Breast Augmentation Options

Implant Type: There are two main groups of implants approved by the FDA for breast augmentation. These are saline filled implants and silicone gel filled implants. In a nutshell, the main advantage of silicone gel filled implants is that they have a consistency that is closer to that of breast tissue, and as such will feel more natural than saline filled implants. Particularly in very slim patients with very little tissue to cover the implants, they will often look more natural as well. In general silicone implants will ripple less than saline implants, another consideration that can be particularly important in slim individuals who have very small natural breasts to cover the implant. The disadvantages of silicone implants are that they are more expensive than saline, the incision required to insert them is slightly longer, and minor adjustments in implant fill are not possible with silicone implants as can be done with saline. At the present time, there is no evidence that silicone gel implants cause strange diseases in humans as was previously speculated, though the problems with silicone implants are similar to saline implants when it comes to issues like capsular contracture or hardening. It is important to appreciate that no implant should be considered a permanent device, and whether saline or silicone are chosen, it will be necessary to replace the implants due to implant failure, or pending implant failure in the future. An average time period that I quote my patients is 12-15 years. In summary silicone gel implants will generally provide the most natural look and feel to the breasts, but saline implants will also work very well for most people. In general, the thinner the individual and the smaller their own breasts, the more strongly I will recommend silicone gel implants.

Size, Shape and Surface Texture of the Implant: Probably the most difficult decision patients have to make when choosing breast augmentation is how big they want to be. There is truly no right and wrong answer when it comes to making this decision, but the decision should be made according to how big you would like to be, and taking into your natural chest and breast size and the thickness and quality of the tissues covering the implants. In general one should of course choose the size that makes one look and feel the way one chooses, but this must be balanced by the disadvantages of going too large which include sagging and stretching of the skin and problems with excessive weight of the breasts.

There are round and anatomically shaped (teardrop) implants, the most commonly used implants in the US is still the smooth round implants, and for the most part will provide excellent results. Texturing of implants is considered by some to decrease the risk of hardening (capsular contracture) but the evidence for this particularly with saline implants is inconclusive. Shaped implants will always be textured, as this is necessary to minimize the chances of the implant rotating after placement. Placement of shaped, textured implants can be more tricky and demanding, and for this reason, many plastic surgeons still prefer smooth round implants both for saline and silicone implants. Newer shaped implants which have a thicker consistancy gel (gummy bear) are available in Europe and are expected to be released in the US in the not too distant future. These implants may have advantages with regard to longevity of the implant and may become more popular.

Incision choices: There are four possible incisions for breast augmentation, under the breast (inframammary), through the lower part of the areola (areolar), through the armpit (transaxillary) and through the belly button (TUBA).

The most common incision used is the inframammary as this is still the simplest incision, and probably still the best incision for silicone implants which require a longer incision and in individuals who have very assymetrical breasts or other problems with the shape of the breasts. In my opinion, the choice of incision is the least important decision, and should one should never compromise getting the best possible shape by choosing an incision that may make this more difficult. The TUBA incision can only be used with saline implants.

Under or over the muscle placement: There are in fact three possible positions for placement of a breast implant, under the pectoral muscle of the chest (submuscular), over the muscle (subglandular) and partially under the muscle (dual plane). In general, in slimmer patients I prefer to place the implant in the submuscular position for  better tissue coverage of the implant thus having fewer problems with being able to see or feel the implant. This is particularly the case with saline implants. In individuals with thicker tissues, subglandular placement may be an acceptable option. Advantages of subglandular placement are the ability to place the implants a little closer together, and in some individuals with very thick tissues who are very broad, they may look more natural.

There is also much discussion about the fact that the incidence of hardening (capsular contracture) is higher over the muscle. Under the muscle will occasionally have problems with movement of the implant when the muscle contracts. This can be a consideration in athletes such as body builders who may choose to go over the muscle with silicone implants for this reason. In slimmer individuals where the breasts sag and it would be desirable to have some muscle coverage, one may choose dual plane, or partially under the muscle. In individuals where there is a little sagging of the breast, completely under the muscle will place the implant too high with an unnatural 'double bubble' appearance. If the breast sags excessively, usually if the nipple is below the breast fold, then a breast lift may be required as well.

I have tried to summarize the most important considerations to be discussed with your surgeon, when planning breast augmentation. Obviously there will be differences of opinion when it comes to the options available to you and the choices you should make. the important thing is that you are knowledgeable about your options, and that you have some understanding of the pros and cons of the decisions you may make.

If you have questions, or would like more information, please feel free to contact us through our Bougainvillea Clinique website at lookandfeelbetter.com