Five Decisions to Make About Breast Augmentation

(and why it will be easier than you think to make them…)

By Dr. Scott W. Mosser

Reading about breast augmentation on the internet can be overwhelming! How can a woman interpret so much information about size, shape, position and type of implant to decide what choices are best? Well, fortunately it’s not as complicated as you may think and in fact your body might be answering most of those questions for you.

Implant texture & shape (smooth versus textured, round versus teardrop)

Implants can come in “smooth” or “textured” sizes, or in “round” or a “teardrop” shape. A textured implant is designed to “attach” to the surrounding tissues (this is believed to lower the chance of scarring around the implant), while smooth implants move freely in the space where they are inserted. Teardrop implants have a bit of shape, and round implants are exactly that – round and symmetrical. You can imagine that the worst thing that could happen to a “teardrop” shaped implant would be for it to fall over on its side and create an abnormal breast shape. For that reason all teardrop implants are textured to prevent movement.

The key is this: visible implant rippling (which is much more common in saline implants) is much more likely with textured implants. So in an effort to avoid the appearance of tiny ripples, the best option is a smooth implant, and since all teardrop implants are textured, this means a round implant is used for virtually all saline implants.

Implant type (silicone versus saline)

Now certainly an entire article could be written on saline versus silicone implants, but the most important thing to know is this: silicone implants are widely considred more natural in their look & feel, while saline implants are the most worry-free in the event of an implant leak.  Both are widely used for both cosmetic breast augmentation and also breast reconstruction surgery.

So again, the decision is commonly made for the patient, and for purely cosmetic breast augmentation the best choice available is usually saline implants.

Implant location (in front of or behind muscle)

You may have heard about “subglandular” or “subpectoral” implant placement. These refer to a decision to place the implant beneath the breast tissue but above the muscle (subglandular) or beneath the pectoralis major chest muscle (subpectoral). It’s true that placement above the muscle can be a bit less uncomfortable than beneath the muscle. However, there are a number of reasons why placement beneath the muscle is preferred. In short, these are 1) a much more natural appearance, simply because there is more of your own body’s tissue between the implant and the surface of the skin. 2) mammography is slightly less accurate when the implant is above the muscle as opposed to beneath it, and 3) the chance that a firm scar (a ‘capsular contracture’) will form around the implant is lower if the implant is placed beneath the muscle. For everyone except the few patients who start out with a fair amount of breast tissue to begin with, subpectoral positioning, or placement of the implant beneath the muscle, is greatly preferred.

One important feature of your body may make placement beneath the muscle by far the best option: If there is not much breast tissue to begin with, then the final result will be much more natural is the implant is placed beneath the muscle. In other words, the more of your own tissues (muscle + breast tissue) there is between the implants and the surface of the skin, the more natural the final contour of the breast will be after augmentation.

Incision location

There are a variety of incisions that work well for breast augmentation, including beneath the breast, around the pigmented areola, right around the nipple (within the pigmented areola), and beneath the armpit. Most patients choose the incision beneath the breast (also called the inframmary incision) because it is hidden within the breast fold and therefore is entirely hidden when the patient is in the upright position. However, an excellent result can be obtained with an incision placed in or around the areola. This is a case where there is certainly no right or wrong decision, and during a consultation I make it a point to explore the pros and cons of each so that each patient can make up her mind regarding which option is best.

Implant size

This is the actual decision that is the most individual and important for you to consider carefully. Northern California, and specifically San Francsico breast augmentation candidates are most often very concerned about maintaining a natural appearance, and there are a number of things you can do to make sure your goals are well-defined and that your surgeon knows your priorities regarding breast size. First, it is helpful certainly to find a surgeon who is a good listener. I find that the best way to hone in on the proper size is simply to listen to the patient describe her goals. Most often, she will mention that her goal is to obtain a proportionate, well-balanced appearance that is larger but still natural-looking.

Another way to communicate your goals to your surgeon is to look for photos that show bodies that are similar to yours, but with a breast size and shape that is what you would like to have. Almost any type of photo, in or out of clothing, will be useful to your surgeon in learning about your aesthetic preferences.

Finally, I like to be sure to give patients the opportunity to try on actual implant sizes in the office. During a consultation my patients have a chance to see what an actual volume amount will do to the appearance of the upper body, and how this relates to the shoulders and hips in a full-length mirror. Not only does it end up being a lot of fun for patients to finally see how they look with many different volumes, but it also gives us the best chance possible let a patient assess her volume goals by using her own body and clothes.

So, as you can see — there are a lot of choices to make, but most of them are really pretty straightforward after giving the matter a bit of thought, and after having a chance to think, talk and learn about the options during a thorough consultation.

Copyright © 2006 by Dr. Scott W. Mosser. This article may not be copied or reproduced in any form without the written permission of Dr. Scott Mosser. Internet links to the sub-page containing this article are permitted.