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Breast augmentation explained

Breast augmentation explained

Step-by-Step Guide to What Will Happen

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What will Stephen discuss with me in my consultation?

During your consultation, Stephen will talk to you about a number of things, including:

  • whether your implants should be saline or silicone
  • whether your implants should be sub-pectoral (under the muscle), sub-glandular (over the muscle) or sub-fascial (between the fascial tissue and the pectoral muscle)
  • whether your implants should be round or shaped; textured or smooth
  • what size the implants should be
  • what kind of incision will need to be made

For more information on what to expect, click here.

What’s the difference between saline and silicone implants?

Saline implants are essentially balloons containing sterile salt water. They have a silicone outer shell. They are inserted empty then filled with salt water via a tube. The implants seal themselves automatically the moment the tube is removed.

Silicone implants have the same silicone shell but come already filled with silicone gel. The gel can either be soft or hard (the hard type is known as cohesive gel), depending on whether you want your breasts to have the feel of natural tissue, or more firmness. Some implants are coated with polyurethane, as this is thought to reduce the risk of capsular contracture and rotation of the implant (the implant moving when in place).

Click here for more information on how to choose the right implants for you.

What is meant by ‘under the muscle’ and ‘over the muscle’ breast augmentation?

The muscle in question is called the pectoralis major. It’s a large, thick muscle that lies over your ribcage and below your breast. Underneath that is the smaller, thinner pectoralis minor muscle. When you hear people talk about ‘pecs’ in relation to bodybuilding, for example, it’s these muscles they’re referring to.

When it comes to breast augmentation, the implants can be placed under or over the pectoralis major muscle. Medical opinion varies over which is the better method, and both types of implants have their advantages and drawbacks. Your surgeon will be able to determine which option is best for you.

Under the muscle(also called sub-pectoral, sub-muscular)Gives a more natural look, as the implants are padded by both the breast tissue and the muscleHas less effect on breast cancer screening (mammograms)Less chance of the skin rippling (wrinkling), particularly on women with low body fatLess risk of capsular contracture (when scar tissue hardens around an implant and becomes misshapen)The muscle supports the implant, reducing the amount of wear to the skinMore invasive surgeryMore painful post-opLonger recovery timeMuscle takes several weeks to find its natural position, causing the breasts to sit highSome animation deformity (when the implant moves as the muscle is flexed), and small chance of this being severeAffects upper body strength, and can interfere with bodybuilding and weightlifting
Over the muscle(also called sub-glandular)Easier, less invasive surgeryLess post-op pain and discomfortShorter recovery timeAllows for more cleavage, as the implants can be placed closer togetherAllows larger implants to be used (though this depends on the amount of soft tissue in the breastsNo animation deformity (when the implant moves as the muscle is flexed)The breasts look less natural and more augmented (though some women might prefer this)More chance of the skin rippling (wrinkling)Higher risk of capsular contractureCan distort mammogram results, meaning more X-rays need to be taken

What is sub-fascial breast augmentation?

The pectoral muscles (and indeed most of the muscles in your body) are surrounded by a thin connective tissue made of collagen, called the fascial tissue. Sub-fascial breast augmentation means placing the implants behind the pectoralis major’s fascial tissue, and not the whole muscle itself (as in sub-pectoral augmentation).

This method of breast augmentation is not widely used, as separating the fascial tissue from the muscle is very difficult and does not tend to yield effective results. (Sub-fascial implants can be more obvious, for instance, as there is less there to conceal them.)

Should I choose round or teardrop implants?

Breast implants come in two shapes, round and teardrop.

Round implants are the traditional shape and the choice for most women because of how they create round and well-proportioned breasts. Teardrop implants are available in a range of teardrop (oval) shapes, which gives the surgeon greater flexibility in matching the implant to your body and the shape of breast you want to achieve.

As with all considerations around which implants to choose for your own augmentation, it’s best to discuss the options with your surgeon.

Round implantsCreate round and well-proportioned breastsAllow for a smooth implant shell to be used, which avoids rippling in the skinMore fluid in their shape, with more natural movement and position
Teardrop implantsGreat flexibility in shape means they can fit any woman’s breast and body typeCohesive silicone gel enables the implant to better hold its shape

Should I choose smooth or textured implants?

All breast implants have a silicone outer shell which is either smooth or textured.

Smooth implants are intended to mimic the breast’s natural movement, while textured implants are designed to better hold the implant in place and stop it from moving or rotating. Textured implants are also said to lessen the risk of capsular contracture, although they’re also known to rupture more frequently than smooth implants.

Some surgeons prefer to use smooth implants to completely avoid the chances of the patient developing anaplastic large cell lymphoma (ALCL), a form of lymphoma associated with breast implants. Though more common with textured implants than the smooth kind, this very rare form of lymphoma is extremely unlikely to occur (around 1 in 30,000–50,000 cases).

Many surgeons argue that the sub-pectoral procedure takes away the need to use textured implants, as inserting them behind the muscle is enough to keep them in place. But as always, it should come down to what your surgeon believes is best for you.

What kind of incision will be made?

There are several types of incision used in breast augmentation, though which kind you have will ultimately be a matter of your surgeon’s recommendation.

Inframammary incision

An incision under the breast, close to the crease where the breast and chest meet. The main benefit of the inframammary incision is that it’s good for hiding scars. It’s also versatile in that it allows the implant to be placed under or over the muscle. Stephen McCulley uses this kind of incision most often.

Periareolar incision

An incision along the edge of your areola (the pink/brown skin around your nipple). This kind of incision is also good for concealing scars, because of the colour and texture of the areola. It also gives the surgeon more precision in placing the implant. However, because a periareolar incision increases the chances of an infection occurring, Stephen McCulley is less likely to use it.

Transaxillary incision

An incision in the armpit. The procedure is sometimes performed with an endoscope (a long, thin, flexible tube with a light and a camera at one end) as it gives the surgeon better visibility when placing the implant. The biggest advantage of this method is that it avoids making any sort of incision in the breast itself.

Can I have a breast lift (mastopexy) and breast augmentation at the same time?

Breast uplift surgery (known as mastopexy) helps to reshape breasts that have sagged due to pregnancy, breastfeeding or the ageing process. The operation is intended to make the breasts feel firmer and look younger, and involves removing and tightening skin and tissue around the breasts and repositioning the nipples. It has little effect on breast size.

It is possible to have a breast lift and breast augmentation in the same procedure. The best candidates are women whose breasts have not only sagged but lost much of their fullness (common in women who have breastfed or lost lots of weight). The surgery aims to restore that fullness.

However, many surgeons will recommend doing the procedures in stages (breast lift first, augmentation a few months later) rather than on the same day. This is because the results of the combined procedures can sometimes be unpredictable and can cause complications in the healing process.

What is the fat injection transfer procedure, and does it work?

Fat injection transfer (sometimes referred to as stem cell fat transfer) is a fairly new technique where women can gain larger breasts without implants and the risks that come with them. Click here to learn more about the procedure.

Are there any methods of breast augmentation that don’t involve incision?

All methods—including the fat injection transfer, which is a form of liposuction—are ‘minimally invasive’ in that they involve making a small incision in the skin. However, a good surgeon will do this with the utmost care and precision and in a way that causes as little visible scarring as possible.

Further Resources

What to Expect During a Breast Surgery Consultation

Choosing the Right Cup Size for Your Breast Augmentation

Your Guide to Breast Augmentation and the Associated Risks