Breast Augmentation Basics

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What is a breast augmentation?

In this post, we discuss breast augmentation with saline or silicone implants. – the most popular type of augmentation. Implants allow a predictable breast enhancement in all body types. Breast augmentation is often performed to replace volume lost from weight loss, breastfeeding, or age or to increase the size of the breast for aesthetic reasons.  It is most appropriate for patients with breasts that don’t sag (normal ptosis). In patients with breasts that sag, the need for a lift is determined by your current nipple position and the quality of your tissue.

A breast augmentation can also be performed using fat harvested from other parts of the body using liposuction – Brazilian breast augmentation. The results from a fat augmentation are less predictable, however, and work best for slightly overweight patients looking for a modest augmentation.

If using your own fat to augment your breasts sounds intriguing, check out: Breast Augmentation With Fat.

What types of implants are used in a breast augmentation?

There are two main types of implants – saline and silicone. Both are made with silicone, however, the fill of the implants is different.

Saline implants are filled with saline in the OR. They are less commonly used because the feel of the implants is not as natural as a silicone implant and we have less control with a saline implant over the shape of the breast.

Silicone implants are filled with silicone at the factory and come in several types based on the “thickness” of the gel within the implant. These include 1) a “Classic” style where the upper part of the implant empties out when staining – leaving the upper part of the breast empty, 2) an “Xtra” style where the fill is thicker and gives more perkiness or rounding to the upper part of the breast, and 3) a “Boost” style where the gel is really thick and help produce a very perky, round breast shape (depending on the breast we are starting with). The choice of silicone type is based on the goals of the patient in regards to the upper breast shape.

Where are the implants placed during a breast augmentation?

The implants can be placed over (sub-muscular) or under (sub-glandular) the pectoralis muscle. Advantages to sub-muscular implants include a lower risk of capsular contracture, lower chance of rippling, better coverage in thin women, and perhaps a more natural upper pole contour. Implants placed under the muscle can, however, be influenced by the contraction of the pectoralis muscle – especially in very athletic women.

Implants placed over the muscle, in contrast, are more visible. This results in larger-looking augmentation and a sharper transition between the natural breast and the edges of the implant resulting in a more done look. Additionally, in thin women, the folding of the implant in the sub-glandular pocket can manifest as rippling of the skin.

What kind of incisions can I expect?

There are a variety of implant types, shapes, and styles, and the implants are most often inserted through one of two different small incisions. These include 1) an incision around the lower half of the nipple-areola (peri-areolar), or 2) an incision in the breast crease between the breast and the chest wall (infra-mammary incision). The choice of incision is based on multiple factors including surgeon preference, patient preference, patient anatomy, and/or type of implant.

What is the recovery like after a breast augmentation?

After surgery, the breasts swell from the trauma of surgery and the tissues become edematous. This combined with the tightness of the skin and the squeeze of the pectorals muscle on the implant can give the implants a high and flat appearance as the round implants are squeezed like a pancake against the chest.

As the swelling subsides and the tissues begin to stretch from the weight of implants, the breasts begin to settle. Over the next few months, the implants settle and the soft tissue and pectoralis muscle relax. The shape changes from high and tight to lower and fuller as the implants round out and more of the implant is in position to provide lower pole projection.

This “drop and fluff” often occurs over the first few months after surgery as the edema finally escapes and the soft tissues relax. This process is often asymmetric as the breasts relax and settle at their own rates. It will take 3 to 6 months to see a final result – although for some patients this process occurs faster.

Get more details on the management of swelling and scars in blog post: Post-Operative Care After Plastic Surgery.

What surgery is right for me?

A detailed examination will help delineate the best surgical treatment. The goal of breast augmentation is to create an aesthetic breast with the size, shape, and projection that is desired by the patient. The decision on the type of surgery and the size, shape, and position of the implants is based on the patient’s anatomy, the type and size of the implant, and the patient’s preferences.

During your consultation, measurements of the breasts are used as a starting point to recommend surgery and in-office sizing, and digital three-dimensional computer simulations are used to help guide your implant choices.