How Surgeons Execute Breast Augmentation Differently — And Why It Matters
Not every breast augmentation is done the same way. Small choices in planning and technique can change cleavage, upper-pole fullness, scar position, and long-term support. This guide explains the details that shape results.
Medically reviewed by Dr. Tim Neavin • Updated
1) Pre-op Assessment and Sizing
A careful plan starts with measurements. Base width, soft-tissue thickness, skin quality, and nipple position set the safe range. Photo review helps align goals with anatomy. Some surgeons size by “look.” Others size by numbers and then confirm with sizers. Both can work when the process is disciplined.
Want a primer first? See the Breast Augmentation Guide.
2) Device Choice and Profile
Fill material and profile change feel, edge visibility, and how the upper pole reads. Silicone often feels more natural and can reduce rippling in thin patients. Saline is simple to monitor and can use a smaller incision. Profile must match chest width and desired projection. The goal is harmony, not just size.
Learn more: Saline vs Silicone Implants.
3) Incision Strategy and Scar Placement
Incision choice affects control and scar location. Inframammary hides in the crease and gives excellent access. Periareolar blends at the pigment border when anatomy allows. Transaxillary keeps scars off the breast but may limit direct visualization. Scar plans should match the device and the pocket work required.
Compare approaches: Incisions Guide.
4) Pocket Creation and Control
Pocket control is where many results are won. Precise dissection defines footprint and sets the borders that shape cleavage and lateral curve. Over-dissection can create lateral drift. Under-dissection can squeeze the implant. The best pockets are symmetrical and stable with the least trauma possible.
5) Inframammary Fold Setting
The fold is the base of the breast. If the fold is too low, the breast looks bottom heavy. If it is too high, the implant rides up and flattens the lower pole. Surgeons may reinforce or reset the fold with sutures. Fold management is essential in asymmetry, constricted lower poles, and larger size changes.
6) Plane Selection: Submuscular, Dual-Plane, Subfascial
Placement changes motion, support, and edge visibility. Submuscular and dual-plane pockets can soften edges and upper-pole contours in lean frames. Subfascial can work when tissue is adequate and motion goals are specific. Plane is chosen after measuring tissue thickness and reviewing activity goals.
7) Hemostasis, Irrigation, and Infection Prevention
Meticulous hemostasis reduces bruising and decreases pocket irregularities. Some surgeons use antibiotic or triple irrigation. Others prioritize minimal handling and closed delivery techniques. The goal is a clean, dry pocket that invites smooth healing.
8) Implant Handling and No-Touch Technique
A no-touch approach places the device without direct contact. This protects the implant shell and reduces contamination risk. Consistent orientation checks, gentle insertion, and careful seating prevent fold defects and edge twists.
9) Closure and Internal Support
Layered closure supports the pocket and the skin. Barbed or interrupted sutures can both work when tension is controlled. In selected cases, surgeons add internal support to protect the fold or reinforce weak tissue. Scar care begins once incisions are sealed and continues for months.
10) Planning for Symmetry
Perfect symmetry is rare. Surgeons balance volume, footprint, fold height, and nipple position. Sometimes the plan includes different implant volumes or pocket adjustments. In some cases a lift improves balance. The goal is symmetry that looks natural in clothing and in motion.
Deep dive: Breast Implant Symmetry.
11) Primary vs Revision: Different Playbooks
Primary augmentation is usually straightforward. Revision surgery can involve capsule work, pocket change, implant exchange, or fold reset. Planning is slower and the surgical map is different. Expect longer OR time and a different recovery pace.
12) Recovery Protocols and Return to Activity
Early recovery focuses on comfort, light mobility, and incision care. Cardio returns first. Upper-body training is last and only after clearance. Your plan is personalized and may change as tissues settle.
See the Recovery Timeline for a week-by-week view.
FAQ
Why do similar implants look different on different patients?
Anatomy and execution both matter. Fold position, pocket accuracy, plane, and closure all influence the final look.
Is there one “best” way to do augmentation?
No. There is a best way for your body and goals. Good plans follow measurements and use the least invasive path that achieves the look.
How do I know a surgeon’s approach is right for me?
Ask how they size, how they set the fold, which plane they recommend, and how they handle symmetry. Bring questions to your consult and review photos that match your frame.
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Board-certified plastic surgeon with extensive experience in breast, face, and body procedures.
