Because there several choices to be made about the style of your implant, it is important to discuss your options with your surgeon.
Two implant surface types are available to augmentation patients, smooth and textured. Textured implants have small bumps on their surface. These implants were developed in hopes of reducing the risk of contracture, a complication some women develop after augmentation. You can read more about contracture and other complications in our FAQs. Smooth implants have a smooth rather than bumpy surface. Many surgeons prefer smooth implants for their softer, more natural feel.
Women have the choice of implants filled with cohesive silicone gel or with saline (salt water solution). Both types of fill have been used since the earliest days of breast implantation. Unlike the older pre 1990 silicone implants with a more liquid fill, modern implants are filled with silicone that has a “gummy bear” consistency. While there is no evidence that exposure to silicone can cause any disease in human beings, some women prefer to have their implants filled with saline. In the unlikely event of a rupture in the outer shell of the implant, saline, a completely bio absorbable salt water solution would be simply absorbed into the body and the implant would deflate. Silicone is not bio degradable and therefore a woman would not likely notice any change in implant volume if there was loss of integrity in the shell of a silicone filled implant. Because of this, the FDA recommends a periodic MRI to confirm integrity of silicone filled implants. Most surgeons and patients agree that saline filled implants do not have the natural feel of silicone filled implants
There are two shape options for implants, tear drop or round. Generally, round implants conform best to the natural shape of the breast and offer women favorable results. Tear drop, or contoured, implants may be a fit for women who have had parts of the breast removed during a previous surgery, such as mastectomy reconstruction. Round implants may be either smooth or textured while shaped implants are always textured.
Implants can be placed either behind the breast tissue, subglandular, or behind the pectoralis chest muscles submuscular. About 75 percent of augmentation is done in the submuscular plane. Studies show that a submuscular placement may reduce the chance for scar tissue contracture and allows for easier mammography following surgery. Submuscular placement typically offers better results for thin women or women hoping to drastically enlarge their breasts. Subglandular placement may offer women with sag in their breasts better results.
Inframammary fold or Sub-pectoral
This procedure involves an incision in the fold underneath the breast and tends to allow the surgeon more direct control of implant positioning. About 70 to 80 percent of breast augmentations are performed using an inframammary fold procedure. The incision placement allows for minimal effects on the milk-producing areas of the breast. The same incision may also be used if complications arise or additional surgeries are needed. Inframammary fold augmentation works well for older patients or mothers, since age and pregnancy allows for a natural amount of sag in the breast. This natural sag allows for the surgical incision to be well hidden for most women. Young women, thin women, or women who have not had children yet and have no crease under their breasts may have a more visible scar with this procedure.
During this procedure, an incision is made in the armpit, or axilla, and is used to insert an implant either above or below the muscle. Some surgeons will use an endoscope, which is a small, fiber-optic camera, to help them complete the surgery. About 10 percent of breast augmentations are done using a trans-axillary procedure. The advantage of trans-axillary augmentation is that there is no scar on the breast itself. A potential disadvantage of this approach is that getting symmetrical implant positioned is somewhat more difficult, and correction of post-operative problems will likely require additional incisions on the breast. Also, there is potential for thickened scars that are visible with sleeveless clothing, bathing suits or while arms are raised.
In this procedure, an incision is made around the nipple-areolar complex and the scar tends to blend into the edge of the areola. Since the incision is very near milk-producing parts of the breast, women who receive peri-aeriolar augmentation may have more problems with breast feeding and nipple sensation following surgery. This is the preferred incision for women with very small breasts who do not have any fold under their breasts.
Trans Umbilical Breast Augmentation (TUBA)
This newer approach to augmentation uses an incision through the belly button. An endoscope, or small fiber-optic camera, is tunneled through the incision to a pocket under the breast. The implant is then inserted through this tunnel and inflated with saline. TUBA is only available for subglandular saline implants. Implants placed using TUBA have a slightly increased chance of damage. During placement, surgeons may possibly tunnel under one of the muscles. If there are any complications or additional surgeries needed, you may need an additional incision made closer to the breast. Lastly, manufacturers often do not honor an implant warranty if it is placed using TUBA. Because of these potential problems, our surgeons do not recommend the TUBA approach.
Contact for more information or to schedule a consultation with a Board Certified Plastic Surgeon 734-998-6022