WHY CHOOSE DR ROSS FARHADIEH FOR YOUR BREAST AUGMENTATION?
Academic Roots
Dr Ross Farhadieh literally wrote the book on this topic, with two textbook chapters (2015 & 2021) in international reference plastic surgery textbooks used around the world by training and practising plastic surgeons.
Breast enlargement is one of his areas of special academic interest and peer-recognised expertise. Dr Farhadieh has provided expert commentary for international plastic surgery journals, and has received worldwide recognition for authoring two chapters on this topic in two internationally critically hailed plastic surgery textbooks: Plastic and Reconstructive Surgery: Approaches and Techniques (2015, Wiley UK) & Plastic Surgery: Principles & Practice (2021, Elsevier US).
Specialist plastic surgeon qualifications
Dr Farhadieh has triple board certification fellowships from the Royal Australasian College of Surgeons, Royal College of Surgeons (England) and the European Board of Plastic Reconstructive and Aesthetic surgery.
In addition, he has three separate subspecialty clinical fellowships including a cosmetic fellowship from some of the world’s leading institutes in London.
Dedicated patient care
The Panthea Clinics team is 100 per cent dedicated to our patients. From clear communication to attentive post-surgery care, we leave no stone unturned.
WHAT IS A BREAST AUGMENTATION?
Also known as ‘breast implants’ this is the most common cosmetic surgery procedure throughout the western world. There are many reasons why you might want to consider breast implants and lift:
- Augment the natural shape of their breasts.
- Accentuate existing or define their contours.
- Help restore breast volume and tissue compromised by breastfeeding, weight loss and/or ageing.
- Correct a noticeable difference in size between the two breasts or asymmetry.
Implants are created using various different materials for both the outer shell and the inner material. The outer shell is made of silicone gel and can be either textured or smooth.
For the filling content, either silicone or saline may be used. The shape of the implants can differ also, with some being round and symmetrical in shape, while more recent innovations offer tear-dropped or anatomical-shaped options. The latter accentuate the lower breast pole once they are inserted, which aims to give a more natural appearance. It is worth noting that tear-dropped implants only come in textured shell form. They have recently been implicated in Breast Implant Associated-Anaplastic Cell Large Cell Lymphoma (BIA-ALCL). Most plastic surgeons have moved away from textured breast implants for this reason. Dr Farhadieh recommends the use of smooth breast implants in the upcoming chapter on breast augmentation to all plastic surgery trainees and plastic surgeons.
At Panthea Clinics in Sydney and Canberra, Dr Farhadieh uses only the highest-quality breast implants available. With a lifetime guarantee, this gives you complete confidence knowing that the risk of complication is low and you’re covered if something does happen to go wrong.
BREAST IMPLANTS PROCEDURE
Different types of procedures
The scientific literature reflects that the inframammary approach is the most commonly utilised, safest and best approach, and is the technique Dr Farhadieh uses. However, there are a few different approaches to breast implants surgery. Axillary or armpit incisions are suited to patients getting saline implants, while periareolar (nipple) or inframammary (below the breast) incisions are usually used for silicone implants. An umbilical incision has also been described albeit it is more a theoretical approach rather than a practical approach. You can see Dr Farhadieh’s videos of this surgery at the top of this page or on our Panthea Clinics YouTube channel.
Initial consultation
During your initial consultation with Dr Farhadieh at either our Sydney or Canberra clinics, we will discuss all options available and formulate an individual plan. The associated risks will be outlined. Smokers will be asked to cease smoking for at least three to six weeks prior to surgery and 3-6 weeks during the postoperative period. You will also be required to stop taking any medications, herbal remedies or supplements that cause increased bleeding for at least two weeks prior to and one week following your surgery. Depending on your age, medical and family history, you may be asked to have a screening mammogram prior to surgery. Preoperative photographic images will be included in your medical records.
Day of procedure
Once your surgery day arrives, your incision lines will be marked while you are awake and you can ask any questions as we go through our checklist. This breast enhancement surgery is performed under general anaesthesia. A long-lasting local anaesthetic is also injected into the surgical area, alleviating any immediate discomfort postoperatively. During surgery, implants are optimally placed on the chest wall partially behind the pectoralis major muscle and partially under the breast gland for the best and longest-lasting results.
The incisions are closed using absorbable sutures before being sealed with dermal glue and covered with tape. There may be some discolouration or mild swelling. However, this will disappear quickly and will be completely resolved within 10-14 days. Patients will usually be discharged either the same day. Throughout this healing and recovery time, straining, bending or lifting should be avoided and you should wear your supportive bra for at least 8 weeks. You will be able to go back to work within a few days of surgery and your breasts will find their final shape within three months. You will receive comprehensive postoperative instructions.
Surgical risks
Although the risk profile is low, all surgery carries a potential for complications. Genetics, exercise, diet, age and other factors determine individual outcomes. Infection, wound breakdown, asymmetry, implant displacement, scar formation, sensory changes are amongst the main complications. Specifically:
1. There are some general risks associated with ANY operation, which include:
a) Infection in surgical wound(s) with resultant redness, pain and possible discharge. In severe cases, wound(s) could break open and need to be re-sutured.
b) Possible bleeding in surgical wound(s) with swelling or bruising.
c) Secretions may accumulate in the lungs and cause a chest infection.
d) Deep vein thrombosis.
e) Death is possible during or after an operation following severe complications.
f) Smoking significantly increases the risk of complications. Therefore, you should completely stop smoking at least 4 weeks prior to surgery, and refrain from smoking for at least 4 weeks.
2. The following facts, risks and complications apply specifically to THIS operation:
a) Antibiotics are given during and after the operation, to minimise the risk of infection. The rate of infection following breast augmentation surgery is low (approx.. 400ml/cc).
f) Implant visibility and/or palpability is possible following breast augmentation surgery, ie. implants can be felt or seen through the skin. The likelihood of these is more common in women who are very thin or have very little native breast tissue, and when larger implants are used.
g) Rippling or wrinkling of the skin over the implants may occur following breast augmentation surgery. This is most likely to be apparent on the lower/inner/outer areas of the breasts, and generally occurs when there is inadequate soft tissue to prevent the implant’s wrinkles or ripples to be seen through the skin. They are also more likely with saline implants.
h) Displacement or movement of any may occur, and this complication becomes more common with larger implants.
i) Polyurethane foam coated implants can reduce the risk of capsular contracture, displacement and rotation of implants. However, there is a 1% chance of developing a temporary rash on the breasts for 1-2 weeks after surgery if these implants are used. They are also associated with a slightly longer recovery phase. Anecdotal evidence suggests breasts are swollen for longer.
j) Dr Farhadieh will endeavour to keep the incisions as small as possible, and these scars will soften and fade with time. You will be given scar management advice to optimise results. However, thickening, widening of the scar may occur that may warrant revision surgery later.
k) Postoperative pain experienced varies from very mild to significant discomfort. You will be given plenty of pain relieving medication following your surgery and this should keep you comfortable, no matter what your level of discomfort.
l) It is common to have intermittent mild discomfort or intermittent sharp pains in the first few weeks after surgery as the swelling resolves and the nerves recover.
m) Numbness of the breasts and nipples is normal for a few weeks after breast augmentation surgery. This usually recovers after 6-12 months’; however, it can be permanent. This is more common with larger implants.
n) Most patients will need to take about a week off work. Heavy lifting, vigorous upper body exercise or any activity that involves ‘bouncing’ of the breasts should be avoided for 4-6 weeks. See Pre and Post-Op Instructions for more details.
o) The sutures used to close the incisions under your breasts are completely dissolvable, but they may be felt through the skin for up to 6-9 months after surgery.
p) ‘Double Fold’ is a contour irregularity that describes the visibility of the original (native) breast fold over the top of the implant. If you are at particular risk of this, Dr Farhadieh will discuss this with you. Further surgery may be required to correct this should it occur.
q) Rupture of any implant is possible. If a modern implant ruptures, the cohesive silicone gel will remain inside the capsule of tissue that surrounds the implant, and will remain sealed off from the breast tissue. Generally, there are no symptoms for the patient.
r) Silicone in the body does not cause or contribute to any diseases. Silicone implants have no effect on the incidence of breast cancer. Patients with implants are encouraged to have regular mammograms or MRIs when appropriate, and these are still highly effective following breast augmentation, they should begin around age 40-45 and continue every 2 years.
s) Breast implants do not normally interfere with lactation or breastfeeding.
t) There may be an association between implants and a form of lymphoma known Anaplastic Large Cell Lymphoma (ALCL) which is extremely rare. There is uncertainty about its pathogenic mechanism, some have suggested textured implants and an indolent infection may be a cause. The FDA has not changed any of its recommendations in regards to use of implants in breast surgery.
u) You may not be satisfied with the final aesthetic results
Please read all information we provide
Before proceeding make sure that you have read all the information sheets and have your questions answered.
When considering any elective surgery, it’s best to put a lot of time and thought into deciding what you want. It is both a personal journey of self-discovery and a search for the options that suit your needs best.
SMALL BREAST IMPLANTS
Breast size is very much a personal preference and/or need. It would be wrong to think all breast implant sizes are large – not at all. Some women only want to make small enhancements to their natural breasts whilst others prefer significant change. Smaller implants are of course available (as are all sizes), and this is something we can discuss in our initial consultation.
BREAST IMPLANTS BEFORE AND AFTER
Please contact our friendly customer service team to view before and after images from other patients who have given us their consent to share.
BREAST IMPLANT COST
We cannot provide a general breast implant price here as it depends on varying factors. Please contact our team so they can acquire some more information and provide you with a no-obligation estimate.
SPEAK TO US ABOUT BREAST IMPLANTS IN SYDNEY & CANBERRA
The number one aim at Panthea Clinics is to deliver the safe outcomes from your breast augmentation surgery. Contact Panthea’s Sydney or Canberra clinics today to book your initial consultation or have your questions answered by our dedicated team of surgical professionals.
Contact us about breast augmentation today!
Frequently Asked Questions
All implants are silicone inside and outside (ie the shell). They have gone through multiple generations of evolution. The first silicone breast implant was invented and clinically used by an American company called Dow Corning an American chemical company in 1962. Fun fact Dow Chemical company was military company contracted to make agent orange used in the Vietnam War. These were the first generation of implants. They were tear shaped in nature and in fact had a patch (Velcro like) to position the implants and prevent from the spinning. This first generation was clinically successful but a second generation was made which were rounders and softer. These implants ubiquitous in the 1970s felt soft and natural. They did however have a high complication rates of rupture and gel bleed. This later is a phenomenon where the molecules of the silicone gel are small ( as they have small cross linkages) and they can “bleed” overtime through the shell that is containing them. All Plastic surgeons of a certain age would have vivid recollections of removing ruptured second generation implants from patients.
During the 1980s, there was even more improvement in the third generation of silicone implants. A newer shell type called polyurethane showed promise of infinitely reduced capsular contracture rate. When the basic science caught up and showed that the reason for this was that the polyurethane shell, delaminated like an onion during its life and therefore allowed the implants to remain in the capsule free and soft. The downside was that it was discovered that high concentrations ( well above those in humans ) it was associated with soft tissue sarcomas ( a form of cancer), later they were implicated in the unusual T-cell lymphoma cancers with textured implants.
The textured implants ( made to emulated the pores in the polyurethane )and the return of the tear shaped implants came in the 1990s with form stable gel (one that does not leak everywhere when ruptured). These 5th generations implants have been with us since. Despite the reduction in capsular contracture rates their association with Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has meant that they are less and less used in favour of smooth shell implants.
Generations of Silicone Implants (Farhadieh RD et al Plastic Surgery: Principles & Practice, US, Elsevier 2021).
Form Stable Gen V Silicone implant
From left to right
Macrotextured tear shaped, smooth round, microtextured round and finally polyurethane implant
Classically, silicone implants used to be placed behind the breast tissues and over the muscles. The problem with this approach was that it has been shown to be associated with higher capsular contracture rates. This is is somewhat mitigated by placing the implants behind the pectoralis major muscle. This has been shown conclusively to reduce capsular contracture rates. Initially complete coverage of the implants by muscles were promoted, the issue then was that when the pectoralis muscle contracted the implants often moved up whilst the breasts moved in another direction, so called implant animation. The dual plane technique was a way to achieve the best outcome, muscle coverage over the upper pole of the implant, thereby obscuring the upper pole for the implant, especially in thinner patients and allowing regular muscle movement reducing capsular contractors. This is the technique that Dr Farhadieh uses in his primary breast augmentations.
Dual Plane techniques I-III, (Farhadieh et al Plastic Surgery: Principles & Practice, Elsevier, US, 2021).
There is some discomfort associated with surgery. Most patients report a ‘tightness’, rather than pain. Recovery and pain perception are however individual based and these may be different across all patient, excellent modern anaesthetic pain relief provides local anaesthetic for the immediate postoperative as well as power analgesic for the days following surgery.
The breasts will not only heal during the first 6 weeks, but will also gradually find their natural postoperative position. Gravity, healing and surgery drive this process. The final shape is usually reached by 3 months. The incision scars will fade over the first 12 months and will often be barely visible beyond the first year.
Within 2 weeks you will be back at work and able to resume most normal activities. During the subsequent weeks you will return to your pre-surgery levels of activity. We have a postoperative regime to help you through this time.
Your scars are routinely placed under the breast fold, hidden from view. Not only do bras or swimwear hide the scar, in time it will fade and be barely perceptible.
Dr Farhadieh believes that the relationship between doctor and patient is sacred and privileged. Our practice is based on compassion, honesty, transparency and, above all, patient welfare. We pride ourselves on making sure that you feel supported at all times. We will be available during each stage of your journey and will schedule short-, medium- and long-term follow-up appointments as part of our overall practice.
Let’s start with what Dr Farhadieh has written and teaches in his chapter on breast augmentation in one of the major international reference textbooks in plastic surgery. “Larger controlled augmentation volumes remain in the realm of promising trials. Breast augmentation surgery remains the most popular cosmetic plastic surgery procedure. Since its inception it has endured controversies. The future shows hope for autologous options along with a need for a good understanding of the aesthetics, techniques as well as potential complications facing this patient population which underpins good and safe surgical practice.” (Farhadieh et al Plastic Surgery: Principles & Practice, 2021, US, Elsevier).
It does however have a place in clinical practice provided all the facts are taken into consideration. Fat grafts have become a popular means of soft tissue augmentation and breast reconstruction in recent years Capitalizing on the benefits of pluripotent STEM cells from adipose tissue remains the holy grail of tissue engineering and regeneration. The benefits of fat grafting are diverse, ranging in the reversal of the effects of radiotherapy post breast cancer surgery and scar contracture from burns, to an adjustment for minor defect correction in breast augmentation. Its use has also been described for women who have undergone breast conserving surgery and total mastectomy. There have been many changes in recent years with better under- standing of fat and stem cells as well as better techniques
So with the above and more in mind it has a very narrow clinical indication and use.
Fat harvested to be prepared for injetction
ADDITIONAL READING
Dr Farhadieh has authored many informative blogs on the breast augmentation procedure and other relevant topics in our blogs section. These include: