We had an extensive discussion about breast augmentation, also known as augmentation mammoplasty. This procedure enhances breast size and shape using implants. Breast augmentation can increase volume, improve symmetry, restore fullness lost after pregnancy or weight loss, and help balance your overall proportions. Our focus is always a result that looks natural on your body and fits your goals.
Goals and Expectations
During your consultation, we reviewed what you want to change and what kind of look you are aiming for, including:
- Desired breast size in proportion to your frame
- Breast shape and profile, such as a natural slope versus fuller upper fullness
- Cleavage characteristics
- Correction of asymmetry if present
- Overall balance with your body
Breast augmentation can make a significant improvement, but it cannot create perfection. Natural asymmetries may remain to some degree, and your anatomy influences the final outcome. My job is to guide you toward an option that meets your goals within the safe limits of your body.
Implant Types and Characteristics
Implant Fill Material
- Saline implants: These are filled with sterile salt water. They are inserted empty and filled once in position, which allows for a smaller incision. If a saline implant ruptures, the body absorbs the saline safely and the implant deflates in an obvious way. The tradeoff is that saline implants can feel less natural and have higher rates of visible rippling.
- Silicone gel implants: These are filled with cohesive silicone gel that closely mimics natural breast tissue. Modern silicone implants use form stable gel that maintains its shape. They generally feel more natural and show less rippling, especially in women with limited natural breast tissue. If rupture occurs, it may be silent, so periodic imaging such as ultrasound or MRI is recommended over time.
- Structured saline implants: These are a newer saline option with an internal structure that reduces fluid movement and improves feel compared to traditional saline. The downside is cost, and patients who want the smoothest, most natural feel usually choose silicone.
Implant Shell Surface
- Smooth implants: These have a soft outer shell and can move naturally within the pocket. They are the standard for most patients and are the implants I primarily use.
- Textured implants: These have a rough surface and were designed to reduce capsular contracture and prevent rotation in shaped implants. Textured implants have been linked to a rare lymphoma called BIA-ALCL, so they are used far less often today. Given this risk, I favor smooth implants in the overwhelming majority of cases.
Implant Shape
- Round implants: These provide fullness throughout the breast and do not have rotation concerns. They can look natural or more augmented depending on the profile selected.
- Shaped (anatomical or teardrop) implants: These are designed to mimic a natural breast slope with more lower fullness. Because they must stay oriented correctly, they are usually textured, which is one reason they are used less often now.
Implant Profile
Profile is how far the implant projects forward for a given base width. Options include low, moderate, high, and extra high profiles. The right profile depends on your chest width, your existing breast tissue, skin quality, and your desired final look.
Surgical Considerations
Implant Placement
- Submuscular placement (under the muscle): The implant sits beneath the pectoralis major muscle. This provides more tissue coverage, helps reduce rippling, lowers capsular contracture risk, and can look especially natural in thinner patients. The recovery is longer because the muscle is involved, and implants can move slightly with pectoral contraction.
- Subglandular placement (over the muscle): The implant sits beneath breast tissue but above the muscle. Recovery is typically shorter and less painful, and there is no muscle animation. This approach can give stronger cleavage, but may show more rippling in thinner women, slightly increases capsular contracture risk, and can interfere more with mammography.
We discussed which placement best fits your anatomy, lifestyle, and goals.
Incision Options
- Inframammary incision (breast crease): This is the most common approach. It offers the best visibility and control for pocket creation and implant positioning. The scar hides well in the natural fold.
- Periareolar incision (around the areola): This can camouflage the scar at the color change of the areola, but it carries a slightly higher risk of sensation changes and can affect breastfeeding in some patients. It also creates more internal scarring, which can increase contracture risk.
- Transaxillary incision (armpit): This avoids a scar on the breast itself, but pocket control is more limited and the armpit scar can be visible with sleeveless clothing. Contracture risk is higher due to increased scarring.
- Transumbilical incision (belly button): This is rarely performed because pocket control is limited. It is only suitable for saline implants and is not FDA approved.
I typically prefer the inframammary approach for its control and predictability, which leads to better aesthetic outcomes and lower complication rates.
Sizing and Selection
Selecting the right implant size is a mix of your goals and what your body can safely support. We considered:
- Your chest wall width and shape
- Your existing breast tissue
- Skin elasticity and quality
- Your lifestyle and activity level
- Overall body proportions
We used sizers in a surgical bra so you could see and feel different sizes. Implant volume is measured in cc and does not map perfectly to cup sizes. Cup sizing varies widely between brands, so the same implant can look different on different bodies. I gave you recommendations based on your anatomy, and the final choice is yours.
The Surgical Procedure
Breast augmentation is performed under general anesthesia as an outpatient procedure. The surgery typically takes less than an hour depending on complexity. Key steps include:
- Making the planned incision
- Creating the implant pocket above or below the muscle
- Careful bleeding control to reduce hematoma risk
- Placing and positioning the implant to optimize symmetry
- Closing the incision in layers with meticulous technique to support good scarring
Recovery After Breast Augmentation
After surgery, you will wear a support bra or compression band for several weeks to protect healing and maintain implant position.
- Discomfort is expected, especially with under the muscle placement, and is controlled with medication.
- Most patients take about one week off work if implants are under the muscle. Over the muscle placement may allow an earlier return.
- Avoid strenuous activity, heavy lifting, and overhead reaching for at least 4 to 6 weeks.
- If implants are under the muscle, upper body and pectoral exercises may be limited up to 8 weeks.
- Bruising and swelling usually improve over 2 to 3 weeks.
- Breasts often feel firm early on and soften over several months as tissues adapt.
- Final results are typically clear at 3 to 6 months as swelling resolves and implants settle.
- Temporary numbness or sensation changes are common and usually improve over weeks to months, though permanent changes can occur.
Fat Injection to the Breast and Safety Concerns
We talked about the growing social media attention around fat injection to the breast. While fat grafting has an important role in breast reconstruction, it carries unique long term risks in cosmetic breast augmentation.
Why Fat Grafting Is Different in the Breast
During fat injection, some fat survives and some does not. Dead fat can form oil cysts or calcify. In the breast, calcifications show up on mammograms. This creates two serious problems:
- False positives: Calcifications from fat necrosis can look like cancer on imaging, leading to repeat scans and unnecessary biopsies.
- Potentially obscured cancer: Calcifications from fat grafting can hide early breast cancer findings, which risks delayed diagnosis.
Because cosmetic breast augmentation is elective in healthy breast tissue, I do not perform fat injection to the breast for cosmetic enlargement. I will not introduce a lifelong screening risk that can complicate breast cancer detection.
Why Implants Do Not Create the Same Risk
Breast implants do not create calcifications that interfere with mammography. They are visible as distinct devices on imaging, and radiologists are trained to image around them using specialized techniques. Your breast tissue remains evaluable.
If you want both lift and volume, a breast lift with implants can address both concerns without introducing fat related calcification issues. For lifting information, see Breast Lift.
Long Term Considerations
Implants are not lifetime devices. Most last 10 to 20 years, though some last longer and some require earlier replacement. You may need future surgery due to:
- Capsular contracture
- Rupture or deflation
- Changes in aesthetic preferences
- Aging, pregnancy, or weight changes
- Implant malposition or rotation
Monitoring
- Silicone implants: The FDA recommends ultrasound or MRI starting 5 to 6 years after surgery, then every 2 to 3 years to detect silent rupture.
- Saline implants: Routine imaging is not required, because rupture is obvious when it happens.
Mammography
Implants do not prevent mammograms. Imaging centers use specialized views to see breast tissue clearly. Always inform your technician that you have implants.
Pregnancy and Breastfeeding
Implants do not usually prevent breastfeeding. Periareolar incisions carry a slightly higher chance of affecting milk ducts. Pregnancy will change breast shape, and your results may shift over time.
Breast Implant Illness (BII) and Safety
Some women report symptoms such as fatigue, brain fog, or joint pain that they attribute to implants, often called Breast Implant Illness. Research has not established a definite cause and effect relationship, but studies continue. Some women feel better after implant removal, and we take any concerns seriously.
BIA-ALCL
BIA-ALCL is a rare lymphoma that can develop in the scar capsule around breast implants, most often textured implants. The overall risk is very low. Symptoms can include late swelling, asymmetry, or a mass years after surgery. When detected early and treated appropriately, outcomes are typically excellent. This is one reason I use smooth implants for most patients.
Potential Complications
Breast augmentation carries risks, including:
- Capsular contracture
- Implant rupture or deflation
- Infection that may require antibiotics or implant removal
- Hematoma or seroma
- Changes in nipple or breast sensation
- Asymmetry in size or implant position
- Rippling or visible implant edges, especially with thin tissue
- Implant malposition, including bottoming out or lateral shift
- Animation deformity with under the muscle placement
- Double bubble deformity
- Interference with mammography, though imaging techniques address this
I take multiple precautions to minimize these risks, including careful implant selection, meticulous surgical technique, prophylactic antibiotics, and close follow up. Following pre and post operative instructions makes a big difference in healing and final outcome.
Making the Decision
Breast augmentation is a personal decision. Take time to process what we discussed, look through before and after photos, and think about what fits your goals. Bring any questions to your next visit. My goal is for you to feel informed, comfortable, and confident in your choice.
Photos were obtained, a quote was given, and the patient will return in a week for further discussion if needed.
