Breast augmentation techniques vary from patient to patient because each one has unique underlying anatomies (i.e., soft tissue coverage and body frame) and cosmetic goals from the surgery.
Nonetheless, a recent survey published by journal Plastic and Reconstructive Surgery shows that certain techniques and breast implant designs are favored by many board-certified plastic surgeons.
The survey was based on the answers of more than 1,000 board-certified plastic surgeons who were asked to fill out an electronic questionnaire.
The survey has shown general agreement in several breast augmentation techniques, which are explained below:
* The inframammary fold incision site is the most preferred entry point. Aside from the precise visibility that minimizes risk of asymmetry, its popularity is also linked to favorable scars as they are hidden within the natural fold of skin.
A good number of patients also need their breast crease to be slightly readjusted, which makes the inframammary fold technique an ideal choice for many.
* The submuscular technique is the most recommended implant placement. Proponents suggest that positioning the implants behind the thick layer of muscle is one effective way to minimize palpable rippling, scar capsule formation (capsular contracture), and unnatural contour.
Meanwhile, placing the implants above the muscle—so only the breast tissue and skin cover and support them—has become a less popular choice because of the increased risk of rippling, especially in small-breasted and thin women.
* Silicone breast implants are the most popular choice. They provide a more natural result and feel than saline implants because of their cohesive filler material, making them an ideal choice for women with little breast tissue to begin with.
Silicone implants that come in smooth surface and round shape (or more like a flattened sphere) are believed to further make the result look and feel natural.
Meanwhile, teardrop implants, which always have a rough or textured outer shell to prevent rotation, are less popular because of the increased risk of palpable rippling and asymmetry if they flip over.
In addition, the most popular breast implant size range is between 300 and 350 cc, as suggested by the survey.
* Recent technologies. Despite the growing popularity of 3D imaging technologies in plastic surgery that allow patients to preview their possible results, they are not commonly used by breast augmentation surgeons.
Also, the respondents do not routinely use fat grafting, either as an adjunct procedure of breast implant surgery or as a stand-alone augmentation technique.
Breast augmentation cost greatly varies from patient to patient, although using silicone implants instead of saline implants can make the surgery about $1,000 more expensive. The use of Exparel injection, pain pumps, and other supplemental devices that give patients a comfortable recovery can also add up to the price.
According to some Upland plastic surgery experts, as of this writing the average cost of breast augmentation is $6,500. However, some patients may expect to pay as high as $14,000 especially if they are having adjunct procedures (such as breast lift) and/or their surgeons cater to high-profile individuals.
Meanwhile, more than 70 percent of breast augmentation patients today are choosing silicone implants due to their more natural results and feel. But due to their higher manufacturing cost, they are more expensive than the saline implant, which are only inflated with a sterile salt and water.
Aside from the higher cost of silicone implants, they also entail MRI scan at least every two years to detect asymptomatic or “silent” leak. Most patients can expect to pay anywhere $1,000-$2,000, which most insurance issuers will not cover unless the patients have had their implants after a cancer surgery followed by breast reconstruction.
A regular MRI scan is not prerequisite for saline implants because in the event of leak the problem is immediately visible, with the affected breast appearing smaller than the other one.
Despite the lower cost of saline implants, their price should not influence the patient’s decision, especially if the goal is to achieve optimal results. It is important to note that women with little soft tissue to begin with are poor candidates for these implants because of the increased risk of palpability and rippling.
Aside from the upfront cost of surgery, patients who wish to augment their breasts with implants should expect revisions in the future. According to several studies, these medical devices can last an average of 10-15 years.
Most US breast implant manufacturers today offer 10-year or even lifetime product warranties. Nevertheless, the patient should still pay for other things such as anesthesiologist and surgeon’s fee, operating/recovery room fee, follow-up office visits, and postop supplies (dressings, painkillers, garments, etc.).
A prudent patient should never shop for the lowest breast augmentation cost, which does not always equate to good value. In most cases, a price that is significantly lower than the average means some unacceptable compromises that increase the risk of infection and poor cosmetic results.
The goal of any prudent patient is to find a qualified plastic surgeon—i.e., board certified by the American Board of Plastic Surgery and other reputable affiliations—who performs breast augmentation on a regular basis.
Most breast augmentation scars after one year are barely detectable, especially if they remain in discreet areas such as within the submammary fold, around the areola’s perimeter, and inside a skin fold of the armpit.
Most incisions used in breast augmentation measure between 2-4 cm, with saline implants typically resulting in shorter scars than silicone implants because they are implanted into the pocket empty before they are inflated with sterile salt water.
In the first 2-3 weeks postop, there is a risk of wound breakdown that makes it important to avoid excessive tension or force. For this reason, patients are generally advised to avoid rigorous physical activities, heavy lifting, and underwire bra which could dig into their submammary fold incisions without them even knowing it due to temporary numbness.
Wound breakdown must be avoided because it often leads to poor scarring—i.e., raised or reddish scars.
To further protect the wound from excessive force, most Orange County plastic surgery experts recommend steri-strips during the initial healing phase. They work by holding both ends of the incision together and removing unnecessary tension on the skin, leading to fine scars.
At three weeks, most patients can shift to silicone sheets, which some studies have suggested to result in great patient satisfaction. Aside from hydrating the skin, they also prevent excessive collagen formation that is responsible for the appearance of thick, raised scars.
Contrary to popular belief, creams and lotions containing vitamin E have no or very minimal effect on scar appearance. Some people may even develop allergic reaction from these products, which could lead to unfavorable scarring.
Scar massage is another modality that has excellent clinical results. It is often started when the incisions are sealed, which happens at around three weeks.
Scar massage, which is often combined with other modalities such as silicone sheets and creams, typically involves stretching the skin around the scar in a parallel direction or applying direct pressure to the scar tissue.
Meanwhile, reddish scars tend to respond better with certain types of laser treatments, which could also improve keloid or raised scars. Treating a small scar may cost $300-$600 per session, with most patients requiring at least four sessions to see a noticeable improvement.
Most breast augmentation scars after one year are imperceptible, assuming that the patients do not encounter infection and stick to their plastic surgeon’s postop instructions.
The breast implants lifespan, according to long-term surveys, is between 10-15 years for most patients. However, the need for reoperation is not just caused by implant failure from “wear and tear,” but also due to a desire for larger size, changes in body weight or breast shape, and rippling.
Some doctors suggest that extending breast implants lifespan, to some extent, can be done through the use of certain designs, which are explained below by experts at the California Surgical Institute.
- Smooth silicone implants—i.e., they are filled with a highly cohesive silicone gel and their outer shell is literally smooth and shiny—are believed to have a lower leak rate than textured and saline implants, which are filled with sterile salt water.
Saline implants are more likely to fold than silicone implants due to the nature of their filler material. Over time, this “wrinkles” affect their stability and can lead to failure.
- Fifth generation silicone implants. Also referred to as gummy bear implants, they have form-stable silicone filler, which does not respond to gravitational effects. But once inside the breast pocket, they are supposed to feel natural and soft to the touch.
Gummy bear implants are believed to last longer than fourth generation silicone implants (liquid type silicone gel) and saline implants.
According to one study, Sientra gummy bear implants have the toughest shell among other brands.
Regardless of the filler material, outer shell, and manufacturer, the consensus is that modern breast implants have notably lower rupture rate compared with previous designs. In fact, anecdotal reports show that the vast majority of patients asking for replacement have non-implant related concerns.
For instance, aging may cause the breasts to sag or the implant’s edges to become visible, which may prompt some women to “downsize” and/or replace their saline with silicone implants.
However, others choose to “upsize” after realizing that their initial implant size no longer complements their now “curvier” or larger body frame.
Palpable rippling is another reason for replacement of implants that are still in good working condition. To address this problem, saline implants might be replaced with silicone implants that are resistant to wrinkles; or downsize to compensate for the lack of soft tissue coverage.
Another way to avoid reoperation is to eliminate factors linked to capsular contracture (scar capsule) such as low-grade infection or contamination at the time of surgery. Daily breast massage is also said to prevent this problem.
The appearance of cleavage after breast implants is primarily determined by the underlying anatomies, particularly the preoperative placement of each breast and chest shape. For this reason, plastic surgeons can only do so much.
If the breasts are inherently positioned far apart from each other, the implants will only increase their volume, so to a certain degree the cleavage may appear fuller. However, it requires at least a C to D cup augmentation to achieve such goal.
Nonetheless, the use of a good support bra remains the best solution for wide-spaced breasts.
Inexperienced doctors sometimes commit a mistake of releasing too much muscle in an attempt to place the implants closer to each other. But this approach has a high failure rate because the chest wall remains unchanged, and it often results in uniboob, or more accurately referred to as symmastia deformity.
To avoid symmastia and other deformities caused by implant displacement, it is important to work within the anatomical limits.
If there is a desire to achieve more cleavage, the subglandular technique might help to a certain extent. It involves placing the implants above the chest muscle, allowing the breast to “stick out” more.
The subglandular implant placement provides more fullness in the upper breast poles compared with the submuscular in which the device lies beneath the muscle.
However, some women find that excessive fullness in the upper breast poles does not look natural, so a good option is to use the submuscular technique.
While the subglandular technique provides more cleavage and allows the breasts to stick out more, it increases the risk of palpable and/or visible rippling, especially in thin or small-breasted women. Also, it is not advisable for saline implants because they are firmer to the touch and are susceptibility to folds, as they are only filled with sterile salt water.
Silicone implants, meanwhile, are filled with a highly cohesive form of silicone gel that behaves and feels like the breast tissue. For this reason, even after placing them above the muscle they could still provide natural-looking results.
Aside from cleavage, a good number of patients also want to achieve a slight lateral bulge, which contributes to a more feminine and curvier silhouette.
Furthermore, it is important that the implants lie approximately at the center of the nipple-areolar complex to achieve a more natural or teardrop shape in which most of the volume is in the lower poles of the breast, as suggested by Upland plastic surgery experts.