Breast Augmentation

Breast augmentation commonly involves adding volume by placement of an implant either above (prepectoral) or underneath (subpectoral) the chest wall muscle. Implants chosen can be filled with saline at the time of surgery or can be silicone gel implants that are manufactured already filled to a specific volume. The implants are round (symmetrical) or shaped (asymmetrical). There are four approaches that can be used: 1) Inframammary – under the breast, 2) Periareolar – at edge of the areola, 3) Transaxillary – through the underarm area, and 4) Transumbilical – through the belly button.

Subpectoral

This placement for the implant is favored when there is not much breast tissue. Placing the implant under the muscle helps to decrease the incidence of capsular contracture. It also camouflages the shape of the implant medially.

Prepectoral

This placement for the implant provides better projection and better cleavage. Recovery from the surgery is relatively rapid and pain free. This placement is best when there is enough breast tissue to cover the implant.

Breast Implants

Saline Implants

These implants are used when the patient prefers not to have gel implants. They have air in them that must be removed using a fill tube inserted into the valve in the implant. Once the air has been removed, the implant can be rolled up and inserted through a small incision. The implant is filled in place with saline to the required volume. The valve is oriented to the front. The fill tube is removed and the implant valve closes. If a saline implant leaks, the saline is absorbed into the body without any effect. Saline implants tend to show curtaining or rippling at the sides especially when leaning forward.

Gel Implants

These implants seem to be preferred by most patients because the gel mimics tissue better than saline. Gel implants seem to have better longevity than saline implants. There are no specific health issues associated with gel implants. They require a larger incision than saline implants. The current generation of implants are manufactured with a thicker shell and with gel that is more cohesive. If a current generation gel implant were to rupture, the gel would not migrate outside the capsule around the implant or spread into the breast tissue. An MRI is the most specific way to diagnose gel implant rupture.