Silicone gel? Gummy Bear? Highly Cohesive? Saline? Round? Anatomical? Teardrop? Smooth? Textured? There are many choices when it comes to breast augmentation surgery and breast implants. Not only do we have choices for the implants themselves, but there are also choices around techniques to inserting them, as well as where the incision site will be placed. We have subglandular, subfascial, and submuscular positions which can be combined with transaxillary (in the underarm), periareolar (between the pigmented skin around the nipple and the normal breast skin), and inframammary (in the fold underneath the breast). But we’re not done yet . . . you also have to decide what size of implant you want, and in some cases, whether or not you need a breast lift. There are so many options when it comes to breast augmentation with implants that the choice may seem overwhelming.
But do not despair…when working with a board certified plastic surgeon, getting to the best choice can be a lot easier than you might imagine. The process starts at the beginning of the consultation. Your surgeon should listen to your ideas, goals, and concerns, and then follow-up with a physical examination that will evaluate the volume of your natural breast tissue, the dimensions of the breast, the tightness of the skin, and the position of the nipples. These factors will guide your surgeon toward recommendations that he or she can discuss with you. For instance, the width of the chosen implant needs to match the dimensions of your breasts. The size of the implant needs to fit with your frame and your aesthetic goals. The shape of the chosen implant helps determine the appearance of the upper part of your breasts.
To see how this all works, let’s think through a couple of scenarios together. First, let’s say the patient is thin, the areola and the breasts are quite small, and the soft tissue in the upper part of the breast is very thin. In this case, because a submuscular implant is less likely to show ripples, the surgeon would likely recommend a submuscular implant placement. If the patient wants a fuller upper pole of the breast, a round implant may be chosen, but if she wants a more subtle, smooth transition between the chest and breast, a shaped implant (“anatomical” or “teardrop”) would be the way to go. And since the areola are small and anatomical implants need a bit bigger incision, placing the scar under the breast would be a better choice.
On the other hand let’s consider a different scenario, this time in a patient who is a bit heavier with moderate thickness of the soft tissue of the upper breast and normal sized areola. In this case, the implant could be placed on top of or underneath the muscle, as the thickness of the tissue will hide the implant nicely either way. The shape of the implant also becomes less important with thicker tissue, as the natural breast shape will have a greater effect. Therefore, a less expensive round implant may be preferable. Although this patient might also be a candidate for a saline implant, with the improved designs of silicone gel implants over the years and with a large amount of data showing the safety and efficacy of silicone gel breast implants, the vast majority of women in our practice are choosing silicone gel implants even in this situation. Silicone gel implants of all types tend to feel more natural, look more natural, and are less prone to produce visible waves and ripples than saline implants.
In making your choice of implants, one technology that has proven to be very helpful and popular with patients is 3-D computer imaging. In this process, an array of cameras take a picture of your chest and then an avatar of your chest is produced in the computer. Because the cameras and computers can calculate distances and volume, it ultimately allows the user to simulate different brands, sizes and shapes of implants on an image of your own body. This helps you choose not only the size of the implants that will fit you, but it also helps you see how different styles of implants might look. Of course, this is a simulation only and you cannot be guaranteed that your final result will look exactly the same. However, studies have shown – and our experience has confirmed – that this is a very helpful tool to help patients make choices.
So in the end don’t let yourself be overwhelmed by choices. Come in for a complimentary consultation with one of the board certified physicians at the Emory Aesthetic Center. We’ll help you understand your choices and choose a great implant and technique specifically designed for you.
About Dr. Eaves
Dr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.
His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).
Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.