There are 3 main questions to consider when thinking about breast implants: 1.) breast implant type and size, 2.) location of incision, and 3.) where the breast implant is placed. Making these decisions requires some degree of experience with breast implants. That is why the final decisions should only be made in consultation with your plastic surgeon. However, it is important for you to do your research and go into this process armed with some knowledge. These choices are also affected by your body type (wide or narrow), amount of breast tissue present and where it is (upper or lower pole), degree of lifting needed, activity level and your desired outcome.
Breast implants have come a long way over the years. Back then, the only real choice was size. Click here for our discussion about choosing breast implant size. Now one can also choose saline vs silicone, round vs tear drop, smooth vs textured, and different profiles. These are a dizzying amount of options even for experienced surgeons! The first choice involves saline vs silicone breast implants. Both have an outer shell made of silicone. Saline implants are filled with sterile saline during surgery and are somewhat adjustable. As a result, they need smaller incisions, can be placed through the belly button and rupture of the implant only leaks saline. They also cost 1/2 as less as silicone implants and can be placed as young as age 18. However, they feel less natural and tend to have rippling on their sides. Silicone implants are more natural feeling and don’t tend to have the rippling. They cost 2x as much as saline, require slightly larger incisions and cannot be placed until age 22. All silicone implants now contain a cohesive gel that is less likely to run out if the outer capsule is ruptured.
Most breast implants placed are round in shape. The last few years brought the introduction of tear drop shaped implants. These are also known as ‘gummy bear’ or ‘form stable’ implants. These gummy bear implants have a highly cohesive gel which means if you cut them in half, they will not leak. As a result, they are also the firmest implants. Round implants are the most popular and commonly placed. They tend to provide more overall breast fullness and cleavage. They are great for women who already have good-sized breast tissue, especially in the lower pole. However they also tend to produce an artificial, implanted look. The tear drop implants were designed to produce a more natural looking result. They have more volume in the lower pole and produce a natural breast silhouette with a gentle slope. Since they are shaped, they require a larger incision and special placement in the breast. Unlike round implants that move freely, tear drop implant movement may require further procedures. Round implants also allow flow of the silicone with movement. So when standing, the lower pole fills more looking like a natural breast. When laying down, round implants will flatten out. Tear drop or gummy bear implants do not flow and may look unnatural when laying flat. Tear drop implants are more expensive than round implants. Tear drop implants may be better for thinner women with less breast tissue who want a more natural look.
Round breast implants (saline and silicone) and now tear drop, also offer choices in profile. The profiles involve the relationship of the projection of the implant compared the width of the base. So high-profile breast implants project furthest from the chest wall and have the narrowest base. High profiles are great for a narrow chest and tend to have less rippling. Low profile implants are best for wider chests and produce more ‘side boob’. Moderate profile implants are the standard size placed. Profile choice depends greatly on chest size and the amount of upper pole fullness desired (more with higher profile).
Most implants placed have a smooth outer surface. This allows them to freely move in the breast pocket. Textured outer surface breast implants were developed to stop this movement in hopes of decreasing the risk of the complication of capsular contraction. This where the breast pocket surrounding the implant becomes tight and hard. However it is controversial if textured implants really decrease this risk. Tear drop or gummy bear implants only come textured as movement of the implants is not wanted. Textured implants also tend to be firmer and have a higher chance of rippling.
Placement of the breast augmentation incision is as important as choosing the breast implant type and size. The choice of incision depends on the type of implant being placed, concern for scars, Plastic Surgeon preference and need for future breastfeeding and if any other breast procedures are being performed. The most common incision used is the inframammary which is placed where the breast meets the rib cage. It is very easy for the surgeon to reach the breast pocket and can be smaller. However it can leave the most visible scar. Periareolar (around the nipple) is also a very common incision. It gives good access and the scar can be hidden the in the border of the areolar. It is also necessary if a breast lift is also planned. It should be avoided if breastfeeding is planned in the future. Transaxillary involves in an incision in the armpit and allows great access for under the muscle implants. The scar tends to be hidden in the armpit. Transumbilical or TUBA involves placing the implants through the belly button. Only saline implants can be used and no scars are visible.
The main choices are under the muscle or subpectoral and over the muscle or subglandular. Under the muscle allows for more coverage of the implant with a more natural look and feel, less rippling and chance of capsular contraction. It is best for thin, active women who have little breast tissue and no sagging and who want a more natural look. However subpectoral placement pushes the implant higher and wider, can be visible with use of chest muscles and has a longer and more painful recovery. Over the muscle placement is good for women with large amounts of breast tissue that is somewhat deflated and who want an easier recovery. It also ideal for women that have some sagging but do not want a breast lift. Submuscular implants also do not interfere with mammograms while subglandular may make reading future mammograms more difficult.
There is also dual plane technique which is a form of subpectoral placement. This involves placing the top of the implant under the muscle and allowing the lower part of the implant to be subglandular. This allows for the advantages of a natural looking upper pole while allowing better filling of the lower pole of the breast. It is best for contracted or tubular breasts and slightly droopy breasts.
Find out more about Breast Augmentation with Breast Implants here.