Breast Augmentation FAQ
Most women conduct extensive research on breast implant surgery before consulting a plastic surgeon. There are countless websites offering advice, and many people have friends who have undergone the procedure and have an opinion on how it should be done. All of this information can be overwhelming and sometimes difficult to understand. I have put together some of the most frequently asked questions about breast implant surgery to help you navigate the process. I hope you find this information useful.
Elizabeth A. Kinsley, MD
What Are the Risks of Breast Augmentation Surgery?
The risks associated with breast implant surgery are the same as with any surgery. Bleeding and infection can occur but are quite rare. Every precaution possible will be taken to help avoid these issues. Anesthesia also carries some risks, but in a healthy woman, these are negligible.
The main risk that is particular to breast implant surgery is capsular contracture. The body will form a capsule around any foreign object, so capsular formation is a normal process. At times, for reasons that are mostly unknown, this capsule may thicken and distort the implant. At worst, it can result in the implant being misshapen or malpositioned. Fortunately, this occurs in a very small number (1-2%) of patients. Medication may improve or resolve the tightening caused by contracture. Sometimes, surgery is required to release the tightened capsule.
The implant can also become malpositioned over time, even without a contracture. This is often seen with submuscular placement, in which the implants are pushed downward and protruding sideways over time.
One of the best ways to avoid complications is by using meticulous surgical technique and hygiene. A bloodless field is essential, and the implant is never touched. The implant is taken from the sterile container and placed into a funnel (like a pastry bag) and the pocket without being touched.
Bottom line: Capsular contracture can occur at any time, but it can be treated.
Should Breast Implants Be Placed Above or Under the Muscle?
Before saline implants were introduced, most breast implants were placed above the pectoral muscles (subglandular). However, when saline implants were placed in the pocket behind the breasts, it frequently resulted in visible rippling, which was not acceptable. To camouflage these ripples, surgeons began using submuscular (under the muscle) placement for saline implants.
For silicone implants, we now have a wide range of options for their size, shape, and profile. The fill volume of an implant, or how much looseness the implant has, affects its appearance once placed, especially when it’s above the muscle. Many silicone implants with subglandular placement have excellent results. Two major benefits of this method are shortened recovery time and a decreased rate of revision.
Silicone implants are only placed below the chest muscles when the patient is very thin or has inadequate breast tissue coverage for subglandular placement. The downside to submuscular augmentation is the risk of muscle animation (having the breasts move when the pectoral muscle is flexed) and downward displacement of the implant over time. The recovery time is slightly longer for submuscular implants but typically only lasts about one to two weeks.
I have performed thousands of augmentations using both submuscular and subglandular placement, and the best advice I can give you is to discuss this with your surgeon.
Bottom line: Either submuscular or subglandular works. Speak with your doctor to decide which one is right for you!
Should I Choose Silicone or Saline Implants?
As a surgeon, I generally prefer silicone implants. This is not to say that I do not occasionally use saline implants; I just think that the look, feel, and durability of silicone can’t be matched by saline.
It is not uncommon to see a saline implant spontaneously “fail” after several years. When this happens, the breast just goes flat, and the body absorbs the saline without any risk. Unfortunately, this usually occurs at a bad time, like the week before a vacation, and the patient has to have the implant(s) replaced.
The silicone implants available today are considerably different from older silicone implants. The outer shells are very durable and difficult to damage. As a test, I gave some to my two young sons and let them play dodgeball, basketball, frisbee, you name it, to see what would happen. The implants did fine through all of this, and I was pleasantly surprised by how durable they were. One of the dogs did finally catch an implant, and the home testing ended, but it was impressive to see what kind of abuse the implants could handle. By the way, saline implants wouldn’t last a day in my house.
Silicone implants also come in an incredible variety of shapes, dimensions, and profiles that can be tailored to almost any breast shape or body type.
BOTTOM LINE: I prefer silicone but use saline if that is what the patient desires.
What Is the Best Shape and Texture for Breast Implants?
Before the introduction of the modern silicone implant, most implants were round. Anatomical teardrop-shaped implants have become increasingly popular and are available in an incredible assortment of sizes and shapes to match any woman’s body type.
Basically, we speak of implants in terms of the cc’s, or volume, they hold. Round implants have the same height and width but vary in profile. The profile is the measure of the implant from front to back, or how much it sticks out from your chest. Commonly used terms to describe an implant’s profile are moderate, moderate plus, high, and ultra high. Choosing which implant to use can take longer than the surgery itself, but this is the most important step of the process.
Patients also now have the option of choosing shaped silicone implants. They come in almost every conceivable combination of height, width, and projection to provide women with “custom” implants. They contain a viscous, form-stable gel that helps the implants look and feel like authentic breast tissue while keeping their shape. These implants can provide amazing results, but they come at an increased cost. For women who have thin tissue, mild sagging, or want the most natural look, this is often money well spent.
As you would expect, textured implants have a rough surface, and smooth implants have a smooth surface. Textured implants have a decreased incidence of contracture, especially when placed in front of the muscle.
Bottom line: There are a lot of choices. Don’t stress! It is my job to figure out which one will work best for you!
Where Does the Surgeon Make the Incision for Breast Augmentation?
Implants can be placed into the body through an incision in the breast crease (inframammary), nipple area (periareolar), or armpit (transaxillary). All of these incision options are fine and heal well. However, if additional surgery is needed down the line, it is very difficult to work through an armpit or nipple incision. For this reason, I generally use the inframammary incision.
Bottom line: The inframammary incision is preferable.
How Do You Choose the Size of the Breast Implant?
For many women, this can be the most challenging part of the process. The first thing to realize is that implants don’t come in cup sizes, so you can’t just order up a B or C cup. Plus, cup sizes for bras are all over the place. You might be a 34C in one bra and a 36B in another. Even with the same manufacturer, you may wear different cup sizes. It is impossible for me to say what your cup size will be after surgery.
After almost 20 years of surgical experience (and shopping for my own bras), I have a good idea of what women mean when they mention a B, C, or D cup. The important thing to remember is that you are adding the implant to what you already have. If your friend got implants that are a certain size and you love how they look, getting implants that are the same size as hers may not give you the same result if your breasts are a different size or shape.
During the consultation, I ask my patients what their ideal cup size would be and work from there. Considering skin laxity, chest width, body shape, asymmetry, and other factors, the patient and I will make a size selection together. I think the best approach is letting the patient try on implants by using state-of-the-art 3D imaging to gain a thorough understanding of what she wants from her new implants.
The old recommendation of “going up a size” can be tossed out the window. Today’s implants are highly sophisticated, even more so than those from just a few years ago. I tend to spend some extra time in the consultation to get it right the first time. I don’t believe that bigger is always better; I believe that right is always better.
Bottom line: This is the hard part. Please understand that there may not be a “perfect” solution and that several implants can give you a very pleasing result.
If you’re interested in breast augmentation, contact Dr. Kinsley today or call (985) 893-3737 to schedule a consultation. She strives to get to know you well during this session so that she can help you choose the ideal implants for your aesthetic goals. You can explore our online gallery and patient testimonials to learn more about the results you can expect with Elizabeth A. Kinsley, MD.