Breast Augmentation is the most common plastic surgery procedure in the country followed only by rhinoplasty (nose job). Although breast augmentation may go by many different names including breast implants, breast enhancement, and boob job, it all means the same thing: to increase the volume and improve the shape of the breast.
There are two main ways to increase the size and volume of a breast:
- using breast implants
- using your own fat
Breast augmentation with fat transfer is a process where fat is removed via liposuction (the third most common plastic surgery procedure) from areas where there is excess fat and then placed into the breasts. The main limitations of fat transfer breast augmentation is having enough fat and getting more than about one cup size increase in breast size in one fat transfer session. The benefit of fat transfer is of course not having a foreign implant and having completely natural breast feel.
By far the most common type of breast augmentation is breast augmentation using an implant. Using an implant for breast augmentation allows the surgeon and patient to achieve nearly any size and shape of breast desired in one procedure. Although there is a ton of information related to breast implant augmentation, I feel there are really only four main points of discussion to determine the ideal breast augmentation plan for each patient.
- Breast implant size
- Breast implant type
- Under of over the muscle
- Incision used for placing the implant
Breast implant size
This is perhaps the most important part of the breast augmentation decision process. Obviously, if there is an ideal breast cup size or volume that a patient is imagining or desiring and the final result ends up being too small or too big, the patient will not be satisfied. To make sure this ideal volume is found, both a mathematical estimation is done as well as sizers used in the pre-operative meeting with the patient. The patient is instructed to bring in a sports bra that fits the cups size that they desire. Using a variety of sizer implants in the office setting allows the patient to fine tune their ideal implant size.
Breast implant type
There are three main types of implants.
- Rounds silicone
- Shaped silicone (aka form stable, anatomic, tear drop, gummy bear implants)
There are advantages and disadvantages to each implant:
- Advantage: lowest cost, smallest incision
- Disadvantage: least natural feel and look
- Advantage: medium cost and incision, most applicable to all patient body types
- Disadvantage: for really thin patients may still not have as natural a look as desired
- Advantage: best suited for thin individuals. Can provide the most natural look or the least likely to be noticed in terms of where the implant starts/stops
- Disadvantage: higher cost. Chance of rotation. Slightly larger incision.
Under or over the muscle
There has been a lot of discussion about this over the years. In general, patients that are athletes that do not want to have the pectoralis muscle cut or impacted will choose on top of the muscle either subglandular or subfascial. Patients that are thin should go under the muscle. Patients that have a lot of breast tissue laxity from either pregnancy or weight loss should also go under the muscle. Everyone else essentially is a candidate for either based on preferences. One caveat is that saline implants should always go under the muscle because of the characteristics of the saline implant.
Incision location to place the implant
The most common incision location used for breast augmentation is a breast fold incision. This is the most common incision location regardless of breast implant type. This incision location affords the plastic surgeon the most control in designing the breast implant pocket. Other incision options include at the border of the areola and through the arm pit. Through the belly button is also an option but this is rarely used anymore. A shaped implant has to go through the breast fold incision since it has to be placed in a specific position.
A few other bits of information for breast augmentation:
- Implants do not have to be replaced at any given time. If you like how they look and feel then you are good to go.
- Implants are life-time warrantied for defects
- The FDA recommends MRI every two years for silicone implants. The reality is that virtually no one does this.
- Mammograms are not affected by breast implants
- Silicone is completely inert and safe.