Please Help How Can I Choose a Right Procedure for Me? Saline Vs Silicon- Scars, Are They Visible? (photo)

F 32 years old, 5'4", 110 lbs no kids. A surgeon suggested for me saline, 400 cc- transumbilical and under muscle. As I saw his pictures and other surgeons I've notice more round shape of breast in the end which I'm hoping to have a tear drop shape also I can see the scar which is one my concerns in the belly button or other area. I've read and tried to understand better but still not sure whats right for me.

Doctor Answers 10

Silicone gel breast implants with the inframammary incision best option

Thank you for your question and photographs. Of course you should follow the advice of a board certified plastic surgeon who has examined you in person and done a thorough evaluation.

That said you are thin without a lot of breast tissue and the risk of visible folds with a saline implant are significant. This risk is lessened with silicone gel implants which also feel more natural.

The trans-umbilical approach requires saline implants and you may void the warrantees on your implants if this approach is used.

The inframammary crease incision is by far the most common incision use for breast augmentation and as the breast falls over the scar it is not visible must the breast is pulled up to reveal the incision.

If you're uncertain about the advice you've been given please consult other board certified plastic surgeons with experienced in breast augmentation.

Please Help How Can I Choose a Right Procedure for Me? Saline Vs Silicon- Scars, Are They Visible? (photo)

I would suggest a silicone implant if you were my patient. You are fairly lean and not a lot of breast tissue. And if you decide to go thru the belly button, I would really suggest that the doctor be trained in the use of the endoscope for more proper placement. I have seen many misplaced implants when done through the underarm and the BB without the endoscope.

John J. Corey, MD
Phoenix Plastic Surgeon
4.6 out of 5 stars 44 reviews

Saline or silicone gel?

There are essentially four ways  to put in implants:  transumbilical, armpit, under the breast, under the nipple.  There are two places where you can put the implants: under or over the chest muscle.  There are two types of implants on the market: saline and silicone gel.  There are numerous sizes and shapes to implants.  Each of these issues should be addressed by your plastic surgeon during your consultation.  As a plastic surgeon who has performed over 5000 transumbilical breast augmentations over the past twenty years, I think you would be an excellent candidate for this approach.  I would be sure to select a plastic surgeon who is certified by the American Board of Plastic Surgery and has a lot of experience with this approach if that is the way you want to go.  There are a lot of "cosmetic surgeons" out there who offer the transumbilical approach and do NOT do a good job with it.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 24 reviews

Implant selection

I would choose:

-anatomic implant (teardrop)

-submuscular (dual I-II)(behind muscle)

-inframammary incision

-silicone implant (cohesive gel; f.e. Allergan's "Soft Touch / TRU FORM 2")

-textured implants

In the other hand, photos are not quite good... I think that there is a slight asymmetry that will need to be corrected.

A proper exam with a board certified Plastic Surgeon will definitely give the correct decision.

Good luck!

Enrique Etxeberria, MD
Spain Plastic Surgeon
5.0 out of 5 stars 7 reviews


I would recommend a submuscular gel implant either cohesive gel or highly cohesive gel.  I have not found the scar to be much of an issue no matter where it is placed.

Todd B. Koch, MD
Buffalo Plastic Surgeon
4.7 out of 5 stars 35 reviews

Cosmetic Surgery is an Art and a Science

Thanks for the question. You have an asymmetry that will need some attention including 1 size difference on the implant size. Under ordinary circumstances, I advise patients to have implants placed behind the muscle. You can better discuss this issue with an exam by a board certified plastic surgeon in your area.Best Wishes Dr Thomas Narsete Austin, Tx 

Thomas A. Narsete, MD
Denver Plastic Surgeon
5.0 out of 5 stars 10 reviews


Based on your photos, you would have the best result with silicone gel implants.  The incision should be placed in the breast crease, or around the areola.  Seek consultation with Board Certified Plastic Surgeons to discuss your expectations and concerns.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 60 reviews


Saline are the only implants that can be placed  via the TUBA procedure.  I have done both through a tummy tuck procedure but it is for a limited patient population.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Best Implant for a very thin woman.

Dear Gabi, Thank you for your question and photos. You clearly have very low body fat, a small amount of breast tissue, asymmetry in your breast folds, as well as high riding folds. Since you have so little tissue, I highly recommend against saline implants. They will feel like water balloons under your tissue, even if placed under the muscle. Silicone is your best bet, and a shaped implant would be even better, given your desire for a natural tear drop shape. The best incisions for this would be in the breast crease or around the areola. No matter what, you will always have a scar, but it can be made a subtle as possible. Best Wishes, Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 47 reviews

Please Help How Can I Choose a Right Procedure for Me?

As a surgeon who has done quite a number of TUBA procedures, I would not recommend it for you because your folds are uneven. (Now that most patients choose silicone, I seldom do TUBA's.) Similarly I would not recommend incision in the axilla. Rather a direct approach that will permit some adjustment of the fold as needed is best--either an incision in the fold or around the areola.

With the modest amount of breast tissue you have, and the large implants you are considering, the silicone implants will give you a nicer outcome. That is another reason not to use the navel as incision site for you.

All incisions leave scars. Choice of scar for implants depends on patient and surgeon preference, and on patient anatomy. If one incision were really superior, we would not be discussing options at all. 

I would suggest getting one or more additional consultations.

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 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.