Decisions in Breast Augmentation

Breast augmentation is major surgery which will change your entire appearance, and isn’t something to rush into. There are a series of decisions that have to be made about how exactly you’ll be having your breasts augmented. Your cosmetic surgeon will want to discuss these with you, to make sure you understand the options and are firmly decided on which course of action you want and why.

1. Saline or silicone gel?
For fourteen years until November, 2006, the FDA had silicone gel breast implants restricted to breast reconstruction. They were unavailable for cosmetic use. Now they’re available again and in a new, even safer form.

Features of silicone gel implants
• Silicone gel implants are generally thought to be more natural in their look and feel.
• They come already filled in a wide range of sizes. Because they’re already filled, their size can’t be adjusted after they’re placed as saline implants can.
• They use a new type of gel which sticks to itself. Even if the shell were to be ruptured (an extremely unlikely event!), the gel inside would not leak. It retains its form and the two manufacturers use the trade names Cohesive Gel and Memory Gel to make that point. It’s a similar idea to those memory foam pillows.
• If you previously had saline implants, you can have them replaced now with silicone gel implants

Features of saline implants
• They come empty and are inserted folded up, then expanded and filled. If you decide you’d like them a little larger or smaller, the saline solution can be adjusted after placement.
• For each given size, they weigh slightly more than a silicone gel implant.
• There is an extra incision location that can be used for saline implants since they are inserted empty. That is known as the TUBA incision and is in the belly button.

2. Placement: subglandular or submuscular?
Implants can be placed over the pectoral muscle and beneath the breast tissue, or beneath both. Some cosmetic surgeons recommend one over the other based on their particular experience with breast augmentation. Others are quite willing to offer both.
• A subglandular placement gives more of a cleavage and a better fill for the bra cup. But there’s also a greater chance of sagging because the breast weight is not supported by muscle.
• A submuscular placement is supported by the muscle and is less likely to sag.

3. Round or teardrop-shaped?
This is entirely individual preference.

4. What size?
Implants are not sized like bra cups. The implant will be of a size to make up the difference between your existing bra size and the size you’d like to have. This is another individual choice, although most cosmetic surgeons do not encourage use of very large sizes that are out of proportion with the rest of your body.

5. Incision location?
There are three main choices:
• Inframammary (under the breast)
• Areola (below the nipple)
• Transaxillary (in the armpit)

This again is an individual preference. In all these locations, the resulting scar will be almost invisible.