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How Do I Choose My Breast Implants?
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How Do I Choose My Breast Implants?

Episode 2: How Do I Choose My Breast Implants?

Today, we're going to be discussing some key considerations in planning for breast augmentation. There are really four big decisions to make when you are thinking about this procedure.

What is the best breast implant for you?

The first one is what kind of implant do you want? And there are two major choices here. The first one is silicone and the second one is saline. Silicone has become really the very much more popular option at this point. It looks and feels more natural than the saline option. There are some people, however, who feel comfortable knowing that if their implant ruptures there is just saltwater there. On the other hand, the silicone implants have been shown to be incredibly safe. And the gel really does just stay put at this point, if there is some kind of implant rupture. In fact, the term silent rupture comes up because if the implant does break, you would very likely not even know it. And it's for this reason that it's recommended that periodic MRI screenings are carried out after a silicone breast implant is placed. So for people that prioritize natural look and feel above all else, silicone is really the way to go. And for folks that would rather have the peace of mind of knowing that if their implant does rupture they'll know right away, saline may be the right decision. There's also another unique kind of implant available called the ideal implant. And that seeks to marry the benefits of a silicone implant with the benefits of a saline implant. Specifically, the ideal implant is filled with saline, but it actually has concentric shells of silicone within it.

Should the breast implant be over the muscle or under the muscle?

So the next issue that you'll want to address is where is the implant going? And the answer obviously is in the breast, but more specifically, is it going to go above the muscle or under the muscle? And in this context, the muscle is the pectoralis major. That's the major muscle of the chest. The advantage to putting the implant under the muscle is primarily that it leads to a more natural looking feel. And that's simply because there's more stuff between the implant and the outside world, that way you have muscle and you have breast tissue and skin. Whereas alternatively, if you put the implant over the muscle, in what's called the subglandular plane, that means it's under the gland of the breast. The only thing between the implant and the outside world is really breast tissue and skin. The only real reason to put an implant in this position is in someone who is extremely muscular and athletic, on the order of a professional beach volleyball player, something of that order. You might have a more significant animation deformity, which means when that muscle fires, if there is an implant under it, the implant can be deformed by the contracting muscle. And that could look odd. So for someone who's extremely muscular, you might want to be putting the implant over the muscle, but otherwise the implant is going under the muscle in the vast majority of cases.

What size breast implant should you choose?

And the last consideration with breast augmentation is the size of implant that you're interested in having. And that is an extremely personal decision. And that takes into account your aesthetic ideals, as well as your body type and body shape. And something that we find very helpful in our practice is advanced 3D imaging, where we take a 3D scan of our patient, and then we simulate different implant sizes so that the patient can see themselves at different implant sizes and get a sense for what they might be most comfortable with. We'd also like to just address one of the terms that I mentioned earlier, which is capsular contracture, and that is a complication that is possible with breast augmentation, where essentially when you put any kind of an implant in the body, a scar forms around it to wall it off from the body. That's how the body knows that the implant or device is not part of itself, but it is remaining in place, in the body at that location. And that's normal. Every time you put a breast implant in, you're going to get a scar around it. And we refer to that scar as a capsule; however, what's not normal is that in a very small percentage of cases that capsule can contract or get smaller. And if you imagine that round or spherical scar getting smaller and contracting around a breast implant, which has a fixed volume, that can cause pain, it can cause a change in implant shape. Or it can actually cause a change in implant position as well. So that is something that you should be aware of as a possibility when getting a breast augmentation, although a very unlikely possibility, and it could mean that the implant has to be removed.

Conclusion

So summing up, breast augmentation remains one of the most popular procedures that is performed across the country and the world in aesthetic plastic surgery. And it's certainly one of the most popular procedures in our practice. And it's something that is extremely gratifying for the patient. And hopefully this overview will help you in your decision making process as you consider the kind of breast enhancement that you're looking for.

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  • Darren M. Smith MD
  • Darren M. Smith MD
  • Darren M. Smith MD

All photos are of models except before and after images.

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