Breast augmentation surgery with either saline or silicone implants is the most commonly performed cosmetic operation in the United States. This surgery is designed to enhance both the size and shape of your breasts with the insertion of implants either beneath the breast tissue or the underlying chest (pectoralis) muscle. During your consultation, Dr. Hu will need to make several decisions based upon your specific needs, aesthetic goals, and anatomy.

Breast implants are made with an identical silicone shell but filled with either saline or silicone. As the implant becomes larger in volume, it also becomes wider and projects out further from the chest. This fact is missed by many patients and must be taken into consideration to get the best results.

There are pros and cons to each implant. The saline breast implant comes empty and is filled with saline (salt water) during the surgical procedure. This allows for the incision to be slightly smaller (about 1 inch), and the implant is inserted empty. The implant has a more dramatic appearance and can produce a bit more “showy” of a result. There is a higher risk of the edge of the implant being visible and postoperative “rippling” with saline implants.

Silicone breast implants are pre-filled with a silicone gel and are manufactured in standard size increments. The silicone implant requires a slightly larger incision (1/2 an inch larger) as it must be put in its proper location completely full. However, these implants tend to feel more natural and behave more like a natural breast. These implants are almost undetectable and have a very low incidence of postoperative visibility or “rippling”. Any patient considering a more “natural” result should consider a silicone implant as it achieves this goal much more consistently than its saline counterpart.

Incisions

The breast implants can be inserted through several different approaches. The most commonly requested incisions are through the breast crease or around the areola (the pigmented part of the nipple). The advantages to the breast crease incision is that the incision is hidden beneath the breast and not usually visible from the front. Areolar incisions are hidden in the color change where the breast skin meets the more pigmented areola and, once healed, are almost invisible. Less frequently women elect to proceed with an axillary (arm pit) approach to prevent any visible scarring near the breast. However, in sleeveless tops or tanks, there is the possibility of visible scarring.

Above or Below the Muscle

The role of the chest muscle in breast augmentation surgery is to help camouflage the saline or silicone breast implant. Most women who are looking to have a breast augmentation are missing enough breast tissue to effectively “hide” the implant from being obvious. We commonly use the chest muscle (pectoralis major) to help soften the look of the implant to make it appear more natural. If, however, you have at least a large B to C cup breast, there is enough of your own breast tissue to effectively hide the implant without using the chest muscle. The advantages of this approach are that the recovery is better tolerated, and there is no risk of movement of the implant with the contraction of the muscle – again adding to a natural postoperative appearance. However, most women who are looking to have a breast augmentation do not have enough breast tissue and must have the implant placed under the muscle.

Implant Size

This is often the most challenging decision of the entire process. The key to choosing the “right” implant is communication between both of us. During the consultation, I will perform a full exam taking note of the size of your breasts, symmetry, breast tissue, skin elasticity and specifics about your chest. Additionally, I will take a number of measurements of your both your chest and breasts. This helps me determine which implants will be appropriate for your specific anatomy. The key measurement is how wide your breasts are as our goal is to augment the entire breast – not choosing an implant that is too wide nor too small. We need to find a specific implant that fits both your anatomy as well as your aesthetic goals.