3 Considerations for Breast Augmentation

When women considering breast augmentation in Seattle ask me about their options, they have three typical areas of concern:

  • Type of implant
  • Implant size
  • Placement of incision

Some surgeons focus on only one of these concerns, approaching breast augmentation as if only the type of implant needs to be discussed with the patient. Others may focus on the implant size without spending as much time to review the other considerations. However, as a board-certified plastic surgeon, I believe in the importance of taking the time to personally meet with each patient, discussing all three decisions and customizing a treatment plan that takes into account that patient’s unique needs and cosmetic goals:

Type of implant: Selecting between a saline or silicone gel model requires an understanding of the relative risks and benefits associated with each device. Saline implants are filled with the same sterile saline solution that is used in IV fluid, and if they leak, the saline is harmlessly absorbed by your body. The newest generation of silicone gel implants appeals to women who prefer the softer, more natural look and feel that gel implants can provide. Although the new generation of gel implants are much more durable, these implants do have a small but recognized leak rate. If a gel implant leaks, the gel is not absorbed and will end up on the inside of the capsule that your body forms around the implant. You body may react to that gel by developing capsular contracture. Fixing a leaking gel implant will require removal of that capsule, as well as replacing the implant. Consequently, repairing a leaking gel implant will involve more surgery and greater expense than replacing a leaking saline implant. So there are long term trade-offs for the benefits that a gel implant can provide

Implant Size: In many cases, women want augmentation because they are dissatisfied with the current size of their breasts. In some situations, however, my patients seek breast augmentation because of changes such as pregnancy or weight loss that have resulted in loss of fullness, particularly in the upper part of the breast, and they may not wish to be significantly larger. We begin by measuring the width of your native breast tissue, which serves as a starting point in picking an implant that is proportionate to your frame. We then use gel implant sizers, placed in a bra, to choose an implant that meets the patient’s goals. We find this a very effective way to decide on the final implant size, and almost never have patients return wishing to change their implant size.

Placement of incision: Most commonly, breast implants are inserted through an incision in the skin crease below the breast (the inframammary fold), or at the border of the areola. Another technique involves inserting the implant through an incision in the armpit using an endoscope to create the pocket. Belly button incisions are not used because they are too distant from the breast and do not allow for accurate creation of the implant pocket, which is an essential part of achieving a cosmetic breast shape. In addition, gel implants cannot be place through the belly button approach.

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