Breast Augmentation

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For many women, feeling confident, alive and vibrant goes hand in hand with looking their best. For thousands of women, achieving such confidence and personal satisfaction has come from choosing breast augmentation. Following their procedure, many women have gone on to experience a transformation in how they feel about themselves and their bodies.

There are many reasons women choose breast augmentation. Some of them include:
Personal Preference

  • For different reasons, women may wish to improve their breast shape or size, or the overall proportion of their breasts and body.
  • Women may also wish to restore their breast shape after natural changes due to aging or weight loss.
  • Balancing breasts that differ in size or shape.

Underdeveloped Breasts

  • For some women, the breasts may not develop enough during puberty.
  • They may appear small or out of proportion with the rest of the body.

After Pregnancy

  • Breasts may sag more or appear different in shape or size after pregnancy or breast feeding.
  • Some women may enhance their breasts after breastfeeding to improve the shape and volume.


  • Breasts that are too big or small may look out of proportion with the rest of the body.
  • Breast implants can help shape the breasts and increase breast volume, making them more proportional with the body.

Your reasons are very personal, and your decisions about breast augmentation should be made by you and your physician based on your personal needs, desires and expectations.

Today, there are many options available for women who decide breast augmentation is right for them.

  • The profile of the breasts extends outside the profile of the chest.
  • There is a balance between the proportions of the breasts and the hips.

*Your doctor will work with you to decide on the best size of the implant, based on your breast tissues, body shape and preferences.


  • Cup size is a common, but unreliable, way to describe breast size.
  • Cup size varies greatly from one brand of bra to another.

  • The WIDER your breast, the LARGER your cup size.

*Your doctor will not rely on cup size alone to determine the best size of implant for you.


  • Your doctor will work with you to decide on the best size of implant for your body.
  • There are 3 important factors to consider:

Your doctor will measure your breasts carefully to determine these 3 factors.


  • The breast is made up of a number of different types of tissue.
  • The breast tissue sits on the top of the muscles of the chest wall.
  • The skin envelope provides the main support for the breast.

The breast is made up of fatty, glandular and fibrous tissues. Inside of it are blood vessels, milk ducts, fat, glands and sensory nerves. Beneath the breast is the pectoralis major, which is a large muscle that assists in arm movement.

For the best possible outcome for your augmentation, it is important to be completely open and honest with your surgeon and nurse.

  • Why do you want breast
  • What do you want your
 breast to look like?
  • What do you like about
 your breasts now?
  • Do you exercise regularly
and eat healthily?
  • Are you planning to 
lose weight?
  • Have there been any concerns
 with breast health in your family members?
  • Would you like to have
 children in the future?

Your surgeon needs to take careful measurements of your breasts to make important decisions about the surgery and implants.

The thickness of  upper breast tissue

The width of the breast

The nipple to in framammaryfold (at maximum stretch)

Skin stretch

There are three common incision sites for the breast implant augmentation.

Breast augmentation is normally performed using one of three common incision sites, around the nipple (periareolar), within the breast fold (inframammary) or under the arm (transaxillary).

  • Periareolar – This incision offers the benefit of being the most concealed.
  • Inframammary – This incision is very popular because it is concealed in the skin fold below the breast.
  • Transaxillary – This incision is less concealed, but it might be a good option for women who do not want any scars on their breasts.

Your doctor will explain each incision choice to you in greater detail and help you make a decision that is right for you.


  • After considering the individual breast tissue, the surgeon chooses the placement that ensures optimal tissue coverage over the important.
  • The breast implants are commonly inserted in two places.

        1. Subglandular placement – Under the breast tissue, but on top of the pectoralis muscle.

        Subglandular placement can make your augmentation surgery shorter and reduce your recovery time. A possible disadvantage could be having your implant edges more visibly noticeable under your skin. Imaging during a mammogram can also be more difficult when your implants are placed subglandularly.
        2. Submuscular placement – Under both the breast tissue and the pectoralis muscle.
        Submuscular placement may reduce the chances of your implants being felt through you skin, and it may help reduce the chance of scar tissue hardening around you implants. It also will make it easier to image your breast during a mammogram. Possible disadvantages of this placement choice could be a longer surgery and recovery period.



Anatomical implants may be better for:

  • Women who desire a natural looking breast augmentation with less fullness in the portion
  • Women who have breast asymmetry
  • Women who wish to compensate for
  • Differences in chest height and width measurements
  • A prominent chest
  • Letter tissue in the lower portion or shortenting

Round implants may be better for:

  • Women who desire a rounder breast with fullness in the upper portion
  • Women with little or no asymmetry
  • Women who wish to compensate for
  • A deficit of breast tissue in the upper portion
  • Moderate breast pseudoptosis (breast tissue sags below the lower breast fold)


The round-shaped implant is the traditional breast implant design and remains the overwhelming choice for women undergoing routine breast augmentation in the United States. Because of the widespread use of round breast implants, the attractive augmentations you see in fashion magazines and the Victoria's Secret catalog are most likely achieved with round implants. Round implants can create soft, round and nicely proportioned breasts. The availability of implants with a range of diameters and degrees of projection (see: Implant Dimensions ) provides great flexibility in fitting round breast implants to any woman's breast and body type.

A key advantage to round implants is that a soft, smooth implant shell can be used. The smooth shell is generally less likely to be felt than a textured shell. And, the smooth shell tends to cause less implant ripples, thereby decreasing the chance of visible implant rippling through the skin. Also, round breast implants tend to be more fluid in the breasts compared to teardrop implants. That is, when the patient is standing the implant assumes a teardrop shape as the upper part of the implant collapses and the lower part fills with fluid. When the patient is lying flat, the breast implant takes a flat shape and tends to move to the outside of the breast. These changes, between standing and lying flat, appear natural and tend to be the natural movement and position a natural breast takes. Saline filled and silicone filled breast implants are both available in multiple round styles.

Teardrop Cohesive Gel Breast Implants
Teardrop-shaped silicone gel breast implants became available in the U.S. in the summer of 2012. These implants have been available outside the U.S. and at a few study centers around the U.S. for many years. These implants are designed to maintain their shape and are often called “form-stable” or “gummy-bear" implants. This silicone gel is thicker than the silicone in traditional round implants and can hold a definite shape. These implants are designed in a wide variety of teardrop shapes. For example, some are designed as “tall” ovals and some are “wide” ovals. Because the cohesive silicone is firmer than traditional silicone, these implants will be more easily felt in thin patients, compared to round silicone gel implants.

Teardrop silicone implants are excellent devices and provide another great option for women. Since these implants are made in a variety of shapes, a greater degree of control can be added in fitting the implant shape and dimensions to a woman’s anatomy and desired breast shape. This control is especially useful in patients that wish to emphasize filling a certain area of the breast, such as the upper pole. In such a case, a shaped implant that is “taller’ than it is wide could be used.

Round vs. Shaped - We Are Here To Help
Breast implant selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion.

Dr. Piya is experienced with the use of all types of the implants for breast augmentation. We think that round implants will continue to be the best choice for most women. However, in some patients shaped-silicone implants will be optimal.

Implant selection is a critical step in your breast augmentation experience. Be assured, we will spend all of the time you need to help you make the best choice.


The Surgery

  • Medications are given for your comfort during surgery. Usually, you will be put to sleep for the surgery.


  • The surgery begins with an incision to allow the implants to be inserted. After the implant has been placed, the incision is carefully stitched closed.
  • Your surgeon may then wrap your breasts in a bandage or give you a supportive Surgical bra.
  • In some cases, the surgeon will insert drainage tubes to reduce swelling and bruising. These will probably be removed after a one day.


  • The results of your surgery will be immediately visible.
  • Over time, postsurgical swelling will resolve and incision lines will fade.
  • After the first 24-48 hours, the recovery timeline can vary from individual to individual.
  • You may need to limit your activity for a few days after surgery.
  • Your doctor will let you know when you can resume exercise or other activities.
  • You may experience some soreness and swelling for a few weeks after surgery.
  • Your doctor will give you specific instructions on how to care for yourself after surgery, including:
  • What medications to take or apply after surgery.
  • How to look after your breasts and the incision site during recovery.
  • When to see you doctor again for follow-up after surgery.

An important part of your recovery may involve wearing a post-operative bra or compression garment. There are designed to provide you with extra support while you heal. Your doctor also may have other specific suggestions for you to follow while you recover. If any problems occur after your breast implant surgery, contact your doctor immediately.

Questions to Ask Your Plastic Surgeon

  • For how many years has the surgeon performed breast implant procedures?
  • How many breast augmentation implantation procedures does the surgeon perform each year?
  • What are the possible risks and complications associated with breast implant surgery?
  • What are all my options for breast augmentation?
  • What shape, size, surface texturing, incision site and placement site is recommended for me?
  • How will my ability to breast-feed be affected?
  • How can I expect my implanted breasts to look over time?
  • Do you have before-and-after photos that I can look at?

Frequently Asked Questions about Breast Implants
What is silicone?
Silicone Material
Silicone is derived from silicon, a semi-metallic or metal-like element that in nature combines with oxygen to form silicon dioxide, or silica. Beach sand, crystals, and quartz are silica. Silica is the most common substance on earth. Heating silica with carbon at a high temperature can produce silicon. Further processing can convert the silicon into a long chemical chain, or polymer, called silicone-which can be a liquid, a gel, or a rubbery substance. Various silicones are used in lubricants and oils, as well as in silicone rubber, Silicone can be found in many common household items, such as polished, suntan and hand lotion, antiperspirants, soaps, processed foods, waterproof coating, and chewing gum.

Are silicone implants safe?
Safety of Silicone

Special studies have been done and have determined that much higher levels of silicone have been found in cows’ milk and commercially available infant formula than and found in the breast milk of women with implants. The institute of Medicine concluded that “There is no evidence that silicone implants are responsible for anymajor diseases of the whole body. Women are exposed to silicone constantly in their daily lives.”

For more information regarding the safety of silicone please refer to the Institute of Medicine Report (IOM) at:

What is Capsular Contracture?
Capsular Contracture

The scar tissue or capsule that normally forms around the implant may tighten and squeeze the implant and is called capsular contracture. Capsular contracture is more common following infection, hematoma, and seroma. It is also more common with subglandular placement. Symptoms range from firmness and mild discomfort, to pain, distortion, palpability of the implant, and/or displacement of the implant. Additional surgery is needed in cases where pain and/or firmness is severe. This surgery ranges from removal of the implant capsule tissue to removal and possibly replacement of the implant itself. Capsular contracture may happen again after these surgeries. You should be aware that closed capsulotomy, the practice of forcible squeezing or pressing on the fibrous capsule around the implant to break the scar capsule, is not recommended, as this may result in breakage of the implant.

Why Does the Body Form a Capsule Around the Implant?
As a natural reaction to any device placed in the body, scar tissue will form around the breast implant surface creating a capsule.

Do implants influence the occurrence of breast cancer?

No studies have ever shown this to be at concern for humans. There is no evidence that implants cause cancer.

How do breast implants affect mammography?
Breast implants may interface with finding breast cancer during mammography and may make mammography more difficult. It is important that you tell your mammography technologist that you have an implant before the procedure. Special displacement techniques and additional views may be required. Discuss any family history of breast cancer with your doctor.

Is it possible to get a silicone allergy?
Silicone Allergy
It is possible for anyone to develop an allergy to almost any substance on earth, however silicone allergies are very rare. We are all exposed to silicone in our environment everyday. It is found in many household items, such as polished, suntan and hand lotion, antiperspirants, soaps, processed foods, waterproof coating, and chewing gum.

What is the average life expectancy of an implant?
Implant Life Expectancy
Implants are not lifetime devices; therefore it is likely that they may need to be replaced sometime in your life. The time period varies from woman to woman. Some women need replacement surgery in only a few years while others may go 10-20 years. There are several different reasons why a woman might need replacement surgery. Sometimes it is a matter of choice, such as a size change or and implant style change, and sometimes removal and replacement is necessary because of a complication, such as reflation, or shifting of the implant.

How long should I wait to resume exercise and other strenuous activities after implant surgery?

Your doctor will be your best guide regarding how long you will need to remain off work and will advise you when and how to resume activities. Recovery periods vary from woman to woman. Generally the first few days are the most uncomfortable. The average time to return to full activities is four to six weeks.

It is important not to sweat into the incision while it is healing. Therefore curtail activity and sun tanning until after the incision is healed and sealed. Don’t over-do activity, especially of the upper body, too early. Let your body rest and heal. You want to minimize swelling around the implant. Going into a Jacuzzi or bath after a month is usually ok. During the early time, one to two weeks following surgery, you don’t want to soak the incision.

Be sure you check with your doctor before returning to your workouts. Patients vary greatly in recovery times. Walking is generally recommended to encourage circulation. The larger the implant you receive the heavier the breasts will be. You should wear good support bras while running to minimize pull on the skin and ptosis (drooping) of the breast.

Can I go to a tanning salon or sunbathe if I have implants?
Tanning Salon/Sunbathing

Tanning at salons or sunbathing will not hurt the implant but may make the scars worse. You should avoid getting sun or tanning rays on the incisions for at least one year after surgery as tanning rays will turn the incisions dark permanently. The implant may feel warm and may take longer to cool down than your body.

When can I fly and/or scuba dive?
Flying/Scuba Diving

Many women scuba dive and fly in airplanes with implants. There may be slight expansion and contraction of the shell with changes in pressure. This may result in a small amount of air bubbles in the implant. With gel implants as with saline filled implants you may feel or hear fluid sounds (gurgling). This should correct itself within 24-48 hours.

When can I wear an under wire bra again?
Under Wire Bra

Most doctors ask that women wait 3 months before wearing under wire bras after implant surgery. Your body will be forming scar tissue around the implant for 3 months. During this time the pressure of the wires could cause the scar tissue to form in such a way that an indentation from the wires could become permanent. After this initial healing time, under wire bras should be worn intermittently to avoid permanent indentation.

Will my breasts still move like normal breasts?
Breast Movement

This depends upon multiple factors, such as the type of implant you receive, the pocket dissection, the way your body holds the implant and whether or not there is any degree of capsular contracture. It is possible for many women to have breast implants that are soft and move nicely, while other women have results that are firmer with an implant more fixed in position.

How much does the implant weigh?
Implant Weight

The weight of an implant varies with size and fill volume. A 250 cc implant filled with 250 cc of gel weighs approximately 250 grams.

Will getting implants cause stretch markson my breasts?

Stretch Marks
Insertion of implants can cause stretch marks but rarely does. If you are concerned, go far a smaller size implant to minimize the stretching of the skin, or choose a Spectrum® adjustable implant to slowly stretch the skin over time.

What effect does smoking have on the healing process after surgery?
Smoking Effects

Smoking causes the blood vessels to constrict, reducing the blood supply and the oxygen carried by the blood to the surgical area. The tissues need this blood supply and the oxygen that the blood carries in order to heal. When the blood supply is reduced the tissues heal more slowly. Different doctors have different time frames for patients to refrain from smoking before and after surgery. We hear anything from five weeks prior and after, to one to two weeks prior and after. Ask your doctor how long he/she would like you to stop smoking before and after your surgery.

Will I lose nipple sensation?
Nipple Sensation

There can be changes in nipple sensation after implant surgery. Feeling in the nipple and breast can increase or decrease. The range of change varies from no feeling to intense feeling and can be temporary or permanent.

Should I be at my ideal weight before I have a breast implant procedure?
Weight Gain or Loss

You should be close to your ideal weight. A significant loss of weight after receiving breast implants could alter the results in a manner that is not satisfactory to you. There could be some ptosis (drooping) and a reduction in size. A significant gain in weight could cause an increase in breast size.

I’m over 50 years old. Am I too old to get breast implants?

General good health is important, not age.

What will happen during pregnancy?

Every woman is an individual and therefore has different results whether before a pregnancy or after. Your breasts will enlarge and will go through all the usual changes associated with pregnancy. The amount of enlargement will vary from woman to woman and the size of the implants will factor into this as well.

Can I still breast-feed?
Breast Feeding

Many women with breast implants have successfully breast fed their babies. Current studies indicate that women with breast implants, either gel or saline, do not have any higher levels of silicone in their milk than women without breast implants. Breast implants can, however, interfere with the ability of some women to breast-feed. The peri-areola incision site is more likely to affect this ability. Some women experience mastitis, inflammation in the breast ducts, during this time, which can also cause capsular contracture. Taking antibiotics when symptoms first appear may minimize the potential for this problem. You should always report signs of inflammation to your physician.

Breast Augmentation Resources
The following list of resources may help you to find more information about breast augmentation and a certified plastic surgeon in your area..

  • American Society of Plastic Surgeons

  • Australian Society of Plastic Surgeons

  • British Association of Plastic Surgeons

  • Canadian Society of Plastic Surgeons

  • French Society of Plastic Surgeons

  • German Association of Plastic Surgeons

  • Italian Society of Plastic Surgeons

  • Netherlands Society of Plastic Surgeons

  • Spanish Society of Plastic Surgeons

  • Brazilian Society of Plastic Surgeons


  • Tebbetts JB, Tebbetts TB. The Best Breast 2: The Ultimate Discriminating Woman’s Resource for Breast Augmentation. Dallas, Texas: Brown Books Publishing Group; 2008.
  • Brown MH, Shenker R, Silver SA. Cohesive silicone gel breast implants in aesthetic and reconstructive breast surgery. Plast Reconstr Surg 2005; 116:768-779.
  • Cárdenas-Camarena L, Encinas-Brambila J. Round gel breast implants or anatomic gel breast implants: which is the best choice? 
Aesthetic Plast Surg 2009;33:743-751.
  • Spear SL, Hedén P. Allergan’s silicone gel breast implants. Expert Rev Med Devices 2007;4:699-708.
  • Hedén P, Bronz G, Elberg JJ, et al. Long-term safety and effectiveness of Style 410 Highly Cohesive Silicone Breast Implants.
Aesthetic Plast Surg 2009;33:430-436.
  • Bengtson BP, Van Natta BW, Murphy DK, Slicton A, Maxwell GP; Style 410 U.S. Core Clinical Study Group. Style 410 highly
cohesive silicone breast implant core study results at 3 years. Plast Reconstr Surg 2007;120(7 Suppl 1):40s-48s.
  • Adams WP Jr. Form stable cohesive gel implants: Advantages and technical essentials. Innov Plast Surg 2007;1:7-14.
  • Maxwell GP, Gabriel A. The evolution of breast implants. Clin Plast Surg 2009;36:1-13.
  • Peter W. Current status of breast implant survival properties and the management of the woman with silicone gel breast implants.
Can J Plast Surg 2000;8:54-67.
  • Data on file. Allergan, Inc.
  • Data on file. Mentor, Inc.
  • Article from ConnallCosmetic Surgery “Round and Teardrop Breast Implants”

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