Breast Augmentation

The Center for Cosmetic & Reconstructive Surgery

Breast enlargement procedures, also called augmentation mammaplasty, are one of the most common body sculpting procedures performed today.

Enlargement of the breasts not only can make the breasts fuller and more youthful looking, but it has the additional benefit of bringing the rest of the body into more pleasing proportions, making the waist and hips appear smaller in comparison.

There are a number of different options available in modern breast augmentation procedures, including options for the type, size, and shape of implant, placement of the incision, and placement of the implant. Each procedure is unique, and is custom designed to meet the needs and goals of the patient.

Choosing an implant

Most implants in general use are constructed of a gel-like outer shell made of silicone, which is filled with a sterile saline solution, to replicate the look and feel of the natural breast. The outer shell portion of the implant is also called the lumen.

There are a number of options available for breast implants today, including:

• Implants consisting of a single lumen, and double lumen implants.
• Implants that are pre-filled with a measured quantity of saline, and those that are inserted, and then filled once the implantation is completed. Double lumen implants may have one pre-filled lumen, and a second lumen that is filled during the procedure.
• Implants with a smooth outer surface, or those with a textured surface.
• Round implants, or teardrop shaped implants.

Choosing an incision

There are a variety of different techniques available today for breast augmentation mammaplasty, each of which has its unique benefits and limitations. What type of incision you choose might depend on other factors, such as the type and placement of implant you've chosen.

Primary types of incision available include the following:

• Periareolar incision.

  A periareolar incision is an incision made around the areola, or the darkened area of skin surrounding the nipple. An areolar incision allows the surgeon to insert and position the implant directly. Any scarring following an areolar incision is obscured by the changes in color and texture of the skin in the area.

• Inframammary incision.

  An inframammary incision is made along the crease along the underside of the breast. The inframammary incision allows the surgeon to directly access the breast area, to place and adjust the implant with precision. Because the incision is located in the crease beneath the breast, any scarring should be obscured from view.

• Transaxillary incision.

  A transaxillary incision is an incision made under the arm, or in the armpit. A transaxillary incision can be used for either an open procedure-meaning a procedure in which the surgeon directly accesses the site-or as endoscopic surgery. Endoscopic surgery is performed through a thin, flexible metal scope, which allows the surgeon to work on remote areas. Scarring from a transaxillary incision will be located in the underarm area, where it is both obscured from view and remote from the implant site.

• TUBA incision.

  A TUBA incision, or Trans-umbilical Augmentation incision, is made inside the navel. The implants are then placed using an endoscope-a thin, flexible metal tube-allowing the surgeon to access the site remotely. Scarring from a TUBA incision is located entirely inside the navel, and should not be visible.

Choosing an implant placement

Breast augmentation mammaplasty procedures also provide several options for placement of the implant, each of which involves tradeoffs of convenience, recovery time, and aesthetic issues.

There are three general placements available for breast implants: Subglandular, submuscular, and subpectoral.

• Subglandular placement.

  Subglandular placement of breast implants means that the implant is placed beneath the mammary gland, but atop the muscle wall along the chest. This type of placement is the least invasive, and subsequently involves a somewhat shorter healing time. However, in some cases, particularly when there isn't sufficient breast tissue to cover the outline of the implant, it may result in more palpable implants.

• Subpectoral placement.

  Subpectoral placement of breast implants means that the implant is placed beneath both the mammary gland and the pectoralis major muscle, at the top of the implant.

• Submuscular placement.

  Submuscular placement of breast implants means that the implant is placed beneath the mammary gland, the pectoralis major muscle at the top of the implant, and beneath other minor chest muscles at the bottom of the implant. This placement completely covers the implant beneath both the soft tissue and the muscle of the chest.

Evaluating your augmentation options

As you can see, there are any number of interdependent factors involved in decisions about your augmentation procedure. Certain types of implants work with certain types of implant placements and incisions, and practical and aesthetic decisions must be carefully weighed on any of a number of issues.

These decisions can certainly appear overwhelming at first, so if you're considering an augmentation mammaplasty procedure, it is often easiest and most effective to do so in direct consultation with a qualified and experienced augmentation surgeon such as Dr. Kotis, who can guide you through the decision making process and help you determine what solution is right for your own needs and goals.

Frequently Asked Breast Augmentation Questions