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Dr Tim Neavin

The Techniques of Breast Augmentation Surgery

Woman breast, closeup. Plastic correction and surgery concept.

According to the American Society for Aesthetic Plastic Surgery in 2018, over one billion dollars was spent on silicone breast implants. Breast augmentation continues to grow in popularity.

In 2018 there were 313,735 breast augmentation procedures. That’s a 4% increase from 2017.

But there are different breast augmentation techniques plastic surgeons can choose from. Which approach and technique is a decision the plastic surgeon and their patient make together.

However, it’s important to have a good understanding of each technique before you walk in for your appointment. Keep reading to learn the various breast augmentation techniques available today.

The Four Basic Techniques for Breast Augmentation Surgery

According to the American Board of Cosmetic Surgery, there are four primary techniques for breast augmentation.

  1. Inframammary
  2. Peri-areolar
  3. Trans-axillary
  4. Transumbilical

Each one has its own advantages and disadvantages.


With the inframammary procedure, a small incision is made in the fold underneath the patient’s breast. This is known as the inframammary fold.

Advantages of Inframammary

The advantage to the inframammary technique is that the incision lets the surgeon gain a wider access point in order to insert the implant with greater precision. While the scar is usually one to two inches long, it can be concealed under the crease of the breast.

This technique allows for minimal effects on the milk-producing areas of the breast. Also, if complications arise or more surgery is required, surgeons can use the same incision.

Disadvantages of Inframammary

There may be a slight increased risk of “bottoming out” using this incision. Also, the scar is not camouflaged as it is for the peri-areolar incision.


When surgeons use the peri-areolar technique, it requires an incision to be made near the outer edge of the patient’s areola. This procedure allows the scarring to be less noticeable thanks to the natural pigmentation of the areola and breast.

Advantages of Peri-Areolar

Surgeons prefer using the peri-areolar technique if they’re also performing a breast lift during the same procedure.

And women with very small breasts who do not have any fold under their breasts also prefer this method.

Disadvantages of Peri-Areolar

Women may experience problems with breastfeeding and a lack of nipple sensation following surgery. However, this is exceptionally rare. The main disadvantage is scarring. Some paients heal wonderfully. Others with darker skin may form darker scars which are more difficulyt to hide than the inframammary scars.


During the trans-axillary procedure, a small incision is made under the patient’s armpit. The surgeon then inserts the breast implant through this opening using special surgeon instruments and a camera to ensure proper implant placement.

Advantages of Trans-axillary

While there is a small scar at the point of the incision, the breast itself stays scar-free.

Disadvantages of Trans-axillary

It’s often difficult with the trans-axillary approach to get the symmetrical implant properly position. It’s possible additional incisions may need to be made to correct the issue after surgery.

There is also the potential for thickened scars that may be visible when wearing bathing suits, sleeveless clothing or when the patient raises their arms.


As the name suggests, a transumbilical procedure means that an incision is made above the navel. The implants are then inserted through the incision and moved up to the breast.

This procedure is only available with saline implants.

Advantages of Transumbilical

This procedure leaves a small single scar but like the trans-axillary technique, leaves no scars on the breasts.

Disadvantages of Transumbilical

Implants using this technique have a slightly increased chance of damage. A surgeon may need to tunnel under one of the muscles.

Also, if you require additional surgeries or experience complications, the surgeon may need to make additional incisions closer to the breast. Since the transumbilical approach is more prone to potential problems, manufacturers of implants may not honor the warranty on the implant.

Plastic Surgeon Preferred Techniques

Plastic surgeons have their own preferred techniques. They base it on a variety of factors.

Implant Type and Placement

Most surgeons prefer round-shaped implants vs anatomically-shaped (teardrop) implants. Surgeons also prefer using silicone implants because they have a smooth surface rather than the more textured surface saline implants have.

Surgeons also widely prefer using the inframammary method as well as placing the implant under the muscle.

Size of Implant

When it comes to making an assessment on the best implant size for each patient, surgeons still rely on lower technological methods. However, some have recently begun introducing 3D imaging techniques to properly size their patient.

Most implant sizes range from 300 to 400cc. This translates into about 2 cup sizes.

Grafting Fat

Fat grafting has gained some attention in recent years but some surgeons feel it poses potential safety issues. While it does not increase the risk of breast cancer, it may interfere with breast cancer screenings.

Fat grafting, which is transferring fat to the breasts from somewhere else on the body is not routinely performed since breat implants have a very good safety profile and generate far more predictable outcomes.

Biomaterial Technologies

While many surgeons are still cautious about both fat grafting and 3D imaging since results almost never look exactly like the images, they are more enthusiastically embracing a new technique. It’s a biomaterial called acellular dermal matrix.

Acellular dermal matrix is a class of synthetic, biological, and composite scaffold materials. They are used to replace and augment missing or deficient soft tissue and skin. These products may be used to correct rippling or implant bottoming out.

Types of Implants

Patients also have choices when it comes to the style of implant you choose. Always discuss your options with your surgeon before having surgery.


There are two types of implants available on the market. Silicone is made from a silicone shell and has gel also made from silicone inside.

Saline is made of a silicone shell with saline (salt water) inside. Both have been used since breast augmentation surgery began.

Look and Feel of Silicone Vs Saline

Silicone implants are often preferred due to their ability to provide patients with a more natural look and feel. Saline implants may leave patients with a less natural look and feel. Often saline feels harder and is more prone to rippling.

However, some patients prefer saline because if a saline implant ruptures, it’s immediately noticeable and the saline gets absorbed by the body. It’s considered to be safe for the body to absorb the saline.

A ruptured silicone implant may go unnoticed indefinitely. While ruptured silicone implants do not cause systemic illness, they can cause hardening of the breast tissues and pain.


There are two options where a surgeon can place your implants. They can be placed either behind the breast tissue, known as subglandular or behind the pectoralis chest muscles submuscularly.

Most patients prefer to have their implants placed in the submuscular area.

Submuscular is Often the Preferred Placement

Surgeons prefer it as well since a submuscular placement is shown to reduce the chance for scar tissue contracture. It’s also easier for women to get an accurate mammogram after surgery.

For thin women or women hoping to dramatically increase the size of their breasts, submuscular placement is also preferred since the muscle pads the implant and reduces the chance of implant visibility.


Patients can choose between teardrop or round shaped implants.

Round Implants

Round implants are preferred by surgeons and patients because they conform best to the natural shape of the breast. And if they rotate after surgrey, the breast shape isn’t changed.

Round shaped implants can be either smooth or textured.

Teardrop Implants

Teardrop implants, however, may be a better fit for women who have had parts of the breasts removed during a previous surgery. This is often the result of a mastectomy reconstruction. Or, in women with little to no breast tissue.

Teardrop implants are always textured. But if they rotate after surgery, the breast will become deformed and require an additional surgrey to correct it.


With round implants, there are two surface types of choose from, smooth and textured.


Textured implants contain small bumps on their surface. They were developed that way to reduce the risk of contracture. But, they have a higher incidence of implant rippling versus smooth implants.

Capsular contracture is a condition where tissue around the implant may harden. It may also lead to deformity and rigidity of joints.


As their name suggests, smooth implants do not contain small bumps on their surface. They also provide the patient with a natural and soft feel while reducing the risks of implant rippling.

How to Choose the Best Surgeons Beverly Hills

You have choices when it comes to selecting the best plastic surgeon to perform your breast augmentation. Always do some research before deciding who to choose.

Pick three or four candidates that you think has the best reputation. Make sure they’re board certified and check out their credentials.

Get Recommendations

Look online at their website and check out their testimonials and reviews. Look to see if they have any before and after photos to look at.

Ask friends and family members who have had breast augmentation surgery to recommend a surgeon.

Ask Questions

Interview the surgeon and their team to make sure you feel comfortable with the type of implant and technique used.

Do not base your decision on cost alone. Remember, this is an investment you’re making and you get what you pay for.

Schedule a Consultation

When you feel confident and ready to move forward with your breast augmentation, it’s time to schedule a consultation. We’re here for you.

Click here to contact us. We’ll schedule a time for you to begin your consultation and get you started on your treatment.