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Surgery Details

Breast augmentation with implants requires an incision and placement of the implant either above or below the muscle.  Breast implants can be either shaped or round, smooth or textured, and saline or silicone.  “Gummy bear” breast implants are of the silicone flavor, and this term often is linked to the breast implant produced by the company Sientra.  Please see the following video further to explain these differences or the FAQ page.

The procedure is almost always performed under general anesthesia (meaning that the patient is asleep).  While it may be possible to perform a breast augmentation under local anesthesia with sedation or nerve blocks, the risks often outweigh the benefits regarding safety and cosmetic outcomes.

An incision will be made in most likely, right above the breast fold (termed inframammary) or around the areola (periareolar).  Less commonly, the incision may be placed in the armpit (trans-axillary) or through the belly button (TUBA “transumbilical breast augmentation).  It is worth noting here that only saline breast implants can be placed through a TUBA approach.  And, only small silicone breast implants can be placed through the armpit.  More information on breast augmentation incisions can be found in the video or FAQ page.

Most breast augmentations are performed with a submuscular approach (meaning that the breast implant is placed under the muscle.  The truth is, only about a third of the breast implant covers the implant.  This is because the pectorals major muscle is partially divided to allow room for the implant.  The extra padding by the muscle will help reduce implant visibility which can be seen as rippling.  It also has the added benefit of probably reducing capsular contracture.
Implants placed over the muscle are referred to as “sub glandular”. The downside to a sub glandular augmentation is that the breast implant ay be more visible in women with small breasts or thin tissues.  The advantage is recovery.  Because the pectorals major isn’t divided, women will be able to return to exercise a bit earlier, and the post-operative pain is less.  There are cosmetic issues to consider when it comes to over or under the muscle implant placement.  Choosing a board certified plastic surgeon with experience will help you decide what approach makes more sense for your body and lifestyle.