Incision Location:  Surgical incisions for breast augmentation are placed in one of two locations.

Inframammary – The inframammary incision is placed underneath the breast, in the crease where the breast meets the chest wall.  This well-hidden incision is the most commonly used for breast augmentation surgery, with patients able to wear bras and bikini tops without having their incision seen.

Periareolar – The periareolar incision is placed at the junction of the paler breast skin, and the darker skin of the areola.  Also well-hidden, it is the second most commonly used incision location for breast augmentation surgery. In order to be used, there must be a minimum diameter to the areola.  Women with small areolas are not candidates for this surgical incision.

Breast Implant Types:  All breast implants have an outer shell made of silicone, and are differentiated based on their internal composition.

Saline Implants – Saline implants are filled with a sterile salt-water solution. Because saline implants are filled after being placed within the body, incisions are typically smaller than for silicone implants.  Depending on the amount of native breast tissue, saline implants tend to feel firm underneath the skin, and have a greater tendency to create ripples on the skin surface.  Should a saline implant fail, the body absorbs the salt water, and the affected breast quickly shrinks.  Saline implants are approved for use in women 18 years of age, and older.

Silicone Implants – Silicone implants are filled with a thick silicone gel.   Silicone implants look, and feel, more natural than saline implants, and are lighter in weight, but because they come pre-filled, incisions are longer than for saline implants. If a silicone implant fails, the gel stays within the original breast pocket, this can make identifying a leak more difficult.  There has been no association between silicone implants and autoimmune diseases, breast cancer, or connective tissue diseases.  Silicone implants are currently approved for use in women 22 years of age, and older.

Breast Implant Sizes:  One size implant does not fit all patients, as numerous considerations guide the size of implants that will work best.

Breast Width – In order to achieve a natural looking result, the width of an implant must closely match the width of the patient’s current breast.  This will allow the implant to sit centered behind a patient’s nipple.  Though all patients will have a range of implant sizes that comfortably accommodate their chest, breast width will help narrow the decision on choosing the best implant.

Implant Volume – Implant volume best relates to the desired increase in breast size. You will have the opportunity to see how different volumes can affect your breast’s appearance.

Implant Projection – Implant projection describes how an implant’s volume can be spread to create different breast profiles. For the same size volume implant, a low profile implant will be wider and flatter, compared to a high profile implant, which will be more narrow but project out further.

Breast Implant Placement:  Implants are placed in one of two positions within the breast.

Subglandular – Implants placed above the muscle, and below the native breast tissue, are in the subglandular plane.  This is a good location for implant placement in women who are starting with a significant amount of breast tissue, and need volume to replace that which was lost with time.

Subpectoral – Implants placed below the muscle are in the subpectoral plane.  This plane has the advantage of reducing implant sagging and rippling, and in women with little breast tissue, this plane lends a more natural appearance.

Breast augmentation surgery begins with an inframammary or periareolar incision.  Identification of the breast tissue and chest wall muscles is performed, before creating a pocket the size of the chosen implant.  The implant is carefully placed into the pocket, and the incision closed in several layers using absorbable sutures.  Sterile gauze is then applied to the incisions, and the chest is wrapped for comfort.

Patients will have the feeling of tightness across their chest for the first few days after surgery, and may require prescription medication to help alleviate pain.  The dressing is removed on their follow-up appointment, and patients are placed into a non-underwire bra.  Patients are advised not to sleep on their side, or on their stomach, to avoid moving the implant into an incorrect position.  Strenuous exercise is avoided for at least 4 weeks after surgery.

We believe in being preemptive to avoid any risks associated with surgery, but occasionally the following may occur:

Bleeding/Hematoma – A small amount of bleeding is common after surgery, but if severe enough, another operation may be required to stop it.  Bleeding can also form a collection, termed a hematoma, which presents as a swollen, painful, and enlarged breast.  These require drainage to prevent secondary problems.

Seroma – A fluid collection may form near, or around, an implant, and require drainage.

Infection – A breast augmentation carries a small risk of infection, but if one occurs, it may require oral, or intravenous, antibiotics.  In the rarest of cases, removal of the implant needs to be performed.

Poor Cosmesis: This includes asymmetries between the right and left breasts, and poor incision healing.

Capsular Contracture:  A circumferential scar is formed around every implant.  Infrequently, this scar can affect the appearance and placement of an implant, or cause a painful tightness.  When severe enough, surgery is required to remove the scar, but the chance of a recurrence remains.

Implant Rupture:  There is a small risk that an implant ruptures.  With a saline implant, deflation is readily apparent, while a silicone implant rupture is more difficult to diagnose as the silicone remains within the breast pocket.  As a result, the FDA recommends an MRI for silicone implants three years after surgery, and every two years thereafter to detect a silicone rupture.  As these MRI’s are not typically covered by insurance, and the risk of rupture is low, most MRI’s are deferred by patients.  Should a rupture occur, nearly all implant companies provide warranties to cover the costs of new implants.  All the implants we use are covered by manufacturer warranties.

Rippling/Waves:  In women starting with little breast tissue, implants may cause skin rippling.  This occurs more often with saline implants, and may require additional surgery to correct.

Implant Malposition: An implant may be displaced in any direction, most commonly down and out from the body.  Correction requires additional surgery.

Nipple Sensation: A change in nipple sensation, either increased or decreased, is not uncommon following surgery.  Usually temporary, sensation typically returns to normal within a few weeks.  In rare instances, this altered sensation may be permanent.

Bra Size – Bra and cup sizes are useful for initial discussions on breast implant sizing, but because of the variety of bra manufacturers, each of which use their own sizing, there is no guarantee on a particular bra, or cup, size after surgery.

Animation Deformity – When an implant is placed in a subpectoral plane, and the chest muscles are contracted, the implant will have the tendency to move in a down and out direction.  This does not cause any damage to the implant, and the implant will return to its normal position when the muscles are relaxed.

Implant Duration:  With changes in their construction, today’s implants are lasting longer than their anticipated 10-year lifespan.  However, implants are not designed to last a lifetime, and additional surgery may be required to replace one, or both, implants if a problem arises.

Mammograms:  In order to view as much of the breast tissue as possible, additional views during yearly mammograms will be required.

Long Term Changes: Much like non-augmented breasts, pregnancy, weight loss, gravity, and menopause will affect the appearance of your breasts and implants.  These changes may require surgery to restore a more youthful contour.

Should I choose silicone or saline breast implants?

The decision on which implant type to select is based on patient preference.  Both types of implants are comprised of a silicone shell, but filled with different material: saline implants contain a salt-water solution, while silicone implants contain a silicone gel.  Silicone implants tend to look, and feel, more natural in the body, and are lighter in weight than their saline counterparts; however, they do require a longer incision, and are for patients at least 22 years of age.

Are silicone implants safe?

Yes.  After a moratorium on the use of silicone implants in cosmetic procedures in the 1990’s, the FDA lifted the ban on silicone implants in 2006, stating they were “safe and effective.” There have never been any confirmed links between silicone implants and an increased risk of health problems.  Today, silicone implants are used three times more frequently than saline implants.

How often will I need to replace my implants?

Due to changes in the construction of today’s implants, patients can maintain their implants indefinitely, as long as there are not any visible reasons to have them exchanged.  Historically, patients were told that their implants should be exchanged every 10 years, the then expected lifespan of an implant, but the current practice is to have implants exchanged only when problems arise.

Will I lose nipple sensation, or the ability to breastfeed, after surgery?

Temporary changes to nipple sensation after breast augmentation surgery is common. Some women have increased sensitivity, while others have decreased sensitivity.  These changes typically resolve within a few weeks.  A breast augmentation does not prevent a woman from being able to breastfeed her child.

Do I still need mammograms after surgery?

Yes, you should continue to have mammograms after a breast augmentation.  Be sure to inform your mammogram center that you have implants, as additional views are needed in order to see as much of your breast tissue as possible.