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Breast Augmentation Considerations by Dr. Niro

When having elective surgery, it’s paramount each patient does their homework beforehand. In this article, Ignite’s Medical Director, Dr. Niro Sivathasan, lays out what to consider before going under the knife. It’s his goal that you come to an informed and educated decision about breast augmentation.


When choosing a breast implant, bigger is not always better. Choosing an implant solely on size is, in my opinion, is the wrong way to proceed. The natural shape and proportions of the patient’s body needs to be considered. Lifestyle variables such as activity level is another piece of the equation. Anatomical factors play a role as well. Existing breast tissue and skin quality also need to be considered. While some patients may think they should “go big or go home”, it may not be the best decision for them personally.

Trending Smaller

In recent years, I have noticed the trend of breast implant sizes swinging toward smaller-sized implants. This was also demonstrated by Harley Street’s, The Plastic Surgery Group. A breast with a smaller nipple-areola-complex (NAC) is rated as being more attractive than one with a larger NAC. Consultant plastic surgeon, Dan Marsh, who is a former colleague of mine in Britain, said that his team has “noticed a trend toward patients choosing a smaller diameter nipple when they are offered a choice of nipple sizes.”

Traditionally in breast reductions, lifts, and reconstruction procedures, the ‘nipple-areola markers’ are typically 46mm in diameter. However, it is evident that a single nipple size is not appropriate for all.  As I have always said, one size does not fit all. This is why it is important to have a thorough and transparent discussion with your doctor.

Above or Below?

This is a question that many patients are eager to discuss.  In Australia, the majority of patients have opted to go ‘beneath the muscle’ (behind Pectoralis major).  In some South American countries, the majority of patients prefer to go in front of (‘above’) the muscle. 
The decision of implant location depends on one’s lifestyle. Factors include: exercise preferences, the amount of overlying breast tissue, and the degree of subtlety desiredI believe that the role of a good doctor is to equip the patient with the knowledge. This empowers the patient to make the most appropriate decision for that particular individual. I aim to do this with all of my patients.

What if My Breasts Are Saggy?

Breast augmentation increases breast size and depending on the type of implant chosen, can make breasts perkierIn addition, using implants enhances the contour and shape of the breasts. As I tell all my patients, the curves and proportions of the patient’s silhouette are more important than the actual size of the implants.

For breasts that have become saggy or ‘bottom heavy’, a breast lift (mastopexy) may be necessary.  This is a more involved procedure than breast augmentation, and requires more operating time. Due to the unpredictability and length of time required, it is a much more expensive (but sometimes necessary) procedure.
Occasionally large breast implants may be used to avoid getting a breast lift. All too often, however, the results are either suboptimal or have a short period of acceptability before gravity wins.  

Thus, for patients with droopy and “empty” breasts, an ‘augmented mastopexy’ is necessary. This combines a ‘boob job’ and ‘boob lift’. In this procedure, volume is given (or restored) to the breasts. A perkier look is achieved and as a bonus, the amount of stretch marks may also be reduced.

It is important to consider the many facets of each patient. Health, lifestyle, personality, and aspirations are all factors that an experienced surgeon considers. I pride myself in directing each patient I work with toward the result that is best for them in the long run.

Let's Discuss Your Options

It is important to consider numerous facets of the patient’s health, lifestyle, personality, and aspirations – not just the expected aesthetic outcome – when undertaking elective surgery, and I pride myself on this aspect.

Please contact us at Ignite Medispa to make your dreams a reality.

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