Which type of Breast Augmentation would you consider for me (incision site, placement and implant)? (photo)

I'm 35, 5'2", 140 lbs & 34/36A. I have seen 3 PS for a BA consult. All 3 recommended silicone. I like the natural feeling & touch of silicone vs. saline & that it doesn't ripple as easily. 2 surgeons recommended a crease incision & one nipple. Either is okay with me but crease might be best since I'd have silicone. Which placement is best for me - sub-facial, partial sub-muscular/dual plane, fully under muscle or sub-glandular? One PS recommended sub-facial and two recommended sub muscular. Help!

Doctor Answers 6

Sub Muscular Silicone Breast Implant Inframammary Crease Incision

Thank you for your question. Most plastic surgeons would agree that there is no 1 best breast augmentation technique. Breast augmentation must be planned according to the unique requirements of each individual patient.

That said, you are very fortunate that you have naturally shaped breasts with no sagging or ptosis. Today most plastic surgeons prefer to place breast implants beneath the pectoralis muscle, called a sub-muscular breast augmentation. The sub-fascial approach is perfectly acceptable but in my hands is a more complex procedure with some increased risk of bleeding, but that is just my opinion and other surgeons may disagree.

Most patients and plastic surgeons today prefer silicon gel implants because they have a more natural feel and are less likely to have visible folds or wrinkles than are saline implants.

Generally speaking silicone gel implants are easier to place more accurately through the inframammary crease incision which provides much more visibility for your surgeon, can more easily accommodate placement of the silicon gel implants preferably through a Keller Funnel, and the incision is well hidden as the breast gland falls over the incision after healing. In my opinion there is more trauma to the skin when trying to place a silicone gel implant through a trans-areolar incision which by definition is typically smaller than the inframammary crease incision.

Be aware that your left nipple areola is more to the side than on the right and this may be more apparent after surgery. Ask your surgeon if he or she can compensate for this asymmetry during surgery.

It is most important however that you choose the plastic surgeon that you feel more comfortable with and feel that you can trust to take care of you during and after surgery.

Your surgeon should be certified by the American Board of Plastic Surgery, be experienced in breast augmentation surgery, and have a very good reputation in your local community. Finally I always feel it is important to trust your gut feeling about your surgeon and be comfortable emotionally with the surgeon that you choose.

My recommendation:

While there are several potential ways to perform this surgery, I think that the dual-plane approach via an inframammary (crease) incision has a lot of advantages, which are described in the plastic surgery literature.  That's what I would recommend for you.  We also use the Keller funnel, and offer our patients a selection of implant types from all 3 FDA-approved manufacturers.  
Choose a Board-certified plastic surgeon with whom you have a good rapport and strong feeling of trust - and who has post-op result photos that you like.

Thomas Fiala, MD
Orlando Plastic Surgeon
4.9 out of 5 stars 80 reviews

Breast augmentation with circumareola lift

I recommend a circumareola approach because you have poor cleavage and your nipples are pointing outward. Using this technique (not Benelli) it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage. Through the same incision, implants can be placed. Aligning the areola, breast tissue and implant over the bony prominence of the chest wall maximizes anterior projection with a minimal size implant. Small round textured silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision. At size 34 A each 100 cc’s of implant corresponds to 1 cup size change. From this, you can compute the volume require to achieve your desired size. Best Wishes, Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

Implant questions

Good questions. First, choose the plastic surgeon whom you trust the most and with whom have developed the best rapport. I like silicone gel implants more than saline as they are softer, and more natural feeling and appearing. I would doubt that your areolas are large enough to use to place a gel implant, even while using a Keller funnel, which I always use.

Best approach for breast implant surgery

I have always said that if you want 10 different opinions, then ask 10 different plastic surgeons. There are many options and choices when it comes to breast implant surgery. Here are the 4 basic questions that need to be answered:

  1. Incision location (inframammary, peri-areolar, trans-axillary and umbilical)
  2. Location of implant (above or below the muscle)
  3. Type of implant (saline, silicone, form stable silicone, smooth, textured, shaped)
  4. Size of implant

Of the above mentioned decisions, the most difficult to choose is the size. I have found after placing over 10,000 breast implants that NO ONE complains about the incisions/scars, but EVERYONE complains about the size!!!

Based on your photographs, I would place the implants totally under the muscle, recommend silicone, although saline would be OK, and choose the incision you and your plastic surgeon feel most comfortable using.

Now, choosing the size is trickier. You need detailed measurements and photographs to determine your breast "footprint" to help decide which size and shape of implant would be best for you. I would look at hundreds of before and after pictures of other women who look like you, to see what they chose. Then, you should try on sizers and different tops/blouses to decide what look would be best for you. Something in the 400 cc range would probably be appropriate for you. Choose the plastic surgeon you feel most comfortable working with, who understands your concerns and has a support staff that relates to you.

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 75 reviews

What to choose for a breat Aug?

Good question, I agree silicone much better in feel and longevity than saline, with your age and your breast shape I highly recommend a dual plane technique, gives you the best of both worlds, the longevity and coverage of under the muscle and the projection and fullness of above the muscle....I do not agree with subfascial placement.

Good luck and choose your surgeon wisely and make sure they have reviewed the "options" in implant size and profile.

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 87 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.