Breast Augmentation Part 2: Implant Options and Placement Techniques

Breast Augmentation (Part 2): Implant Options and Placement Techniques

Written by Jamal Bullocks, M.D. on Jun 24, 2015 5:30:00 PM

In my previous post, I shared answers to some of the most important and frequently asked questions from patients about breast augmentation surgery. In this post, I’ll delve into questions related to the breast augmentation procedure itself. 

What Are My Options When it Comes to Implants?

breast_implants-stk212574rkeThere are two different types of implants: silicone and saline. Both are safe and approved by the U.S. Food and Drug Administration.  

Silicone implants tend to feel more like a natural breast and are essentially a silicone shell encasing a firm, silicone gel. Because the silicone gel is firm, there is low risk for the implants to leak if there’s damage to the shell. The biggest question I get concerning silicone implants has to do with safety because there was once a moratorium on them while the FDA evaluated whether they were safe. That study has been complete for years; the FDA determined they are safe and the moratorium has been lifted. In fact, silicone is the most popular choice for implants. 

Though silicone is the most popular, typically because it feels more natural, that does not mean that it is always the right choice for patients. Saline implants are also a safe and viable option if silicone won’t match your needs. Saline implants are essentially a bag of salt water in a silicone casing. They are typically the choice for patients who want a more firm, projected breast. 

How Are the Implants Put into Place?

There are four options when a surgeon performs breast augmentation surgery, two fairly common ones and two less so. Because each body is different, not every procedure will be a good match for every patient. Here are the options: 

  1. Via incision around the areola: This option is good for people who have larger areolas, or for people who need a combined lift and augmentation or a reduction in the size of their areolas. During this procedure, implants are put in place through an incision made around the colored portion of the nipple.
  2. Inframammary: This procedure takes place through the fold where the breast meets the chest wall. It is the most common because that particular area is a good place, particularly for women, to hide any potential scarring. It’s the most common procedure because it ties in well with the breast fold, and also because it decreases the potentiality of sensation changes around the areola. It may not be a good option for people who do not have a well-defined crease, however.
  3. Trans axillary: This option takes place via incision through the armpit. The purpose of this particular practice is to minimize scarring on the breasts; however, it can leave some scarring on the armpit. Trans axillary placement is less common, so if you’re going this route, it’s important to find a surgeon who is familiar with the procedure and has a lot of experience performing it. It also requires a certain body type to perform well. In terms of patient characteristics, candidates must have symmetric breasts without a lot of deflation or sagging.
  4. Trans Umbilical Breast Augmentation: Also called TUBA, this is the least common augmentation procedure. It is critically important you find a surgeon who is skilled with this type of surgery. For this procedure, implants are inserted through an incision in the belly button to eliminate scarring. Only saline implants may be used.  

Does the Implant Go Over or Under the Muscle?

The short answer is that it just depends on the patient.

In general, if a patient has less tissue to start with, it’s typically more beneficial to place the implant under the muscle for better coverage. A patient has less tissue, there isn’t a need for additional coverage and the implant can be placed over the muscle. Either way is fine, and your surgeon will help you decide what option will work best for you.  

Must I have my implants replaced every 10 years?

This is a common myth I hear. There is absolutely no set time frame on the maintenance of your breast augmentation. There is a potential maintenance cycle because it’s basically a foreign body. Your body will change and the implant will not, so you may decide to come in and have the contour of the breast reshaped. This is not an automatic 10-year maintenance cyle, however. Some of my patients never have it done and others have gone more than 20 years before deciding to come in. It is entirely up to the patient, what they want, and how their body changes with age.  

What questions do you have about breast augmentation surgery and implants? 

Bullocks_JamalDr. Jamal Bullocks is a board-certified Plastic Surgery specialist whose clinical interests include reconstructive breast surgery, cosmetic surgery for men and women and body contouring after weight loss. 

Topics: breast augmentation, saline breast implants, silicone breast implants, breast implants, surgical options for breast implants

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