Breast Implants

Quick Facts About Breast Implants

Average Treatment Cost: $3,500-$8,000
Procedure Time: 1-2 hrs
In/Outpatient: Outpatient
Anesthesia: General or local with intravenous sedation
Recovery Time: 7-14 days; strenuous activity in 3-4 weeks
Duration of Results: Long-lasting
Financing Available. Apply Now
What you should know

What Are Breast Implants

Breasts are like fingerprints—they’re unique from one person to the next. A size and shape that looks good on your friend may not be compatible with your body, which is why skin elasticity, natural breast size and shape need to be taken into consideration.

“Breast augmentation with implants is the gold standard for getting better-looking breasts because size, shape and profile can all be addressed,” says Miami Beach plastic surgeon Leonard Tachmes, MD.

If you aren’t happy with the size or fullness of your breasts and would rather not resort to specialty bras, consider surgery. “Think of breast augmentation like putting a bigger pillow into a pillow case. There are some limitations but for the most part, the skin stretches very well,” says Duxbury, MA, plastic surgeon  Christine Hamori, MD. Most women want a natural look when considering breast surgery.

Implants, either silicone or saline, offer a permanent fix for larger, fuller, more proportionate breasts. Fat can be used, too. Your plastic surgeon may recommend a lift in addition to implants, if there’s sagging or loss of volume.

For the most natural look, La Jolla, CA, plastic surgeon Reza Sadrian, MD, says that breast diameter, as well as the profile, shape and positioning of the implants, needs to be taken into consideration. “Implants should fit the body appropriately. If they are too big for your body’s natural diameter, the implant will stick out at the sides, be too high up on the chest and just look too large overall,” he says. 

About 10 years or so after your augmentation, you may be ready for a touch-up. A desire to change size, obtain a more natural feel, remedy natural sagging or correct capsular contracture are reasons to have implants replaced.

Saline vs. Silicone

Silicone: Now available for women over the age of 22, silicone gel implants have come a long way from their predecessors, and are considered a safe and effective option for breast augmentation. Across the country, currently, there are still more saline implants used than silicone.

Patients and surgeons alike report that silicone offers a more natural look and feel, and they may be more suitable for very thin patients, since silicone implants better conform to the natural shape of the body.

Saline: These implants are filled with sterile salt water that can be safely and naturally absorbed by the body in the event of a leak. These implants can be prefilled, or filled at the time they are inserted. They can also be adjusted later.

When it comes to choosing between silicone and saline implants, talk to your plastic surgeon about the look and feel that you’re trying to achieve. “Saline implants usually cost less and require a smaller incision. Plus, if they deflate, it’s easier to notice,” says Concord, CA, plastic surgeon Eric Mariotti, MD. “But if you’re looking for a more natural-feeling implant, opt for silicone, which tends to ripple less,” he adds.

“Silicone implants feel more natural than saline implants, especially in those with thin skin or little breast tissue. Saline implants can feel comparable to silicone in patients with thicker skin and more breast tissue. Both saline and silicone implants can provide a very natural-looking breast,” says Beverly Hills plastic surgeon Garth Fisher. 

A type of form-stable silicone implant, known as the gummy bear implant, is currently awaiting FDA approval. Unlike traditional silicone implants, which have a honey-like consistency, this new form-stable implant is more like Jell-O, so its shape will stay intact. Shaped like a teardrop for what is claimed to be a more natural look, the implant contains the same type of silicone as what’s currently used, but has three percent more cross-linking molecules

“Think of silicone as having little bridges. This implant just has more bridges, which keeps the filler from moving around,” explains New York, NY, plastic surgeon Tracey Pfeifer, MD. Although the implant has yet to be approved stateside (it is used in Canada, Europe and South America), it has a leakage rate of nearly zero and is great for reconstructive purposes or for someone who’s really small or flat.

However, because of the shape of the implant, and the stable filler, it’s believed that the only place to make an incision, which needs to be longer than normal, will be in the breast crease, since the implant is not as compressible as other silicone implants.

Implant Shapes

Implants come in different shapes, like round or teardrop (also known as “anatomical”).

Round implants, which are circular but flat, stick out from the body farther, making the breasts project more. Round implants are also good for those who want more fullness in the upper part of the breast.

Round implants are usually placed under the muscle and can give more fullness to the upper portion of the breast. Since round implants don’t move much, they almost always keep their round shape. 

Smooth round implants are the overwhelming choice of most surgeons because they tend not to wrinkle as much as textured implants. Plus, if they happen to rotate, the breast does not look abnormal. “Plastic surgeons have different opinions, but I prefer round implants to achieve a more natural shape,” says Newport Beach, CA, plastic surgeon Sanjay Grover, MD.

Teardrop implants (sometimes called contoured), slope downward just like natural breasts, which makes them look more natural. Teardrop implants also have a textured shell—if the implant happens to rotate while in the breast, the breasts can become distorted.

“However, they are only available in saline, and the sizes, widths and heights are limited,” says New York City plastic surgeon Tracy Pfeifer, MD. “But they’re a great option for those who are narrow and want a lot of volume.”

Teardrop implants tend not to be as full as a round implant. However, because of their shape, teardrop implants may provide better projection and a more natural look for some patients. They can potentially rotate, which may cause an unnatural distortion.

When choosing your size, remember that breast implants are measured in ccs—the higher the number the larger the implant. Most implants can hold at least 400 ccs of filler (sometimes more), and about every 150 to 200 ccs equates to an increase of approximately one to one-and-a-half cup sizes. To determine the ideal implant size for you, the width of your breast and tissue needs to be taken into consideration.

If you don’t have enough volume, a small implant can create fullness. To avoid the look of bony, wide-spaced cleavage, it’s important to take your natural breast width into consideration, which your plastic surgeon will measure, since cleavage, in general, greatly depends on the width of the sternum and shape of the chest wall. Keep in mind that even with an augmentation or a lift, some patients may still need to wear a bra that pushes the breasts up and toward the center to achieve the desired cleavage.

Choose Your Size

Breast implants are measured in cubic centimeters or cc3—the higher the number, the larger the implant. Most implants can hold at least 400 ccs of filler (sometimes more), and about every 150 to 200 ccs equates to an increase of approximately one to one-and-a-half cup sizes. To determine the ideal implant size for you, the width of your breast needs to be taken into consideration.

According to Washington, D.C., plastic surgeon Scott Spear, MD, the majority of women who undergo augmentation desire breasts that sit high on the chest to fill any empty space that may exist.

“It’s important to take into consideration the implant size that your breasts are physically able to withstand. Not everybody is built to accommodate large implants,” says News Orleans plastic surgeon Kamran Khoobehi, MD, which is why there is a risk of long-term problems with oversized implants, such as:

  • Tissue, fat and muscle thinning
  • Reoperation
  • Pressure atrophy
  • Bottoming out
  • Rippling, wrinkling and ridges
  • Stretchmarks
In choosing the size of implants you want, you should also consider how you want your profile to look.

Moderate-profile:  Implants with Minimal Projection

These implants give a small amount of projection and don’t stick out from the chest as much.

Advantage: Good for wide chests.

Disadvantage: Minimal projection.

Moderate-profile Plus: Universally Flattering Implants

Project more than moderate implants but not as much as high-profile implants, and are slightly tapered.

The advantage: Good for naturally small, narrow chests; don’t create excessive width on the side.

The disadvantage: Can ripple and put pressure on the breast tissue.

High-profile:  Implants for Maximum Projection

These give ample projection and fullness. High-profile implants are narrow with a small base so they project more.

Advantage: Give good cleavage and some lift; believed to ripple less.

Disadvantage: Can give too much fullness at the top of the breast, causing a fake look.

With so many different types of implants available, it’s important to know the right terminology when it comes to discussing shape and size with your doctor.

 


 


Incision Decision

There are multiple different locations where the incision for a breast augmentation can be done. Where your doctor will play the decision is dependent on the ultimate goal you are trying to achieve.

1. In the crease of the breast (inframammary): Most plastic surgeons agree that an incision placed in the crease of the breast is the best method for providing symmetry. Also, if you ever need revision surgery in the future, your doctor can use your existing scar instead of having to make a new one. However, your scar may be more visible “This is the most commonly used incision because it’s the easiest way to get the implant placed,” says Grand Rapids, MI, plastic surgeon Dennis Hammond, MD.

2. Around the nipple (periareolar): Many surgeons and patients prefer this incision since it heals the best and the incisions are small. And once you are all healed, your scar should be virtually undetectable. Yet some women, especially those with very small areola, may not be appropriate candidates for this incision. There may also be scarring of some of the breast ducts, which could interfere with breastfeeding, although most patients can adequately breast feed after undergoing surgery with this incision.  “I have always felt that this incision provides the highest percentage of ‘good’ scars because there is an opportunity for the scar to blend with the color of the areola. Even if you heal poorly, this part of the body is not typically exposed,” says Beverly Hills, CA, plastic surgeon Garth Fisher, MD.

3. Through the armpit (axillary): This option is best if you’re looking to be virtually scar-free on and around the breast, but placing an implant through the armpit can be difficult since it’s hard to squeeze it in. If revision surgery is needed, your surgeon will need to make a secondary incision in order to remove or replace your implant. “It’s essential that an endoscope is used so that the placement of the implant is exactly within the pocket, otherwise you run the risk of the implant sitting too high,” says New York City plastic surgeon Tracy Pfeifer, MD.

Implant Placement

Just like you and your doctor can decide on the location for your incisions, you can also decide whether or not you want the implant placed under or over the muscle.

1. Over the muscle (subglandular): Placing the implant over the muscle can also give the breasts a slightly lifted look. Since the implant is placed over the pectoral muscle and below the breast tissue, recovery time is usually shorter because there is less trauma to the underlying tissues 

Yet, implants placed over the muscle sit closer to the surface of the skin, making them more detectable through touch and more visible if your skin is thin. And in a mammogram, your doctor cannot see as much breast tissue due to the placement of the implant.

 “Silicone implants allow for more patients to have their implant placed subglandularly (in front of the muscle) because there is less rippling and visibility with silicone,” explains Washington, DC, plastic surgeon Scott Spear, MD.

2. Under the muscle (submuscular): Positioning the implant below both the pectoral muscle and the breast tissue allows for the implant to be less visible and acting as an internal bra, keeping the implant in place. The implant is also only partially covered by muscle, so it’s less likely to cause problems with mammograms.

But it’s a more painful recovery because the internal anatomy of the tissue behind the breast is changed more.

According to New York City plastic surgeon Tracy Pfeifer, MD, placing the implant under the muscle is good for those that are thin because it provides extra coverage over the implant, which gives a more natural look.

Fat Transfer

If you only want to go up about one cup size or so and prefer not to have implants, fat grafting is the next best thing. Fat grafting involves surgically removing fat from one area of the body (with microliposuction) and transplanting it to another. Even though some of the fat will be absorbed, the majority of it lasts indefinitely. 

Fat is a natural filler, so the results don’t look “operated on.” There is minimal scarring as opposed to the larger scars left from implants. Plus, “the tissue is your own and does not need periodic replacement like implants do,” says Salt Lake City, UT, plastic surgeon Renato Saltz.

When a woman receives implants during reconstructive surgery, she may experience some implant deformities. Some experts find supplemental fat injections to be an outstanding option for smoothing and reshaping reconstructed breasts with implants. 

Who they are for

Women who want to permanently improve breast shape and/or size or who want their post-pregnancy figures back. If you’re happy with the position of your breasts but you’d like them to be a little fuller, implants can help replace the breast tissue that diminishes after having a baby, and may even be able to eliminate the need for a breast lift as long as you have healthy, elastic skin and no excessive drooping.

Verona, NJ, plastic surgeon Paul Loverme, MD, says that recovery from breast augmentation may be easier in women who have had children, as opposed to those who have not. “The skin is already stretched so there can be less discomfort, and because there’s not as much tightness, the breasts take on a natural appearance quicker,” he says. 

Who they are not for

Anyone who is not concerned with breast volume or position.

Anyone who is not willing to undergo surgery.

What to Expect

Before your surgery, your doctor may ask you to look at before-and-after images to narrow down the size, shape and projection you’re after. He may also ask you to try on different implants by placing them in your bra, a tight T-shirt or bathing suit, which is a great way of giving an estimate of what you may look like with larger breasts before committing to surgery. 

During surgery, an incision will be made in either the crease of the breast, around the nipple or in your armpit. After the implant is inserted, the incision site is then sutured up with stitches that either dissolve or need to be removed by your surgeon a few days post surgery.

Immediately after surgery, you’ll probably feel weak from the anesthesia and may be nauseous. Your breasts will be bandaged, and you may not see them until your first check-up.

After a few days, you may be in some pain, and your implants will sit high and may feel hard since they have not settled. There will be some bruising and swelling, and you will need to wear a compression garment or tight sports bra to help the healing process.

A few weeks later, your implants have started to settle and will look more natural. Your scar will still be red and may be thick, but it should fade with time.

Post-Treatment Care

“Most of my patients correlate the soreness and heaviness to what it feels like when your milk comes in after having a baby,” says Concord, CA, plastic surgeon Eric Mariotti, MD. In most cases, you’ll be able to return home the same day as your surgery, but it’s best to have someone take care of you during your recovery period.

“I recommend to take it easy for at least the first week,” says Grand Rapids, MI, plastic surgeon Dennis Hammond, MD, who also adds that it’s important to massage your breasts every day for the first six weeks after surgery. “This keeps the breast soft and reduces the incidence of capsular contracture. But you can only massage implants that are round,” he says. Before you begin massaging your breasts post-surgery, talk to your plastic surgeon about when to start massaging and how to properly do it. 

Inside Tips

Implant shells are available as either textured or smooth. A textured shell may require a longer incision because the surface makes it harder to place. Smooth round implants are the overwhelming choice of most surgeons because they tend not to wrinkle as much as textured implants. Plus, if they happen to rotate, the breast does not look abnormal. 

Some augmentation patients choose to wear push-up bras to even further amplify the size of their breasts. “It’s fine to wear a bra like this if you have implants, but you want to make sure you don’t wear one too soon after surgery or you could possibly push the implant out of its pocket and out of place,” says New York City plastic surgeon Tracy Pfeifer, MD.

After your plastic surgeon gives you clearance to wear any type of bra (usually after three weeks to three months or so), you should be OK to wear a push-up bra with an underwire, if you desire. “I don’t recommend my patients to wear one on a daily basis, but every once in a while is OK,” says La Jolla, CA, plastic surgeon Reza Sadrian, MD. 

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