A well-augmented breast has a natural fullness, with gentle sloping off the chest wall. There should be natural cleavage without webbing between the breasts and only a certain amount of perkiness.

There are three main telltale signs of unnatural-looking breast augmentation:

Breast implant margin: This should be soft and imperceptible, as obvious implant edge visibility, especially in the midline, will resemble the Tori Spelling or Posh Spice look.

Breast implant size: an implant that is too large for a small frame is usually an obvious give-away that a patient has had a breast augmentation. The best example of this is Pamela Anderson-style breasts. Women wanting to go from an A cup to a full D cup need to understand the limitations of Breast skin.

Perkiness: An augmented breast that is too perky will tend to look fake, as a small amount of droop is natural. When a patient lies on her back, the breast implants should roll to the side like natural breast tissue and not sit up like rigid peaks.

There are three main Breast "looks" that patients strive for. Please click on the relevant galleries:

Natural Look: In-proportion
Natural Look: Out of proportion
Augmented Look

Dr Tavakoli has come up with the 6 following broad categories of patients seeking Breast Enhancement in Australia. Most breast patients should fall into one of the categories:

Enhancement
1. Tight Skin, Poor Shape & Small Breasts (commonest patient)
2. Good Skin, Good Shape & Small Breasts
3. Good Skin, Good Shape & Moderate Breasts

Restorative
4. Tight Skin and Tuberous shaped (Grades 1-4)
5. Poor Skin, Good Shape (Weight Loss &/or Post-Pregnancy)
6. Poor Skin, Poor Shape (Weight Loss &/or Post-Pregnancy)

Essential Clinical parameters

There are six main clinical parameters for breast implants on initial consultation:
Patient's body build and height
Patient's own breast size, shape and symmetry
Nipple position in relation to the breast mound
The quality of breast skin (thickness & stretch marks)
Chest wall shape and dimension (Hollowed vs Pigeon Chest walls)
Patient's desire for new cup size: Under-proportion, In-proportion or Over-proportion augmentation

After establishing the crucial parameters in the clinical examination, the process of tailor-making the 'correct' breast augmentation begins.

I specialise in Minimal Incision Technique & Minimal Pocket Bleeding producing Rapid Recovery after Breast Augmentation Surgery.

There are three choices about where to make the skin incisions for breast enlargement surgery. They can be in the breast fold (inframammary), around the nipple (periareolar) or underneath the armpit (transaxillary). These incisions can all produce scarring ranging from excellent to poor. Although patients may voice some initial concerns about the location of their scars, they are ultimately far more concerned with the final shape and size of their breasts. In fact the rate of scar revision for unsatisfactory scarring in Breast Augmentation is less than 0.05%.

Generally, a great majority of patients in my practice opt for the inframammary incision (breast fold). I also find this incision has the least amount of interference with breastfeeding and nipple sensation and it generally heals very well.
I find the periareolar incision particularly useful in some Asian and African patients with higher risk of keloid scarring but the nipple-areola must be at least 4.0 cm in diameter. Furthermore, the periareolar incision also allows one to perform the full Benelli breast lift or nipple lift where this may be indicated in mildly droopy breasts.

Transaxillary (armpit) incision carries high risk of cleavage problems (too much gap) and is reserved for a few select patients with small chest wall. The transumbilical (belly button) incision popularised by the Fox reality show Dr 90210, is ONLY reserved for the use of saline implants. As I am not a huge fan of saline implants due to extremely high risk of problematic "rippling" I do not personally favour the "belly button" incision.

Please note that my Clinic has the latest World Laser technology FRAXEL. The fractionated laser works amazingly well in most scars to eliminate the redness and improve texture of scars in cosmetic surgery patients with poor healing.

ROTATION ISSUE: It should also be noted that teardrop or anatomical implants do have a tendency, estimated at about 2-5 percent, to rotate. This is far more likely to occur when surgeon places he implant over the muscle andpatient has lax and droopy skin allowing movement to occur.

Unfortunately, this problem can only be corrected by secondary surgery. The rate of tear drop implant rotation in women who continue to use the chest muscles in their exercise routine is much higher. Round implants do not cause "rotation" issue. Please also note that Polyurethane coated tear drop (anatomical) implants have a much lower rate of rotation of around 0.05 percent but feel much firmer.

Behind the Muscle or Over the Muscle

The next consideration is where to place the breast implant - on top of or behind the muscle. In general, I prefer to place breast implants behind the muscle so that they are partially covered. I find the pectoralis muscle allows a smooth takeoff from the chest wall. If put directly on top of the muscle, the breasts can look like rounded balls on the chest which is a definite give-away. It is also my opinion that placing the implant under the muscle will, in the long run, have an impact on breast droopiness. Also for older women that need breast screening, it seems that behind the muscle placement is superior from a mammogram and ultrasound imaging point of view. A further advantage of the submuscular pocket is a lower rate of capsular contracture.

But it is not all perfect with the submuscular placement of implants. The negatives of the submuscular pocket is that it may create "winking" on animation or flexing of the pectoralis muscle. Implant migration and displacement is also more likely in this pocket.

Dual-Plane Technique

In women with mild droopy (ptotic) breasts, I use the dual-pocket technique of dissecting both on top of and underneath the pectoral muscle (50% over and 50% under the muscle), but inserting the breast implant behind the muscle. This new technique popularized by Texan Plastic Surgeon Dr John Tebbett and Swedish Plastic Surgeon Dr Per Heden is proving very successful with most types of breast augmentation that I see in my practice.

In rare cases of moderate droopy breasts where the patient does not wish to undergo a breast lift procedure for fear of scaring, I will consider placement of the implant on top of the muscle. This pocket is referred to in the plastic surgery literature as subglandular or subfascial . Generally speaking, it is a relatively painless pocket with excellent short-term benefits but in my opinion far less long-term advantages compared to the submuscular or subpectoral pocket placement. Having said this please note that most types of constricted or Tuberous breast corrections are done with implants in the Subglandular or Subfascial pocket as the risks od Double -Bubble is considerably higher in Tuberous breasts.

Many women are concerned with obtaining the exact or perfect cleavage. No one wants to have breasts that look like Posh Spice or Tory Spelling.

I try very hard to maximise the cleavage or reduce the gap in all my patients during the operation. The range for a good cleavage is 1.5 cm to 2.5 cm (as per image). Anything less is achievable but at risk of damaging the muscle or breast tissue creating Symmastia or Monoboob. Anything more can create patient anxiety and dissatisfaction.

When I mark the cleavage area before the surgery I take note of 2 important parametres: 1. the muscle take off 2. exact breast width or breast plate. Then the width of the breast implant is paramount in obtaining a close cleavage.

Please note that one of the most important aspects of breast augmentation is the position of the Breast Fold/Height vs Breast Width. In most women seeking breast augmentation the Width is much more than the Height and therefore it may be that they will get a better outcome with an oval shaped Anatomical implant.

Should you become pregnant following your operation then your existing breast tissue will be subjected to the normal hormonal influences of this period and therefore your breast will enlarge and the skin will stretch accordingly. Likewise, once the pregnancy and any associated breast feeding ceases, your breast tissue will then shrink down. It is impossible to predict to what degree these changes will occur; however, the breast implant volume will remain the same throughout these.

Breast feeding is certainly possible when implant is placed behind the muscle and the implant is not inserted through the nipple-areolar complex. Whether placement of implant behind breast tissue (in front of the muscle) has bearing on breast feeding is still debatable. Prolonged breast feeding, however, will create possibility of stretch marks on the breasts and certainly accelerate breast droopiness (ptosis) which may or may not require surgical correction. 

A general anaesthetic is used when the breast implant is placed under the pectoral muscle. Dr Tavakoli works with a skilful group of anaesthetists that perform both general and "twilight-sedation" anaesthesia. Dr Tavakoli only operates at fully accredited operating facilities where the administration of both types of anaesthesia is permitted.

Some surgeons perform breast augmentation surgery in their consulting rooms under so-called "twilight-sedation" without having the appropriate license for full general anaesthetic. With sedation there is marked risk of waking up in the middle of your surgery. Beware of clever marketing ploys that promote the use of sedation for boob jobs. Simply ask your surgeon if the choice of different anaesthesia is available to you.

In addition to general anaesthesia, Dr Tavakoli uses plenty of local anaesthetic around the surgical site in order to make the immediate recovery period very comfortable.

Your breasts will be somewhat swollen and bruised postoperatively. Dr Tavakoli uses drains for 24 hours in order to reduce the rate of bruising and swelling. The latter usually settles in about two to three weeks. Sometimes swelling may be slightly different between the two sides. This is normal and settles with time. However if a great difference develops between the two sides then you must contact us for advice.

Following a breast augmentation, the breasts may appear to be placed quite high up. This is also normal. During the first two months postoperatively the breast implants will gradually lower and settle from the effects of gravity into a more natural position. Do not be alarmed if one side settles quicker than the other, as this sometimes occurs.

Following the operation you will have a light dressing in place which will need to be kept dry until your follow-up appointment. At this time the surgical wounds are inspected and lightly cleaned. There are no stitches to remove, as these are internal and dissolvable. Always remember to read and follow the postoperative instructions that will be given to you.

You should plan to avoid activities which require much raising of the arms above the level of the head for 10 days after surgery. With great care, you can drive about 10 days after surgery. Patients can usually return to work in 7 days unless their occupation requires particularly strenuous movements and lifting. In such cases, 2-3 weeks should be allowed.

• Neck and arm stretches may begin immediately
• Walking can commence within 7 days,
• Light jogging within 3 weeks,
• Gym and Pilates after 4-6 weeks
• Upper body weights 6-9 weeks
• Contact sports / Martial arts/ Boxing / Soccer after 12 weeks

Dr Tavakoli has developed a large practice specialising in Correction of Tuberous breasts deformities.

The Tuberous (snoopy or cone-shaped or constricted base) breast deformity is a rare entity affecting young women bilaterally or unilaterally. There are mild, moderate and severe grades of this condition. Women usually inherit this condition and when severe it can cause significant psychological issues.

The Tuberous deformity is characterised by a constricting ring of tissue at the base of the breast, which leads to deficient horizontal and vertical development of the breast with or without herniation of the breast tissue toward the nipple-areola complex and areola enlargement. Tuberous breasts are invariably asymmetrical in size in 90% of cases.
Interestingly enough pregnancy and rapid weight loss can convert  Mildly tuberous breasts to Severely tuberous.

As you can imagine surgical correction is quite complex. The treatment in simple terms includes:

Mild forms: Augmentation with Anatomical implants only
Moderate & Severe forms: 3 procedures need to take place. Breast reduction and flap procedure to get an even breast thickness in ALL quadrants, Periareolar Breast Lift & Augmentation with anatomical implants. In some cases Fat Grafting may be needed at 6-12 months post-operatively to complete the transformation.

Medicare item numbers exist for this condition making correction of tuberous breast a reconstructive/corrective operation. Please click here read the following CASE STUDY on this condition.
Click here to view Dr Tavakoli's extensive Tuberous Correction Breast Gallery

The Von Heimburg classification describes 4 grades:

Grade I: hypoplasia lower medial quadrant,
Grade 2: hypoplasia of both lower quadrants with adequate areolar skin,
Grade 3: hypoplasia both lower quadrants with limited areolar skin,
Grade 4: hypoplasia of all quadrants.

This is a very common problem (up to 80% of ALL women) as women seldom have identical breasts. Breast Asymmetry can be corrected in many ways. Implants can be used as well as Breast Lift procedures.
Dr Tavakoli uses different size implant for each breast in 25% of all his cases. Generally speaking Dr Tavakoli only corrects asymmetry of more than 1/4 cup size. Very slight breast asymmetry are recorded but best left untreated.

NB. Dr Tavakoli will advise if you need any extra procedures and explain the exact reason at the time of your initial consultation. The extra cost will also be discussed well in advance. Please note that only a properly specialised plastic surgeon can carry out these extra procedures combined with breast augmentation.

Long "floppy" nipple condition usually occurs as a result of prolonged breast feeding. More commonly is seen in Asian patients. If not corrected the nipples can be quite obvious after breast augmentation as nipples can be seen protruding in tight T-shirts etc... Dr Tavakoli prefers to perform this operation on women who have finished with breast feeding duties.

Click here

Dr Tavakoli has a large referral base of women with poor breast augmentation outcome from other centres in Australia and New Zealand. These terrible complications or undesired outcomes are very rare in experienced hands but no plastic surgeon in the world including Dr Tavakoli has a zero complication rate.

Unfortunately in great majority of revisional cases patients are psychologically affected and counselling is required to help patients through the corrective surgery. Dr Tavakoli 's team can organise counselling for patients undergoing corrective breast surgery.

Dr Tavakoli has a great deal of experience in correcting post breast augmentation complications. Most of these unsatisfactory outcomes occur as a result of poor patient selection and inadequate surgical skills to deal with a difficult breast condition but other problems can occur as a result of poor healing and scarring of the patient. Please note that the fees/cost for corrective surgery are higher than primary augmentation.

Please note that although complications are uncommon in Breast augmentation surgery they can happen around of 5-7% cases. Please read the list below before your consultation as good knowledge of the complications allows Dr Tavakoli to complete the comnsultation and the informed consent.

Please note that all complications are greater in smokers and those that return to full gym activity too soon after breast implants surgery.

Immediate

This is the most serious complication of breast implants. A capsule or capsule formation is a layer of scar tissue that normally forms around any artificial material placed in the body. It is important to realize that this is the natural response of the body to foreign material. Most times this capsule is so soft that it is virtually undetectable and therefore does not affect the breast implant in any way. Capsular contracture or hardening occurs when this layer of scar tissue shrinks around the breast implant, squeezing it so that it starts to feel firm, or in some cases, quite hard. Most capsular contractures experienced today stem from the smooth shell silicone breast implants placed some years ago. The capsule contracture rate in the past was 30-35% (in the 1980's breast implants).

With the onset of textured shell breast implants, the problem of capsular contracture has been significantly reduced, now being between 5%.

The cause of capsular contracture is not totally clear, but seems to be multifactorial. It is important to realize that there are degrees of contracture and that the majority of women, who do develop this hardening, develop it only to a mild extent. In the minority however, it may be severe enough to be bothersome, even painful and may cause distortion of the breast. The condition may occur in one or both breasts and to a different degree either side.

It may develop any time, even years later although it is most likely to happen in the first 3 years after surgery. Unfortunately at this time there is no effective way to prevent capsular contracture if it is going to occur. However as mentioned previously, encapsulation is no longer the problem that it was. Having mentioned all the above, it is important to note that capsular contracture is not in itself a health risk other than its possible interference with mammography.

Are the prostheses safe? Can they cause cancer?

In Australia and Europe current sales figures show a distribution of 90% silicone, 10% saline. As modern silicone gel implants have been available since 1963, surgeons therefore have over 35 years of experience with these types of breast implants. This is more than any other type in use. Evolution has brought changes and improvements over the years with the introduction of textured surface envelopes made of newer formulations designed to minimize the "bleed" or diffusion of what is usually tiny amounts of the silicone oil fraction of the gel contents.

Importantly the standard silicone gel by most accounts, arguably "feels" the most natural of all breast implants. This is probably as a result of the inherent smoothness of the silicone gel content.