Patients are often surprised by the choices and considerations they’re faced with when considering a Breast augmentation. Looking at your breasts the way a doctor does can be an emotional event full of new information which may be hard to process.
However, it is essential that you and your doctor are on the same page regarding the type of implant and surgical approach that will be used. After the initial consultation, I prefer to see all of my patients one more time to be sure that we have answered all of the questions.
Here are 7 questions you should discuss and answer before having your breast augmentation procedure:
1) Saline or silicone?
There are two main types of breast implants, saline and silicone.
Saline implants are silicone shells that are inserted empty and then filled with sterile saline after they’re placed into your breasts. Silicone implants are inserted into the breasts in their full gel form. More than 90% of my patients choose silicone implants since they definitely have a more natural feel.
If a patient is also having a Breast lift with implants, I strongly recommend silicone implants over saline. For more information about how silicone stacks against saline, read my blog post where I discuss saline vs silicone Implants in much greater detail.
Silicone implants are safe and if you have any doubt please read more about silicone implant approval history with the FDA.
2) What size implant?
This is perhaps the biggest consideration in the minds of most women. Your breast size after surgery depends on two things: how big you were before surgery and the volume of the implant inserted.
Breast implant volume is measured in CC’s (30cc = 1oz). The most popular implant size is 425 cc. To get a general idea of you how might look with 425 cc implants right from home, place 42 ounces of water in a freezer bag and place that in the lower part of your bra.
During your consultation, your plastic surgeon should let you try on actual implants by placing them inside your bra. Bring different shirts to your consult to help make this decision.
3) High profile or moderate profile?
Although implant volume is important, the shape of the implant is just as important. Most women want to be sure their breast augmentation procedures leaves them looking proportionate.
A good proportion is not only determined by the breast implant size, but also by the shape of the implant as compared to the size and shape of her chest wall and torso.
The choice of moderate vs. high profile has a lot to do with your anatomical chest frame dimensions. For example, if you have a really narrow chest, the round moderate profile implants may be too big of a diameter for your chest wall. You may need the high profile oval shape, which is less wide.
The choice of implant will also affect the type of breast augmentation cleavage you get from your procedure. See moderate profile vs high profile implants to learn even more.
4) Textured or smooth implants?
Some implants have a textured surface while others have a smooth surface. A smooth implant is softer and able to move more freely than a textured implant.
For the past 20 years, the trend has been to go with smooth implants. I use smooth implants in most of my cases, and recommend textured only in rare instances. Some textured implants from Allergan had a voluntary recall in 2022.
5) Under or over the muscle?
Breast implants can be placed over the muscle or under the muscle. Below the muscle, as it is commonly referred to, is actually a partial insertion of the top part of the implant under the pectoralis major muscle.
99% of the time I recommend placing implants under the muscle because it gives the most natural look and the best long term result.
When the implant is placed under the muscle, I highly recommend a pain pump or exparel injection. It is just too painful post operatively to not have this extra pain control.
With either a pain pump or exparel injection, the implant under the muscle is more easily tolerated in the immediate post op period.
6) Where to have the incision?
There are several types of breast augmentation incisions used by plastic surgeons including the inframammary incision, the infra areolar incision, the axillary incision and even the TUBA incision.
There is not one best incision for all breast augmentations. Every case is individualized based on the patient’s specific choices and objectives.
Most patients with a preference have based their opinion on someone they know having had that type of incision and either liking, or not liking, the way it looks.
The truth is, every type of incision has its pros and cons. To learn more, read my detailed explanation of the types of Breast augmentation incisions.
7) With or without a breast lift?
If you have sagging breasts and a loss of fullness in the top portion of your breasts, you may benefit from having a breast lift in conjunction with your breast augmentation. Often, with age and particularly after pregnancy, the breast skin is stretched or the nipple begins pointing downward.
For those patients, who wish to achieve the fuller appearance with better cleavage, I recommend getting breast augmentation with a breast lift.
If you only need a small lift, watch my Breast lift video where I discuss how the crescent mastopexy gives excellent results and very little scars.
To determine if you may be a candidate for a breast lift without augmentation, see After pregnancy: Breast lift or Breast augmentation?.
Want to learn more? See me explain and discuss these decisions live in this Breast augmentation video.
Ready to Take the Next Step?
If you’re considering breast augmentation, I’d love to help you make the best decision for your goals.
Schedule a consultation with me to discuss your options, ask questions, and get expert guidance.
(originally published on Nov 29, 2010)
