Breast augmentation is the most popular cosmetic procedures in the U.S. Perhaps one reason for the popularity of this procedure is that women have so many options for breast implant surgery today. Not only do they have several different types of implants to choose from, but also choices of size, shape, incision location, and placement.
Women today have a choice when considering breast implant surgery. The options that result in the best outcome for you will depend on a number of factors, including your anatomy, existing breast tissue, and your personal aesthetic preferences. Dr. Smith will work closely with you to individually-tailor a breast implant surgical plan that best suits your needs.
Choosing the right size, shape, projection, and type of implant has everything to do with your satisfaction with the results of breast augmentation. With the Crisalix 3D imaging system, you have the opportunity to clearly see the differences in appearance in the array of implant sizes and shapes now available. Try on your look before making a decision so your breast enhancement, when completed, is as you imagined and simply, perfect.
The two main types of breast implants are:
Saline: These are round silicone shells that are filled with saline solution after they areplaced in the breast, allowing for smaller incisions. Saline solution is easily absorbed by
the body in case of rupture. Saline implants are less costly than other types of implants. The disadvantage is that they feel firmer and less natural than other implant types.
Silicone: This type of implant is a silicone shell filled with silicone gel. It is a popular option because of the natural look and feel. Leaks are more difficult to detect and treat
than with saline implants and periodic MRI testing is recommended by the FDA to ensure the implant has not ruptured. “Gummy bear” implants, also known as form stable silicone implants, are a specific type of silicone implant. Gummy bear implants consist of a silicone shell filled with silicone gel of a consistency similar to gummy bear candy. These implants are available in round and teardrop shapes and are firmer than regular silicone implants.
One brand of implant, the “Ideal Implant,” does not exactly fit into either of the above categories. The Ideal Implant has a smooth silicone shell and is filled with saline, like the saline implant
described above. However, the Ideal Implant is considered a “structured” saline implant because it has internal silicone sheets (or “baffles”) that prevent the saline from sloshing around in the implant. This results in a more natural look and feel than traditional saline implants and a reduced chance of rippling or scalloping.
The two common placement options for breast implants are:
Subglandular (under the breast tissue and over the chest muscle): This placement may reduce time spent in surgery and recovery time and make your implants easier to access in the event of any future surgery. However, the implants may be easier to see and feel through the skin with subglandular placement.
Submuscular (under or partially under the chest muscle): Recovery may be longer with submuscular placement. However, it has a more natural look and feel, reduces the risk of
visible rippling or wrinkling, makes mammograms easier, and may reduce the risk of capsular
Implants are available in two main forms:
Round: Round implants are circular when viewed from the front and are symmetrical when viewed from the side. This results in an equal amount of projection in the upper and lower pole of the breast when the implant is placed. Round implants are the most popular shape of breast implant used in aesthetic breast augmentation surgery.
Anatomic (Shaped): Anatomic breast implants are roughly shaped like a tear drop when viewed from the side. They are called “anatomic” because they approximate the shape of a breast in profile. Anatomic breast implants are designed to provide more projection to the lower pole of the breast than the upper pole. While they are sometimes useful in aesthetic breast surgery, they are more frequently used in breast reconstruction.
Implant profile refers to how far an implant will project from the chest wall (the distance from the front to the back of the implant when the implant is viewed from the side). While different breast implant manufacturers use slightly different terms to describe the different implant profiles that are available, a general guide is:
There are two kinds of implant shell:
Smooth (a smooth surface): Smooth implants are exactly what they sound like, smooth. They feel almost slick to the touch. These implants are very popular for use in aesthetic breast surgery, and are available in a variety of fills and shapes.
Textured (a rough surface): Textured implants are designed to have a three-dimensional pattern on their surface. Also available in a variety of shapes and fills, textured implants
are thought to have a reduced risk of capsular contracture as compared to smooth implants. However, by placing smooth implants under the pectoralis major muscle, the difference in capsular contracture rate between textured and smooth implants becomes minimal.
A small incision is required to place a breast implant. Any incision will leave a scar. These scars are, however, well-hidden and go on to fade a great deal over time and are generally very hard to see. There are three popular locations for placement of the breast implant incision:
In the breast fold: The most popular location for placement of the breast implant incision is in the breast fold (the “inframammary fold” or “IMF”). By placing the scar in this location, it is very well hidden and covered by the breast.
At the border of the areola: An incision can be placed between the pigmented skin of the areola and the “regular” breast skin. The incision generally runs along the bottom half to two-thirds of the areolar border. This is called a “periareolar” incision, and in the right candidate can create a scar that is extremely well camouflaged.
In the underarm area: By placing the incision in the underarm area, or axilla, no incision isplaced on the breast at all. This is called a “transaxillary breast augmentation.”
Textured implants have a rough surface designed to “stick” to breast tissue. This design is intended to keep the implant in position. There is also a reduction of capsular contracture risk with textured implants. Smooth implants do not have this rough surface. We are now able to reduce the risk of capsular contracture with smooth implants to almost the same degree as with textured implants by placing the implant under the pectoralis muscle. Textured implants have been associated with a very rare form of cancer (ALCL – anaplastic large cell lymphoma) which has never been reported in association with smooth implants. Given this association between textured implants and ALCL, even though it is a low risk association, Dr. Smith uses only smooth implants except in very specific scenarios.
The inframammary (in the breast fold) approach offers direct access and excellent control of the breast implant pocket. The resulting scar is very well hidden. The transaxillary (underarm) approach offers the advantage of having no scar on the breast itself. However, the risk of infection and capsular contracture is slightly elevated with this method. The periareolar approach also carries an increased risk of capsular contracture and infection. In some candidates, however, the scar can be very well hidden in this location.
This is a very personal decision. Silicone breast implants look and feel the most natural. However, some women feel more comfortable having salt water (saline) rather than silicone gel in their bodies. The Ideal Implant offers a compromise between these two options. Additionally, saline implants and the Ideal Implant can be inserted through a slightly smaller incision than silicone implants, for which the incision is already quite small.
This depends on your body shape and the look you are trying to achieve. Low profile implants tend to look less “done” than high profile implants, however in someone with a narrow breast, high profile implants may be a good option since they allow for more volume to be placed in a narrower implant that will fit the breast. The majority of implants Dr. Smith uses are in the moderate profile range.
The advantage of placing implants under the muscle is that there is more tissue between the breast implant and the outside world with this approach. This leads to a more natural look and feel. Additionally, submuscular (under the muscle) implant placement is associated with a lower risk of capsular contracture. In some patients who are professional athletes or otherwise have very developed pectoralis muscles, it can be advantageous to place the implant over the muscle. This is because in these individuals, flexing the very strong pectoralis muscle can cause the implant to change shape (this is called “animation deformity”). It is very unusual outside of body builders and others with similar physique for it to be worthwhile to place the implant over the muscle.
Round implants provide a pleasing, feminine shape in breast augmentation. These are the implants used in the majority of patients in Dr. Smith’s practice. However, some patients require more volume in the lower pole than the upper pole of their breasts. These individuals would likely see a better result with an anatomic, or shaped, implant.