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Breast Implants Surgery – Get the Bustline You Want

silicone and saline breast implants piled together

Each year, hundreds of thousands of women undergo breast implant surgery, a plastic surgery procedure designed to improve the appearance of the breasts. Also called breast augmentation surgery, most women undergo the procedure to enlarge breasts that are naturally small, though some have it to correct disproportionate breasts or repair breast deformities.

Breast implants are also sometimes used in breast lift surgery, in which saggy, drooping breasts are repositioned higher on the chest. Combining breast augmentation and breast lift allows the surgeon to add volume as well as create a perkier, more youthful bustline.

In addition, women undergoing breast reconstruction following a mastectomy or trauma to the chest may have implants placed in their chest as part of that procedure.

Silicone vs. Saline Breast Implants

If you are considering breast implant surgery, one of the first questions you will need to ask is, Which breast implant is right for me?

There are two main types of breast implants: saline and silicone. Each type has the same basic implant anatomy — a rubbery silicone shell with filling. The difference is in the filling. Saline implants are filled with a saline (salt and water) solution, while silicone implants are filled with silicone gel.

Each type of implant has advantages and disadvantages. For example, silicone implants are considered more natural to the touch, but saline implants cost less.

Potential side effects of the two implant types also differ. For example, if the shell of a saline implant ruptures, the resulting effect is obvious because the saline drains from the implant (and is harmlessly absorbed by the body). However, if a silicone implant ruptures, the resulting effect may not be evident right away.

In either case, surgery will be necessary to remove or replace the ruptured implant. More information about removal of breast implants is available here.

The Safety of Silicone Breast Implants

In the past, concerns emerged that silicone implants posed health risks, including an increased risk of systemic diseases such as lupus and arthritis. The Food and Drug Administration (FDA) placed a moratorium on silicone implants in 1992 so the safety of these devices could be studied. However, in 2006 the agency concluded that there was no evidence of risk and lifted the moratorium.

In fact, the FDA has now approved three new “gummy bear” silicone implants as well: Allergan’s Natrelle 410, Sientra’s line of form-stable implants and Mentor’s MemoryShape. These implants are filled with a highly cohesive, form-stable type of silicone gel that has the consistency of gummy bear candies (thus the nickname).

For a complete review of the history of silicone breast implants, see our page on implants and the FDA.

Your Breast Implant Surgery Consultation

The first step in the breast implant surgery process is a consultation with a board-certified plastic surgeon who has extensive experience performing various types of breast surgery. During this meeting, the surgeon will perform an examination of your breast tissue, discuss your goals for surgery and tell you what you need to know about breast implants. Based on his or her examination, the surgeon will determine whether you are a candidate for surgery.

Once the surgeon has deemed you a candidate for surgery, he or she will discuss all your implant choices, including whether to go with saline vs. silicone implants as well as the size, shape and texture of your implants.

Implants come in various sizes, and your surgeon will guide you on choosing the right size to help you achieve the look you desire. In addition, your surgeon will help you decide whether you want a more natural, teardrop shape or a more rounded look. Implants also come with either smooth our textured shell surfaces, and your surgeon will help you decide which is best for you.

During your consultation, your surgeon will also answer the question, What does breast augmentation cost?

Placement of Breast Implants

Another important decision to be made prior to surgery is where to place the implants in relation to your breast tissue and chest muscles. There are three basic breast implant placement options:

  • Subglandular, or above the pectoral muscles – In this placement, the implants are situated behind the breast tissue but in front of the chest muscles.
  • Partial submuscular, or partially behind the muscles – In this case, the implants are placed behind the breast tissue and partially behind the muscles.
  • Complete submuscular, or completely behind the muscles – With this placement, as the name makes clear, the implant is placed fully behind the muscles.

The best placement for you will depend on several factors, including your lifestyle, the amount of natural breast tissue you have, the size of your implants and your desired appearance. Only a board-certified plastic surgeon can help you make this decision.

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Image courtesy of Clinic Compare

Placement of Surgical Incisions

The location of your surgical incisions is also a key decision you must make in consultation with your surgeon. There are four options for your breast implant incisions:

  • Under the breast (inframammary incision) – The surgeon makes incisions in the folds where the breasts meet your body.
  • Around the nipple (periareolar incision) – The surgeon creates incisions along the edges of the areolas.
  • In the armpit (transaxillary incision) – The surgeon gains access to your chest through incisions that are well-concealed in your underarm area.
  • In the navel area (transumbilical, or TUBA, incision) – The surgeon makes an incision around your belly button and places the implant in your chest by means of a tunnel through your body cavity.

Your surgeon will help you choose the incision type that is best for you.

Male Breast Implant Surgery

While most breast implant surgery patients are women, men who desire a more masculine look sometimes undergo surgery to receive male breast implants. Unlike breast implants for women, which are relatively soft and rounded, male breast implants are smaller and harder, and are designed to enhance the size of the chest’s pectoral muscles.

For more information on breast implant surgery, contact a surgeon from our network of board-certified plastic surgeons.

What You Need to Know About Breast Implants

Reviewed by Walter Erhardt, MD

Breast implants can change the size, shape and profile of your breasts. This popular plastic surgery procedure may help soften the toll that advancing age, childbearing and breast-feeding have taken on your breasts. (Sagging breasts require a breast lift, which can be performed with or without implants.)

During breast augmentation with implants (augmentation mammoplasty), implants are inserted behind your breast and the chest (pectoralis) muscle just under your breast. Implants can range in volume from 120 mL (milliliters) to 850 mL. You can view some examples in our gallery of breast augmentation before-and-after photos.

In addition to differing in volume, implants vary in shape, profile, outer thickness and outer surface layer.

There are a few alternatives to breast augmentation with implants. Fat grafting breast augmentation involves harvesting fat via liposuction from another area of your body and injecting it into your breasts. Fat grafting is typically used to improve the appearance of your breasts after surgery to treat breast cancer, to correct a congenital breast deformity or to even out any imperfections occurring after breast augmentation with implants, such as wrinkles or ripples. The long-term effects of fat grafting to a normal breast are not fully understood, and the degree of augmentation possible via grafting is only modest at best. For these reasons, fat grafting for cosmetic breast augmentation is still considered experimental by many plastic surgeons.

Another alternative, breast auto augmentation, uses your own tissue to enhance your breast size and shape.

Silicone versus Saline Implants

Some women feel that silicone implants are smoother and feel more like natural breast tissue than saline-filled implants. Both types of implants have their share of advantages and disadvantages that you must weigh, together with your surgeon, when planning your breast augmentation surgery.

The good news is that both types of implants are considered safe. The Food and Drug Administration (FDA) removed silicone implants from the consumer market in 1992 as a precautionary measure after conflicting reports of possible complications surfaced. Some of these complications required breast implant removal. However, silicone gel-filled breast implants were fully exonerated and reapproved in 2006. (Read more about implants and the FDA.)

Breast implant options in the development pipeline include highly cohesive silicone gel implants — also called gummy bear implants — and adjustable saline implants that allow implant volume to be adjusted after surgery.

Breast Implant Placement

Breast implants augment the breast’s shape via:

  • Subglandular implant placement
  • Partial submuscular implant placement
  • Complete submuscular implant placement

These placements vary from shallow (subglandular) to deep (complete submuscular). The right placement for your breast implants is based on your anatomy as well as your goals and expectations. You should express your desires to your surgeon, but make sure to take his or her expert opinion into account. Improper implant placement can create complications such as breast augmentation double bubble, wrinkles and rippling.

Your choice of breast implant placement can also affect your breast augmentation recovery time.

Breast Implant Incisions

Implants are inserted behind the breast tissue or the chest muscle through carefully placed incisions. The four main types of incisions used for breast augmentation surgery are:

  • Periareolar (around the nipple) incision
  • Transaxillary (in the armpit) incision
  • Inframammary fold (under the breast) incision
  • Transumbilical (in the belly button), or “TUBA,” incision

Discuss these options with a board-certified plastic surgeon. He or she can help you make these important decisions regarding your breast implant surgery.

Start your search for the right surgeon now.