carry a higher risk of rupture and rippling. If they rupture they lead to complete loss of breast shape.
The touted benefits of saline implants are thin capsule formation around the implant and if it was to rupture the content being saline which is simply absorbed by the body.
However with modern generation silicone implants being of extremely high quality the benefits of these silicone implants clearly outweigh those of saline implants.

Mentor Implants

Mentor is probably the biggest implant manufacturer in the world with the longest safety track record of any manufacturer.
At Mode Plastic surgery we routinely use Mentor implants for both our reconstructive and cosmetic surgery patients.
Available in both round and anatomical device shapes, smooth and textured, we are able to select the best device for a particular patient.
Furthermore their microtexturing offers lower risk of ALCL than other manufacturers that employ macrotexturing to their devices (see our information on ALCL).
Mentor implants come with a lifetime warranty.

Motiva Implants

The newest manufacturer on the block is Motiva however their implants are backed by years of research and extensive experience overseas.
Motiva implants also offer other benefits not seen before in other implant manufacturers’ devices, which is why we at Mode have employed their use:
- Microchip technology – which can be scanned externally by a Q-reader. This allows instant detection of serial number, size and type of implant to be detected allowing for safer record keeping. If a patient was to ever see a surgeon decades down the track this information can be essential, and particularly if there was ever an issue with the implant device.
- Nanotextured technology – delivers the benefits of textured devices with safety profile of smooth implants.
- Ergonomix implant technology – a special category of ‘round’ implants that have a softer gel imparting a natural feel to the breast, and also behaving like ‘anatomical’ implants with the effect of gravity.

MonoBloc construction – the outer shell and inner content are not two separate things but the implant is constructed as one unit.
Offer of 5 year extended warranty period (for surgical fees) and lifetime implant protection – Like Mentor Motiva offer a lifetime guarantee for their implants. This means should the implant ever become faulty the company will replace them free of charge. However patients can still be faced with surgical, anaesthetic and hospital fees for an operation in the event of device failure – Motiva offers the option to purchase extended warranty for 5 years during which period they will also contribute towards the cost of other fees associated with the operation, offering a complete peace of mind.

Motiva implants are slightly more expensive than the Mentor round implants however Motiva Ergonomix implants being comparatively priced to Mentor anatomical devices (for cosmetic patients).

Lifespan of implants

Modern generation silicone implants are of very high quality but as with all foreign bodies they have a lifespan and must eventually be replaced.
Currently we state that the implants will last 10-15 years. However this does not mean that you will definitely need to sign up for surgery at the 10 year mark.
Dr Aggarwal will examine you every year following breast implant surgery. This is to ensure there are no changes in the breast shape as well as integrity of the implant.
If there is any suspicion of implant integrity or the implants are over a decade it may be worthwhile obtaining imaging at that stage. If imaging detects a problem with the implants or there are other reasons for surgery (e.g. scar revision, breast lift, etc) you will be offered surgery for exchange of implants.

Size of Implants

Implants are measured in volume, cubic centimetres (cc), rather than the cup size.

A smaller breast implant can range from 150 to 200cc.
Moderate sizes range from 200cc to 350cc
A large implant is anything over 400cc
A very large implant can go up to as high as 800cc or more in Australia.

Dr Aggarwal will discuss the most appropriate implant size as smaller implants will have a big impact on smaller body frames, and similarly larger body frames or chest sizes may require a larger size for a similar effect.

Risks & Complications

Every surgery carries risks, and therefore one must consider if risks outweigh the benefits for your own personal situation. If they do then the surgery may be well worth it. Dr Aggarwal will discuss the pros and cons of surgery with you during your consultation.

General Complications

Risks of anaesthetic – there are general risks of going under an anaesthetic such as a mild stress on the heart and lungs, risk of reaction to anaesthetic drugs and risk of blotting in the legs. These risks are generally low in patients who are otherwise fit and healthy.
Bleeding (1-2%) – any bleeding is controlled during surgery however unexpected bleeding can occur in the immediate postoperative period. If this occurs it will necessitate a return to theatre to control the bleeding.
Infection (<1%) – this is extremely rare given the precautions taken to prevent contamination of implants (read the 14 point plan). However you are given antibiotics during induction (when you are going to sleep), as well as a course of oral antibiotics after your surgery to keep this risk to a minimum.

Implant Complications

Implant palpability – it is possible to usually feel the implant at the lower, outer part of the breast in thin persons as this is where the coverage is the least. However in very thin individuals or those with small breasts or little soft tissue cover it may be possible to feel or see the implant elsewhere.
Rippling – softer gel implants are more prone to rippling than higher cohesive gels. Patients with thinner tissues are more likely to experience this where it can be possible to both see and feel the rippling of the implant. Rippling can occasionally be masked by fat grafting or by change to a firmer gel implant.
Rupture – rupture rates of modern day silicone gel implants are very rare. If they do occur they are picked up incidentally on imaging as the form stable implants maintain their shape despite the rupture. However given implants are foreign bodies they will lose integrity over time and will eventually need to be replaced.
Rotation – this is only an issue for anatomical (or tear drop) implants. To prevent this an exact size of pocket is created to match the size of an implant. If there is a concern regarding rotation, round devices obviate this risk.
Capsular Contracture – The body reacts to a foreign body such as a silicone implant by forming a layer called the capsule around it. In 5-8 % of patients this capsule can become hard over time changing how the implant feels, and sometimes how it looks. It can also become painful in extreme cases.
- Most of these cases occur in the first year after insertion of breast implants
- Most manufacturers cover this complication as part of their lifetime guarantee.
- Studies indicate that capsular contracture is lower with textured implants (especially when placed in subglandular plane or just below the breast and above the muscle), and lower with submuscular placement of implants
- More recent literature indicates that this may be related to contamination of the implants during insertion with a chronic response of the body to a ‘biofilm’ of bacteria on the implant surface causing the capsule to become hard.
- The treatment for capsular contracture involves removal of the implant, removal of the capsule and insertion of a new implant with care taken to prevent capsular contracture. However in some patients who have had recurrent capsules the only solution is to permanently remove the implants.

Soft Tissue Complications

Atrophy of tissues – a foreign object like silicone pushing against the normal breast causes it to thin. The bigger and heavier the implant the greater the degree to which this will occur. As the tissues thin implant visibility, palpability and rippling become more pronounced and the risk of implant malposition become higher. We therefore caution against selection of large implants and Dr Aggarwal will usually guide you as to what size will suit your frame whilst trying to minimise this risk.
Change in nipple sensation – this can occur in up to 15% of patients but is usually short lived and returns to normal after a few weeks to months.
Animation deformity – this is movement of the implant with muscle activation. This occurs in all patients having submuscular placement and for this reason for the first 6 weeks the pectoralis muscles should not be heavily used to avoid movement of the implant. Long term extreme use of the pectoralis muscles (such as heavy bench pressing) should probably be avoided altogether to avoid long term implant malposition. Some degree of implant movement with pectoralis muscles will occur in all patients and should be expected rather than seen as a complication.
Unusual breast shape – it is common for the initial shape of the breast to be unusual as the tight pectoralis muscles with a subpectoral implant take time to relax and for the implant to settle due to gravity. This can take approximately 6 weeks to 3 months. However occasional problems can occur including:
- Malposition
  - Implant moves either centrally, laterally (down the side), up or down, needing revision surgery for correction
- Double bubble
  - Can occur in patents with tuberous breast deformity where the fold of the breast needs to be lowered.
  - The old fold gives the appearance of a fold on the breast as well as the new fold where the implant sits. This can be camouflaged with fat grafting
  - Occasionally this is due to an inferior malposition of the implant (implant moving too far down) which needs to be corrected surgically.
- Asymmetry
  - Most women’s breasts are asymmetrical and breast augmentation can highlight small asymmetries that were not noticed previously
  - Significant asymmetries are aimed to be corrected by surgery
  - However there can be asymmetry of scars, shape, nipple position and it is important to discuss these before surgery with Dr Aggarwal.
- Waterfall deformity
  - This occurs when the implant sits too high and the breast appears to have fallen off the front of the implant
  - This can be due to one of two problems
    - The implant failed to adequately lift the breast and a breast lift was required in addition to the augmentation procedure
    - The implant is sitting too high and needs to be lowered by division of the lower part of the pectoral muscle.

ALCL

What is breast implant-associated ALCL?

Breast implant-associated ALCL is a rare type of cancer.
It usually presents as a swelling of one breast due to accumulation of fluid (delayed seroma)
This occurs on average 7.5 years after the insertion of implants. However it can occur much sooner than this (as early as less than a year) and late as 27 years after the operation in Australian and New Zealand data.
Less commonly, breast implant-associated ALCL can take the form of a lump in the breast or a lump in the armpit.
Most cases of breast implant-associated ALCL are cured by removal of the implant and the capsule surrounding the implant.

What is the risk?

The risk in the literature varies widely from 1/3,000,000 to 1/50,000.

However a recent study conducted in Australia (Wilkinson et al PRS 2017) documented the risk as:

Biocell or macrotextured implants (Allergan, Inamed, McGhan) = 1/3817. These implants are not used at Mode Plastic Surgery.
Polyurethane implants (Silimed) = 1/7788. These implants are not used at Mode Plastic Surgery.
Siltex or microtextured implants (Mentor) = 1/60,631. We commonly use these implants carrying the lowest risk of ALCL of all textured devices.

What causes BIA-ALCL?

At this stage this is currently being investigated and new research is ongoing. It is likely to be multifactorial caused by the type of implant, the genetic predisposition of the patient (their background), and if there was any contamination of the implant during insertion. Due to the association with textured implants, at Mode Plastic Surgery, Dr Aggarwal prefers smooth round implants from Motiva (zero/negligible risk of ALCL), or microtextured implants from Mentor (low risk of ALCL). A study by Adams et al PRS 2017, demonstrates that with defined steps to minimise bacterial contamination there were no documented cases of BIA-ALCL in even macrotextured implants. At Mode Plastic Surgery, Dr Aggarwal employs the 14 point plan to prevent contamination of breast implants.

What is the 14 point plan?

This is a plan developed in consensus by plastic surgeons across the globe but especially from Australia and USA to reduce bacterial contamination of implants thought to cause not only BIA-ALCL but also capsular contracture

This plan, employed by Dr Aggarwal in all his implant surgeries includes:

Use of antibiotics via a drip at the time of anaesthetic induction (when the patient goes off to sleep)
Avoid peri-areolar incisions (Dr Aggarwal favours the inframammary fold incision for this reason)
Use of nipple shields to prevent spillage of bacteria
Perform meticulous dissection of the breast implant pocket
Performing careful control of any bleeding
Avoiding dissection into the breast tissue (where bacteria live).
Using a dual plane pocket if required (Dr Aggarwal uses this routinely)
Cleaning the breast implant pocket with betadine or antibiotic irrigation solution
Minimising skin-implant contamination
Minimising the time of implant opening, reposition and replacement of implant
Changing surgical gloves prior to handling the implant. We also use clean or new instruments that were not used in the pocket dissection
We avoid using a drainage tube, where possible
Closing the wound in layers
Recommending our patients use antibiotic prophylaxis to cover subsequent dental or surgical procedures that produce bacteraemia, and at Mode Plastic Surgery we offer lifelong follow-up

Should implants be removed, just in case?

Given the rare occurrence of the disease, we do not recommend removal of breast implants.
Thousands of women have breast implants in Australia each year and have done so for many years without issue. The same applies for millions of women around the world.
This disease affects a very small minority – it is therefore important to be aware of it, consider it before committing to surgery and knowing what to look for.

How is breast implant-associated ALCL diagnosed?

If you develop a late swelling of the breast following breast implant you should inform us immediately.
Dr Aggarwal will refer you for an ultrasound and at the same time a fluid sample will be collected which will be sent off for a special marker of the disease (CD30)
You will not be required to undergo special imaging unless the marker returns positive from the ultrasound guided aspiration.

Should women with implants be screened for ALCL?

Given the rarity of the disease, regular screening is not yet recommended by the TGA
At Mode Plastic Surgery, we suggest yearly ultrasounds after the 10 year mark largely for checking implant integrity. If you have any sudden onset of swelling after your breast implant surgery, even if it is years down the track, you should seek medical attention or notify us to see Dr Aggarwal.

Are some women more at risk of breast implant-associated ALCL than others?

BIA-ALCL has occurred in women who have had breast implants for both cosmetic and reconstructive reasons
However currently there are no reports in Australia of BIA-ALCL occurring in women who have only ever had smooth implants.
At the time of preoperative consultation you should discuss this with Dr Aggarwal.

What is the prognosis and treatment of breast implant-associated ALCL?

Most cases are cured by removal of the implant and capsule surrounding the implant.
If a patient was to develop BIA-ALCL on one side we would generally recommend removing the implants and capsules on both sides.
All cases are discussed in a multidisciplinary setting with involvement of a haematologist with experience with ALCL. Occasionally chemotherapy or radiotherapy is needed – usually when there is a solid lump (not just fluid filled).

Procedure FAQs

Do I need a referral for breast augmentation?

It is now mandatory to obtain a GP referral for all cosmetic plastic surgery consultations.

Where can I see Dr Aggarwal?

You can see us at our main practice at Gordon, or at our other locations at Hornsby, Hunters Hill, Potts Point or Camperdown.
Please scroll to the bottom of the page to find out more information about these locations.

Where will I have my operation?

Usually Hunters Hill Private, Sydney Adventist or SAN Day surgery.

What can I do to prepare for surgery?

Stop smoking at least 2 weeks before surgery
Cease fish oil, and other supplements such as Ginkgo, Ginseng, Turmeric/Circumin, Garlic and herbal supplements.
Please discuss with Dr Aggarwal if you are on blood thinning medications as to when you should stop and recommence those.

After surgery, will I need to wear a special surgical bra?

Yes for a total of 6-8 weeks.
You should not wear any bras with an underwire during this period

Will I be able to exercise after surgery?

You should not do any exercise that raises your blood pressure for at least 72 hours after surgery to avoid the risk of an unexpected bleed
Heavy upper body exercise that activates the pectoralis major muscle should be avoided for 6-8 weeks
Extreme heavy duty upper body exercise such as very heavy bench pressing should perhaps be avoided for at least 12 weeks and perhaps permanently as this risks displacement of the implant from its ideal pocket location.
You should note that there will be some movement of the implants with exercise as they are commonly placed under the muscle

Will I need special medications after surgery?

Dr Aggarwal will provide you with the necessary scripts for antibiotics and pain relief.
For the future you should remember that if you are ever having dental work or other invasive procedures to cover yourself with some oral antibiotics as there is a small risk of bacteria entering the bloodstream with such procedures that can reach the implant cavity.

Will I need further surgery?

Yes. Once you have implants, you will require surgery at some stage to exchange them. As they are foreign objects they have a lifespan of roughly 10-15 years.

How will I know if my implants have ruptured?

Given modern silicone implants are composed of cohesive gel, you will often notice no changes in shape when they intially develop a small rupture.
We suggest a yearly ultrasound after the 10 year mark. If there is any suspicion of rupture on an ultrasound it does not necessarily mean that the implant is ruptured but you should contact us to see Dr Aggarwal. He will most likely advise you to obtain a MRI, and if rupture is confirmed we will discuss implant replacement/revision surgery with you.

When will I be able to swim after breast augmentation?

You may swim in a pool or beach after 2 weeks as this is the time it takes for the incision to heal.

When will I be able to drive after breast augmentation?

No, you need someone to drive you home after breast augmentation surgery, and you should not drive for the first week after breast surgery.

Do you offer twilight anaesthetic or sedation for breast augmentation?

No
All our breast augmentation surgeries are performed under general anaesthesia given by an accredited anaesthetist
The surgery is performed in an accredited private hospital
It is usually a day surgery procedure but you will need someone to pick you up and accompany you home after the procedure
Some patients elect to stay overnight

Will breast implants change the sensation of my breasts?

This is uncommon but it is possible that there is a reduction in nipple sensation for a period after breast augmentation. In the minority where this happens, in most of those cases the sensation returns to normal weeks to months after the procedure. It can take as long as 12 months.
Permanent loss of sensation of the nipple is rare.
If this is of significant concern to you, you should not have surgery on your breast.

Can I breastfeed after breast augmentation?

Implants should have no impact on your ability to breast feed.
However even in the normal population (women who do not have breast implants) up to a third of women cannot breast feed at all, and a third require additional supplementation for their infant. These proportions of women are unchanged after breast augmentation surgery.

Can I have imaging for breast cancer screening after having implants?

Yes
This is easier if the implants are placed in a subpectoral or submuscular position.
Radiographers are used to and well accustomed to imaging breasts with implants that need to be displaced temporarily to allow the breast tissue to be imaged.
It is important for you to participate in regular screening as you would have otherwise done for breast cancer based on your age and family history.

Can implant cause cancer?

There is no association between breast implants and breast cancer
Patients should still however continue their regular screening for breast cancer based on their age and family history
In Australia it is recommended for women who reach the age of 50 to undergo 2^nd yearly mammography for breast cancer screening in the absence of other significant family history – if you have a strong family history you may be required to start breast cancer screening earlier
Textured breast implants more recently have been associated with a rare lymphoma called ALCL. The risk is extremely low and we still consider implants to be very safe way of augmenting the breast – we will discuss the type of implant used and its safety during the consultation.

Are there any alternatives to breast implants for augmentation?

Yes but none are as reliable, or cost effective
Fat transfer for a natural augmentation does exist but is limited by
- Areas of fat available for harvest: the skinnier you are the less likely it is that you will have fat deposits elsewhere to harvest
- Fat grafting is unpredictable and approximately 50% of the fat does not survive the transfer
- This means that it has to be ‘overdone’ to an extent – but all the fat must be in contact with tissues that provide it with good blood supply, otherwise it dies and can form hard cysts (fat necrosis).
- The procedure is time consuming and often needs to be repeated.
- The hours it takes to perform a single procedure and often a second means it is extremely expensive.
Dr Aggarwal does frequently perform fat transfer procedures but these are often used as an adjunct to implants to further refine the results of breast augmentation surgery.

Procedure Pricing

We offer packages for breast augmentation which include:

Mentor or Motiva implants
Surgical fees
Hospital fees (the fees differ based on your hospital of choice)
Anaesthetist fees
Surgical bra/garment
All follow-up

A quote for this procedure will be provided to you after a consultation with Dr. Aggarwal. You can also call or email our office for our current indicative pricing.

Please note that our breast augmentation pricing does not include:

Preoperative consultation fees
Breast lift (mastopexy) – an augmentation mastopexy procedure is quoted separately as it substantially increases the complexity of the procedure.
Surgical fees for future implant revisions

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