Why the choice of practitioner deserves careful research

Deciding who will perform your breast surgery is one of the more consequential decisions in the process, and one of the harder ones to research well. A great deal of the material available online is promotional rather than informative, which makes it difficult to separate verifiable facts about a practitioner from marketing language.

This guide sets out what can actually be checked before you book a consultation: how medical registration works in Australia, what the title “surgeon” now legally means, which qualifications are relevant to breast procedures, and what the regulatory pathway requires of both you and the practitioner. It also covers the questions worth asking at consultation, and the marketing claims that should prompt caution.

Breast procedures are surgical procedures. Whether you are considering breast augmentation with implants, breast enlargement using fat transfer, a breast lift, a breast reduction or implant removal, each carries risks that should be discussed with you in detail before you consent. Those risks are set out in more depth on our risks of breast surgery page, and more generally under risks of plastic surgery.

What the title “surgeon” legally means in Australia

This is the single most useful thing to understand, because it changed relatively recently and it is frequently misunderstood.

Until 2023, the word “surgeon” was not a protected title in Australia. A medical practitioner with general registration could describe themselves as a surgeon of one kind or another without holding specialist surgical qualifications. Following reforms introduced by the Medical Board of Australia and the Australian Health Practitioner Regulation Agency (Ahpra), the use of the title is now restricted.

In practical terms, this means that when you see the title used, it should correspond to a verifiable specialist registration — and you can check it yourself, free, in a few minutes. It also means the distinction between the following is worth understanding:

• Specialist plastic surgeon — holds specialist registration in plastic surgery, typically indicated by the postnominal FRACS (Fellow of the Royal Australasian College of Surgeons) in plastic and reconstructive surgery. This involves accredited surgical training over a period of years, assessed by examination.
• Cosmetic surgeon — historically a descriptive term rather than a recognised specialty. A practitioner using it may hold general registration and additional training from a non-specialist college, which is not equivalent to specialist registration.
• Cosmetic physician — a medical practitioner who performs non-surgical procedures and does not perform surgery.

None of this tells you whether a particular practitioner is a good fit for you. What it does tell you is what training pathway sits behind the title, which is a reasonable starting point for further questions.

How to verify registration yourself

Ahpra maintains a public register of every registered health practitioner in Australia. You can search it by name at ahpra.gov.au and confirm:

• that the practitioner holds current registration
• their registration type, and whether it is general or specialist registration
• their recognised specialty and any field of specialty practice
• any conditions, undertakings or reprimands recorded against their registration

If a practice website states a registration number, it should match the register. It is reasonable to check, and reasonable to ask if something does not line up.

You can read about Dr Richard Hamilton’s training and qualifications on his profile page, and about the practice more broadly under our philosophy.

Procedure-specific experience is a separate question

Specialist registration establishes a training baseline. It does not tell you how frequently a practitioner performs the specific operation you are considering, which is a distinct and reasonable thing to ask about.

Breast surgery is not a single operation. The technical considerations differ substantially between procedures, and experience does not automatically transfer from one to another. It is worth asking directly how often a practitioner performs the procedure you are considering, and how they manage complications when they arise.

Augmentation with implants

Breast augmentation using implants involves decisions about implant type, size, profile, and whether the implant sits behind the chest muscle or directly beneath the breast tissue. These decisions are made on the basis of your individual anatomy, including existing breast tissue, skin quality and chest dimensions.

Implant selection is a substantial topic in itself. If you are weighing up the options, our articles comparing saline and silicone implants and discussing implant size selection cover the considerations in more detail, along with a general overview of implant options.

Enlargement using fat transfer

Fat transfer to the breast, also described as fat grafting or autologous fat transfer, uses fat harvested from elsewhere on the body. It is a different operation with a different risk profile, different limitations on the volume achievable, and a degree of unpredictability, because a proportion of transferred fat does not survive.

The volume achievable through fat transfer is generally more modest than with implants, and further procedures may be required. Whether it is a suitable option depends on factors including available donor fat and your individual goals. We have covered how fat transfer compares as an approach and how to weigh implants against fat grafting separately.

Breast lift, reduction and combined procedures

A breast lift (mastopexy) addresses breast position and skin envelope rather than volume. A breast reduction removes breast tissue, fat and skin, and is sometimes considered where breast size is associated with physical symptoms such as neck, shoulder or back discomfort. Whether either procedure is appropriate is assessed individually.

In some cases a lift is considered alongside augmentation, which increases the complexity of surgical planning. Recovery expectations differ between procedures — we have written separately about recovery after augmentation, recovery after a breast lift, and the risks and recovery timeline associated with breast reduction.

Scar length, position and visibility vary between individuals and cannot be predicted with certainty. Any procedure involving an incision results in a permanent scar.

Revision surgery and implant removal

Implants are not permanent devices. Further surgery may become necessary over time, whether because of a complication, a change in your preferences, or device-related factors. A practitioner experienced in breast implant removal and revision work is managing a different set of technical problems from primary surgery, including capsule management, tissue changes after long-term implant presence, and decisions about whether to replace, remove, or combine removal with a lift.

We have discussed implant removal and replacement in more detail, including what tends to prompt these procedures.

Other breast procedures

Related procedures include male breast reduction for gynaecomastia, inverted nipple correction and prominent nipple correction. A general overview of the procedures performed at the practice is available on our breast procedures page, and we have written specifically about what inverted nipple surgery involves.

The regulatory pathway: what is required before surgery

Australia regulates cosmetic surgery more tightly than many comparable jurisdictions. The steps below are minimum requirements, not optional extras, and a practice that treats them as obstacles to be hurried through is telling you something useful.

A referral is required. You need a referral before attending a consultation for cosmetic surgery. This is ordinarily from your usual general practitioner, who is well placed to consider your general health and history.

Two consultations apply. The assessment process involves more than a single appointment, and the first consultation with the practitioner who will perform the surgery must take place before you consent.

A cooling-off period applies. For adults, a minimum seven-day cooling-off period applies before major cosmetic surgery proceeds. The purpose is straightforward: to give you time to consider the information you have been given, without pressure, and to change your mind.

Additional protections apply to patients under 18. A three-month cooling-off period applies rather than seven days, along with a mandatory assessment by a registered mental health practitioner. Hamilton House performs cosmetic surgery for adults aged 18 years and over only.

Psychological assessment forms part of the process. Practitioners are required to consider your mental health as part of assessing suitability. This includes screening for body dysmorphic disorder, which is a recognised contraindication to cosmetic surgery. Where appropriate, referral for psychological assessment supports informed decision-making.

You are encouraged to seek a second opinion. This is not a formality. An independent view from an appropriately qualified practitioner is a reasonable step before any elective operation.

You can read about how the process runs at this practice on our patient journey page, and the relevant paperwork is available under patient forms.

What a thorough consultation should cover

A consultation that gives you what you need in order to consent should address, at minimum:

• your relevant medical history, current medications, smoking status and general health
• your reasons for considering surgery, and what you are hoping the procedure will address
• the surgical options available for your anatomy, including the option of not proceeding
• the specific risks and possible complications, both general and procedure-specific
• what recovery involves, including time away from work and restrictions on activity
• the likely need for further surgery over time, and what that would involve
• total costs, including surgical, anaesthetic, facility and follow-up fees
• what happens if a complication occurs, and who is responsible for managing it

Risks associated with breast surgery may include bleeding, infection, changes in nipple or breast sensation, asymmetry, scarring, problems with wound healing, capsular contracture, implant rupture or displacement, effects on breastfeeding capacity, complications of anaesthesia, and the possibility that a further procedure is needed. This is not a complete list, and the risks relevant to you depend on your circumstances. They should be explained to you individually, not handed to you as a leaflet.

If a consultation leaves you feeling that questions were deflected or that risks were minimised, that is worth weighing.

Assessing a practitioner’s photographic records

Clinical photographs can be informative, but they need to be interpreted with some care, and the regulatory requirements around them exist for good reason.

Where photographs are shown, they should be of actual patients of that practitioner, taken under consistent conditions — the same lighting, angle, pose and framing before and after — and they must not be edited, filtered or retouched. Advertising that includes patient images is required to carry a clear statement that results vary between individuals.

What photographs can reasonably show you is the range of outcomes a practitioner has obtained, including scar position and healing, across cases with some similarity to your own starting point. What they cannot show you is what your own result will be. Outcomes depend on your anatomy, tissue characteristics, healing response and a number of factors outside surgical control. No photograph of another patient predicts your result.

Be cautious about photographs that appear inconsistently lit or posed, that show only a narrow selection of cases, or that are presented alongside claims about how a procedure made someone feel. Patient testimonials about clinical care are prohibited in advertising for regulated health services in Australia, and their presence is itself a warning sign.

Three-dimensional imaging and expectation-setting

Some practices, including this one, use three-dimensional imaging as part of surgical planning. Hamilton House uses Vectra 3D technology to assist discussion at the consultation stage.

It is important to understand what a simulation is and is not. Three-dimensional imaging is a planning and communication tool. It can help clarify the conversation about proportion and volume, and it can help identify where expectations may not be achievable. It does not predict a surgical result, and a simulated image is not a representation of the outcome you will obtain.

Facility accreditation and anaesthesia

Where your surgery takes place matters as much as who performs it. Reasonable questions include which facility is used, whether it is accredited for the procedure and level of anaesthesia involved, who administers the anaesthetic and what their qualifications are, and what arrangements exist for transfer if a complication requires hospital care.

Procedures at this practice are performed at Hamilton House Day Surgery. You can read about the practice and its facilities if you would like more background.

Continuity of care after surgery

The relationship with your practitioner does not end when the operation does. Reasonable follow-up arrangements include scheduled review appointments, monitoring of wound healing, clear guidance on when to resume activity, and an accessible point of contact if you have concerns.

Ask specifically who you contact out of hours, whether follow-up appointments are included in the quoted fee, and who manages a complication if one arises. Ask what happens if you need revision surgery, and on what basis.

For implants specifically, ask about long-term monitoring, what device information you will be given, and what the current guidance is on surveillance. If you are travelling for surgery, follow-up logistics deserve particular attention, and we have set out how this is handled for patients from out of town.

Cost, and why the cheapest quote warrants scrutiny

Cosmetic surgery is not covered by Medicare where it is performed for purely cosmetic reasons, though some procedures performed for functional or medical reasons may attract a rebate. Your practitioner and your general practitioner can advise on whether this may apply to you.

A quote should be itemised. Ask what it includes and what it does not: surgical fee, anaesthetist, facility, garments, follow-up appointments, and the cost of managing a complication or performing revision surgery.

Substantially lower pricing usually reflects a difference in something — practitioner qualifications, facility accreditation, anaesthetic arrangements, time allocated to the procedure, or the follow-up care included. Surgery performed overseas or interstate at low cost introduces additional considerations, particularly around continuity of care and who manages complications once you have returned home. We have discussed these issues in detail under the risks of overseas and cheap interstate surgery.

Timing, and the questions a practitioner should raise with you

A practitioner assessing you properly will raise timing, and may advise waiting. That advice is worth taking seriously rather than treating as an obstacle.

Pregnancy and breastfeeding. Breast size and shape change during pregnancy and lactation, and those changes continue for a period afterwards. Surgery undertaken before these changes have settled may not produce a durable outcome, and further surgery may be required. Where you are planning a pregnancy in the near future, that is relevant to the discussion. We have written separately about the considerations that arise with surgery after pregnancy.

Breastfeeding capacity. Some breast procedures may affect the ability to breastfeed. The degree of risk varies with the operation and the technique used, and it is a question to raise explicitly if future breastfeeding matters to you.

Weight stability. Substantial weight change after surgery may alter the result, and this is particularly relevant where fat transfer has been used, since transferred fat behaves like fat elsewhere in the body.

General health and smoking. Smoking and nicotine use increase the risk of wound healing problems and other complications. A practitioner will ordinarily ask you to stop for a defined period before and after surgery. Certain medical conditions and medications also affect suitability and healing.

Age. Suitability is assessed individually, and specific age requirements apply to some implant types. This practice performs cosmetic surgery for adults aged 18 years and over only.

Long-term implications worth understanding before you consent

Some consequences of breast surgery extend well beyond the recovery period, and they are easier to weigh before surgery than afterwards.

Implants are not lifetime devices. Further surgery may become necessary, whether for a complication, device-related factors, or a change in your own preferences. It is reasonable to ask a practitioner what timeframe they typically discuss with patients, and what revision would involve.

Breast screening. Implants may affect the technique used for mammography and the interpretation of images. Radiographers should be told that implants are present so that appropriate views are taken. Breast surgery does not remove the need to participate in routine breast screening according to the guidance that applies to you, and any new breast change should be assessed regardless of prior surgery.

Device records. You should be given information identifying the implants used, including manufacturer, type and serial numbers. Keep it. In Australia, implant details are also recorded in a national registry, and you should be told how this applies to you.

Ongoing awareness of device-related conditions. There are recognised conditions associated with breast implants, and the evidence base continues to develop. A practitioner should discuss current guidance with you, and you should feel able to raise any concern you encounter in the media or elsewhere without it being dismissed.

Scarring is permanent. Any procedure involving an incision leaves a scar. How it matures varies between individuals and cannot be predicted with certainty.

If you have concerns about a practitioner

If you have concerns about the conduct, health or performance of a registered practitioner, or about advertising that appears not to comply with the requirements, you can raise it with Ahpra. Concerns can be made through the Ahpra website, and advertising complaints can be submitted the same way.

Knowing this pathway exists is useful in itself. It is also worth being aware that any conditions, undertakings or reprimands recorded against a practitioner’s registration appear on the public register, which is one more reason to look at it before your first appointment rather than after.

Warning signs in cosmetic surgery marketing

Australian advertising rules for regulated health services prohibit a number of practices. Encountering them suggests either unfamiliarity with the rules or indifference to them:

• Patient testimonials about clinical care. Prohibited in advertising for regulated health services, including on social media and in content posted by third parties on a practice’s behalf.
• Time-limited discounts, package pricing or prize draws. Inducements of this kind are heavily restricted, and pressure to decide quickly is inconsistent with a mandatory cooling-off period.
• Language that trivialises surgery. Descriptions suggesting a procedure is simple, quick or requires no meaningful recovery misrepresent what is involved.
• Claims about emotional or psychological benefit. Advertising should not suggest that a procedure will make you happier or more confident.
• Guarantees of any kind. No surgical outcome can be guaranteed.
• Sexualised or glamorised imagery, or any advertising directed at people under 18.
• Vague credentials. Titles that sound specialist but do not correspond to a verifiable registration on the Ahpra register.
• Pressure to consent at a first appointment, or reluctance to discuss risks and complication rates.

Questions worth taking to your consultation

It is entirely reasonable to arrive with a written list.

On qualifications: What is your registration type and specialty? What is your Ahpra registration number? Where did you complete your surgical training? Are you a Fellow of a specialist college, and in which specialty?

On experience: How often do you perform this specific procedure? What is your complication rate for it? How do you manage the complications that occur most frequently? How many revision procedures have you performed?

On my case: Am I a suitable candidate, and why? What are the alternatives, including not having surgery? What limitations apply given my anatomy? What would you advise against, and why?

On risk: What are the specific risks for me? What is the likelihood I will need further surgery, and when? How would that be managed and costed?

On logistics: Where will the surgery take place, and is the facility accredited? Who administers the anaesthetic? How long will I need away from work? What activity restrictions apply, and for how long?

On aftercare: How many follow-up appointments are included? Who do I contact out of hours? What happens if I am unhappy with the result?

If any of these questions is met with impatience, that is information.

Informed consent is a process, not a signature

Consent is not a form you sign on the day. It is the outcome of a process in which you have been given adequate information about the procedure, its risks, its alternatives and its likely course, and have had sufficient time and freedom from pressure to consider it.

The referral requirement, the consultation structure, the psychological screening and the cooling-off period all exist to support that process. A practitioner who observes them carefully is doing what the regulatory framework requires. A practitioner who treats them as friction is not.

Speaking with Hamilton House

Dr Richard Hamilton, MB BS (Adelaide), FRACS, is a specialist plastic surgeon practising in Adelaide, South Australia. Procedures are performed at Hamilton House Day Surgery in Cumberland Park. You can read more about his background and qualifications, and about the approach taken at the practice.

If you would like to discuss whether a procedure may be appropriate for you, speak with your general practitioner about a referral in the first instance. You are welcome to contact the practice with any questions about the process, and further guidance on selecting a practitioner is available on our selecting a surgeon page.

Hamilton House performs cosmetic surgery for adults aged 18 years and over only.