Silicone breast augmentation is a cosmetic surgical procedure designed to enhance breast size and shape by inserting silicone gel-filled implants.
Ultimately, the patient’s decision considers several factors. Silicone implants provide a more natural look and feel. This is because silicone breast implants use a cohesive silicone gel that mimics the feel of natural breast tissue. With cohesive silicone gel breast implants, particularly the new Generation 6 implants, there’s also less likelihood of visible rippling and wrinkling. However, detecting ruptures may be more challenging, and the FDA recommends periodic monitoring through MRI imaging every several years.
Saline implants offer adjustability during surgery for baseline breast volume asymmetry, require smaller incisions, and have the advantage of prompt rupture detection as the saline solution is harmlessly absorbed by the body. For patients that require the use of their pectoralis major muscle (e.g. athletes), saline implants placed subfascial (above the muscle) may offer lifestyle advantages. However, some people complain that saline implants feel like “water bags” and, in thin patients, rippling of the implant may be visible.
In recent years, Ideal Implants have come on the market. These are saline implants that look and feel more like silicone. Read more about Ideal Implants.
Generally, there are two common locations to place the implant: above the muscle (pre-pectoral) and under the muscle.
Within the category of pre-pectoral placement (above the muscle) historically the approach was subglandular placement. However, more recently many surgeons such as Dr. Desrosiers have switched to subfascial placement when using a pre-pectoral approach.
In the traditional subglandular approach, the implant is positioned between the breast tissue and the chest muscle (the pectoralis). This may result in a shorter recovery time and less discomfort compared to submuscular placement. However, subglandular implants may be more visible, particularly in women with less breast tissue, and there is a slightly higher risk of capsular contracture (scar tissue formation around the implant).
Subfascial placement involves positioning the breast implant beneath the fascia, a thin layer of connective tissue covering the chest muscles. This placement combines some of the advantages of traditional subglandular and submuscular placement. Namely, it offers increased coverage and support for the implant, potentially reducing the visibility of rippling and palpability. Additionally, it aims for a more natural appearance while lowering the risk of capsular contracture compared to traditional subglandular placement. Moreover, healing may be quicker than submuscular placement.
The second approach is submuscular, or under the muscle, and involves positioning the breast implant beneath the chest muscle (pectoralis major). This offers several advantages, including maximum implant coverage and support, potentially reducing the risk of visible rippling and palpability. Submuscular placement may also provide a more natural-looking result, especially in women with minimal breast tissue or a thin chest wall. Additionally, it may lower the risk of capsular contracture compared to subglandular placement. However, it may result in a slightly longer recovery time and increased discomfort immediately post-op due to muscle manipulation during surgery.
We use Allergan, Mentor, and Sientra silicone implants.
Yes, when performing silicone breast augmentation, we use a device called a Keller Funnel. It’s similar in appearance to a cake icing bag. During surgery, the silicone implant is placed directly from its sterile container into this sterile funnel. The funnel is then inserted into the breast pocket, and gentle pressure is applied from the outside, much like squeezing icing onto a cake. This maneuver allows the implant to slide through the tip of the funnel and into its designated position within the breast pocket. This technique is essentially touchless, meaning it minimizes direct handling of the implant. Studies have suggested that touchless implant placement can reduce the risk of complications such as capsular contracture and infection. You can read more about Keller Funnels in the links below.
You can check our video on breast implant sizing. In brief, it depends on the patient’s aesthetic goals and, importantly, their underlying anatomy. Approximately 20 measurements are taken to calculate the range of implant sizes that will match your natural anatomy and then discuss this with you to achieve your aesthetic goals. The office also has hundreds of sizer implants and compression bras to help you gauge your final look.
The selection of breast implant profile involves a collaborative decision-making process between the patient and the surgeon, considering the patient’s anatomy and desired aesthetic outcomes.
High profile implants are characterized by a narrow base width relative to their volume. Compared to high profile implants of the same volume, moderate plus and moderate profile implants have a wider base width. High profile implants are often preferred by patients with narrower torsos to avoid the appearance of “side boob.” By choosing a higher profile implant, patients with narrower chests can achieve a more proportionate and balanced appearance, minimizing the risk of implants extending too far to the sides. Likewise, patients with a wider chest may achieve a more natural look by selecting a moderate plus or moderate profile implant to best match their natural frame.
Ultimately, the optimal implant profile depends on factors such as chest width, breast dimensions, desired projection, and the patient’s aesthetic goals, which should be carefully discussed and evaluated during the consultation with a board-certified plastic surgeon.
We have a whole separate post on this!
Commonly, Dr. Desrosiers recommends placing the breast augmentation scar in the inframammary fold (IMF). The IMF is where the breast meets the chest wall. Scars from IMF incisions are typically well-hidden within the natural crease of the breast, making them less visible.
Unless a breast lift is needed, Dr. Desrosiers often prefers to place the breast augmentation incision in the IMF for two reasons. First, the scar is well-hidden within the natural crease where the breast meets the chest wall. Second, this placement helps mitigate potential issues that can occur with circumareolar approach.
If there is hypertrophic scarring or keloid formation, it can be more painful in the nipple location as well as affect aesthetics more substantially. Likewise, circumareolar scars that are hypochromic (lighter than normal skin) or hyperchromic (darker than normal skin) do not color match the native areola. This gives a bullseye appearance. Also, a circumareolar approach has the inherent risk of possible injury to the nerve, leading to loss of nipple sensation, or more rarely hyper-sensation.
Because the IMF incisions are not easily visible, any of these wound healing issues can be revised with less psychosocial impact. Hyperchromic scars can be treated with lightening creams, scar gels, and laser scar therapy. Revising keloid scars in the IMF area is generally relatively straightforward.
It should be noted that for patients that require a simultaneous mastopexy or breast lift (or those patients who are looking for a revision and already have areolar scars) then the circumareolar scar is generally indicated.
Other less common incision placements include via the axilla (armpit) or the umbilicus (belly button). Dr. Desrosiers generally prefers IMF placement over transaxillary (through the armpit) or transumbilical (belly button) incisions for breast augmentation surgery.
While transaxillary and transumbilical incisions offer the advantage of hidden scars, they are less commonly chosen due to several serious limitations and many potential drawbacks.
First, one significant concern is the limited access provided by these approaches. This can hinder the optimization of final symmetry and aesthetic results. Second, not all types of breast implants are suitable for transaxillary or transumbilical placement. In other words, saline breast implants are likely the safest option when using these two approaches. Third, transaxillary surgery carries the risk of complications such as intercostobrachial nerve injury, which can have serious consequences.
It’s also worth noting that an IMF incision is often necessary when exchanging implants later in life, resulting in multiple sets of scars for some patients. Therefore, while hidden scars in the belly button or in the arm pit may appeal to some, the practical considerations and potential risks associated with transaxillary and transumbilical incisions should be carefully weighed in consultation with a qualified plastic surgeon.
The majority of women with breast implants experience no serious complications. The procedure has a 98% “Worth it Rating” on Real Self as of the writing of this article. However, there are some risks associated with breast implants, including infection, wound healing issues, and scarring, which are seen in any type of cosmetic surgery. More rare risks are breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), breast implant-associated squamous cell carcinoma (BIA-SCC) and systemic symptoms commonly referred to as breast implant illness (BII). The information below will help you better understand the association between these devices and their risks. You can read more about the risks and benefits of breast augmentation surgery here: FDA Website, ASPS Website.
Dr. Desrosiers understands that each patient is unique and requires individualized care. With his expertise and dedication to achieving exceptional results, Dr. Desrosiers is committed to guiding you through your breast augmentation journey with confidence and support.
To learn more about breast augmentation or to schedule a consultation with Dr. Desrosiers, please contact us at 305-403-2922 or concierge@ArthurMD.com.
Providing Cosmetic, Reconstructive, & Craniofacial Plastic Surgery in Miami and West Palm Beach.