Breast implants are available to suit the needs and preferences of just about every patient wanting a breast augmentation. Some women seek breast augmentation to correct congenital or developmental anatomical abnormalities, while others are striving to repair the toll of age or breastfeeding by restoring their breasts to a more youthful and upright position. Other women simply want to have a larger size bust, which is more proportionate to their overall body size.
Breast implants may also be required to reconstruct a damaged or missing breast, which has sustained injury, illness or mastectomy. There are countless reasons women undergo breast augmentation and each one has unique importance to the individual.
Careful discussion of your expectations and concerns with your chosen surgeon, along with planning and assessment, can help to achieve a successful outcome and natural-looking results. You should thoroughly discuss your goals and motivations with a surgeon you trust and with whom you feel comfortable.
Listening to your surgeon’s feedback and advice will go a long way in ensuring your breast augmentation expectations and motivations are realistic. Satisfaction with breast augmentation results ultimately depends on your understanding of the capabilities and limitations of the procedure.
1. Breast implant shape
Choosing the right breast implant is dependent on your existing breast size, shape, symmetry and projection, body type, and your personal preferences.
There is no one breast implant shape that is best for everyone. Your surgeon is the best resource for determining what breast implant is best for you and your body type.
Round implants
Round implants are circular with an even projection of volume. They are a good choice for those who want more fullness in the upper part of the breast and tend to give greater cleavage. Many surgeons agree that round implants are typically the best choice for those patients with well-shaped natural breasts who desire a straightforward breast enhancement.
Teardrop implants
Teardrop, or anatomical, implants more closely resemble the natural shape of a breast, gradually sloping downwards to produce an attractive straight line from the collarbone to the nipple. Teardrop implants tend not to be as full as round implants but because they are fuller in the lower half they can also provide greater projection in proportion to the size of the base, making them particularly suitable for women with little natural breast tissue. Mild elevation of the breast and the nipple can also be achieved, making them particularly suitable for women who have mild droopy or tuberous breasts.
2. Breast implant size
Breast implant sizes are designated by their volume, typically ranging from 90 to 900 cubic centimetres (cc), or by their weight. One gram of silicone is equivalent to slightly less than 1ml (1cc). The higher the number, the larger the implant.
They are also made with different diameter bases to suit different widths of chest wall and with low to high profiles (amount of forward projection). For this reason, each manufacturer produces a number of ‘styles’.
It’s important to take your natural breast width into consideration. Your surgeon will measure the base diameter of your chest to determine the ideal width of implant. If the implant is too wide for your chest, you may get ‘webbing’ between your breasts (symmastia) or too much ‘side boob’. If the implant is too narrow, it will not fill the chest appropriately and be difficult to create a shapely cleavage.
The choice of implant projection is to a large extent a personal one. A woman with adequate breast tissue and a shape she is happy with may opt for a low-profile implant that will simply increase the size of her breasts. Another patient seeking to create cleavage, or a patient with some degree of sag, may prefer a high-profile implant that can help achieve these results.
Your surgeon will take into consideration the width of your chest and breast tissue and advise you on the most suitable implant size and style for your individual anatomy.
3. Breast implant material
This next crucial factor looks at the type of fill (saline or silicone) as well as the shell of the implant wall (smooth or textured).
Silicone vs saline
Saline and silicone breast implants both have an outer silicone shell; however they differ in material, consistency and techniques used for placement. Both types of implants have their own advantages and risks.
Silicone gel-filled implants are used more commonly in Australia. Silicone implants contain a cohesive gel, designed to mimic real breast tissue. It has a slightly firm, non-runny consistency, which can give a more natural feel. As the gel is not liquid, the risk of dispersal if the implant ruptures is minimised. It also typically maintains its shape better than a saline implant, especially in the upper part of the implant.
Saline-filled implants use a medical-grade saltwater solution, which makes the implant feel like a water-bed. This can be controlled to an extent by the volume of ll in the implant. If implant rupture occurs, the saline is absorbed by the body. However, saline implants feel firmer than silicone implants and have a higher risk of visible folds and ripples.
Unlike silicone gel implants, saline implants can be filled through a valve during surgery. Because of this, the insertion of the implants generally requires a smaller incision than that associated with silicone gel implants. The amount of fill can also be adjusted after
surgery, which is not possible with fixed silicone gel implants.
Smooth vs textured
Implant shells can be smooth or textured. Smooth-shelled implants are easy to insert and may make the breast move and feel more natural than a textured shell in certain patients. However, they have increased risk of capsular contracture (hardening of the breast), which is a common reason for re-operation.
Textured implants have a thicker shell and the very nature of their surface means they can grab onto and adhere to the surrounding tissue, causing less friction between the implant and breast pocket and therefore helping to reduce the risk of capsular contracture. Many surgeons also believe it offers them greater control over the ultimate shape of the breast.
Round implants come in smooth and textured shells, but anatomical implants have textured surfaces only to allow for better integration with the surrounding breast tissue. The implant may still ip or move and distort the appearance of the breast, so the surgeon must be experienced with this type of implant.
The polyurethane foam coated implant provides a texture specifically designed to reduce rates of capsular contracture. The foam coating means the collagen fibres around the implant do not line up, and are less likely to slide over each other and contract. Instead, the fibres assemble in a circular pattern around the foam and are unable to form a hardened capsule. There are some differences in the surgical plan of foam-coated implants; for example the pocket size generally needs to be bigger than usual.
Regardless of the type of implant women choose, the shape, texture and size can be customised to reflect her individual body type and breast augmentation goals.
4. Incision site
The three main incision options for breast augmentation surgery are the inframammary crease (under the breast where it meets the chest), periareolar (around the nipple) and transaxillary (inside the armpit).
Inframammary
The inframammary incision is by far the most common breast augmentation incision used today, made in the crease under the breast close to the inframammary fold. The surgeon creates a pocket for the breast implant, which is slid up through the incision, then positioned behind the nipple.
This incision offers the best exposure for visualisation and allows the implant to be placed over, partially under or completely under the chest wall muscle. The scar is hidden in the crease under the breast.
Periareolar
For the periareolar incision, an incision is made just beyond the areola, which is the darker area of skin surrounding the nipple. The incision should be made at the very edge of the areola where the dark tissue meets the lighter breast tissue, which makes the scar least visible.
Similar to the inframammary incision, the periareolar incision allows the surgeon to work close to the breast.
It is possible for the surgeon to easily and precisely place the breast implants in various positions in relation to the chest muscle. However, this is the only incision that involves cutting through breast tissue and ducts, and sensitivity in the nipple may be reduced.
Transaxillary
The transaxillary incision is made in the natural crease of the armpit and a channel is created down to the breast. This may be performed with an endoscope (a small tube with a surgical light and camera in the end) to provide visibility. The implant is inserted and moved through the channel into a prepared pocket.
The greatest advantage of an underarm breast augmentation incision is that no scar is left on the breasts. The scar is virtually invisible in the armpit fold and lack of tension generally makes for straightforward healing.
The transaxillary site is relatively far from the breast, where the surgeon needs to create a pocket for the implant, so visibility is limited. There is also a higher incidence of the implant being positioned too high and a greater risk of breast asymmetry after surgery.
5. Breast implant placement
The placement of breast implants has a significant impact on the final outcome of breast augmentation and therefore it requires individual consideration.
Experienced surgeons base their implant placement decisions on factors such as the patient’s quantity of breast tissue, natural breast size and symmetry, dimension and shape of the chest wall, amount of subcutaneous fat and quality of breast skin.
Generally, there are three placement options: subglandular (in front of the muscle), submuscular (behind the muscle) and dual plane (partially under the muscle). There are pros and cons for each position.
Subglandular
The subglandular pocket is created between the breast tissue and the pectoral muscle. This position resembles the plane of normal breast tissue and the implant is placed in front of the muscle. Sometimes the implant is covered by a thin membrane, the fascia, which lies on top of the muscle. This is called subfascial placement.
This position is suited to patients who have sufficient breast tissue to cover the top of the implant. This procedure is typically faster and may be more comfortable for the patient than submuscular placement. There is generally less post-operative pain and a shorter recovery period because the chest muscles have not been disturbed during surgery. The implant also tends to move more naturally in this position.
However, subglandular breast implants may be more visible, especially if the patient has little breast tissue, little body fat and thin skin.
With subglandular implants, there tends to be more of a pronounced ‘roundness’ to the breasts, which may look less natural than those placed under the muscle, but this is a matter of personal preference.
Submuscular
The implant is placed under the pectoralis major muscle after some release of the inferior muscular attachments. Most of the implant is positioned under the muscle.
This position can create a natural-looking contour at the top of the breast in thin patients and those with very little breast tissue. The implant is fully covered, which helps to camouflage the edges of the implant, as well as rippling. With this placement, data has shown there is less chance of capsular contracture occurring.
There may be more post-operative discomfort and a longer recovery period. The implants may appear high at first and take longer to ‘drop’.
Dual plane
This is where the implant is placed partially beneath the pectoral muscle in the upper pole, where the implant edges tend to be most visible, while the lower half of the implant is in the subglandular plane. This placement is best suited to patients who have insuf cient tissue to cover the implant at the top of the breast but who need the bottom of the implant to fully expand the lower half of the breast due to sag or a tight crease under the breast.
This position minimises the rippling and edge effect in thin patients while avoiding abnormal contours in the lower half of the breast. Generally, this placement is able to achieve a more natural shape to the upper portion of the breast instead of the ‘upper roundness’ that can be more common with subglandular implants. However, it involves more complex surgery, which if not performed correctly may result in visible deformities when the pectoral muscles are contracted.
