Breast Augmentation Decision Guide - Salt Lake City

The most important decision to make for a patient considering breast augmentation is who is performing the surgery.  Choosing a board certified plastic surgeon with vast experience in breast augmentation surgery is a must.

The other decisions that must be made in their relative order of importance are 1) implant size and dimension, 2) implant type (saline vs. silicone), 3) below or above muscle, 4) incision choice.

What is my best breast implant size?

Other than choosing the best plastic surgeon for you, the breast implant size is probably the second most important and difficult decision to make.  To help you determine your perfect size we will help you try on implants of various sizes based on your current breast size and desired goals. Dimensional analysis of your breasts at the time of the consultation will help to choose the proper size for your frame.   Generally, if women are unhappy with their choice of breast implant size, they wish that they had gone larger. There are definitely disadvantages to going too large, with higher complication rates associated with larger implants. This is what makes this decision difficult.

“What will I look like after breast augmentation”.  3D breast imaging. Dr. Yates is currently the only plastic surgeon with Vectra 3D breast augmentation imaging.  A 3D image is taken and a simulated image can be created with a variety of implant sizes. This is excellent in determining degrees of asymmetry. A patient can “see” their size before surgery.   A real game changer.

Breast implant type (saline vs silicone?)

1) Silicone breast implant

Advantages : Silicone breast implants are more natural feeling than saline implants. Silicone implants have less breast implant visibility and rippling.  Silicone implants can have a more natural shape, particularly for very small breasted women.  Ruptures are less common.

Disadvantages: Silicone breast implants are more expensive. Because they come pre-filled the incision and scar are longer. There is less adjustability with silicone implants if the breast size is different.  Although ruptures are less common, if a silicone breast implant fails this can result in a “silent” rupture that could lead to breast hardening or deformity which can be difficult to improve surgically.

2) Saline breast implant

Advantages: Saline breast implants are less expensive. There scar can be smaller and there is more adjustability of breast size with saline implants . If there is a failure, a saline implant simply deflates and it is relatively simple to have a new implant replaced.

Disadvantages: Saline breast implants are a little less natural feeling and more prone to rippling.  For smaller breasted women the shape with saline implants can look rounder and generally more “augmented”

* For women with larger frames or more breast tissue to cover the implant, there is less advantage for the more natural feel of a silicone implant. In this case the advantages of saline implants may outweigh silicone implants. At the time of your consultation, Dr. Yates will help you decide which may be best for you.

Breast implant placement (above or below the muscle?)

With very few exceptions, Dr. Yates believes that implant placement below the muscle gives a more natural result. There is a little less pain when the breast implant is placed above the muscle. Long term benefits of breast implants beneath the muscle include; improved shape, less potential interference with mammography and decreased risk of capsular contracture.

This patient presented to Dr Yates with a subglandular breast implant and capsular contracture. Revision required breast implant and capsule removal and implant pocket change to below the muscle for an improved shape and decreased risk of recurrence of capsular contracture.

Which incision is best?

1) Transumbilical breast augmentation (TUBA) - The incision is placed around the belly button. The breast implant pocket is developed through this incision through a small tunnel in the abdomen. Dr. Yates feels strongly that this is a very inaccurate method for breast augmentation. Only saline implants can be used. Any revisions (which are unfortunately all too common with this incision) need to be done with a large incision on the breast. This incision is marketed as “scarless breast augmentation”. It is a good marketing tool…who wouldn’t want breast augmentation without scars? The problem is that the risk of implant rupture is higher, and the risk of implant malposition is extremely high. Most plastic surgeons would never consider this incision.

2) Axillary (armpit) incision – A fairly popular incision choice as similar to TUBA, the scar is placed off of the breast. Dr. Yates does not generally prefer this incision as there is no way to feel (with fingertips) inside the implant pockets simultaneously to be sure they are exactly the same. This makes this incision choice less accurate with a higher revision rate. Any revision requires an additional larger scar on the breast.

3) Periareolar (around the nipple) – If this scar heals well it can be nearly invisible – hidden in the color contrast between the skin and areola. Concerns with this incision include slightly increased risk of loss of nipple sensation, possible interference with breast feeding and a risk of infection and capsular contracture from bacteria in the milk ducts.

4) Inframmamary (below the breast within the crease) - The most popular choice for breast enhancement in our practice and among most plastic surgeons. Generally this scar hides very well in the crease beneath the breast. The scar can be very short for saline implants (1″) and can be relatively short (1.5″) even for silicone implants.

*Dr. Yates prefers inframammary for its advantages the majority of the time.   At the time of your consultation, Dr. Yates will help you decide which may be best for you.

The inframammary or “crease” incision demonstrated on this graphic has two major flaws 1) it is much too long and 2) it is above the crease. Dr. Yates takes pride in a short scar well hidden in the crease.

Breast implant shape and texture?

The two basic breast implant shape choices are round and tear drop or anatomic. The tear drop shaped breast implants were developed hoping to help achieve a more natural shape. This has not been shown to be the case. The disadvantages include a thicker implant shell and the possibility of breast deformity if there is any rotation in the implant.

To decrease the risk of contracture, textured implants have been developed. The contracture rate has been proven to be slightly less but there are significant disadvantages of textured breast implants as well. These are more likely to be visible and unnatural feeling than a smooth implant.

*For both saline and silicone breast implants Dr. Yates prefers smooth round implants for most patients.

Breast implant profile?

Many patients state they desire a certain breast implant profile, for example high profile implants. The profile has to do with the projection of the implant in relation to the diameter of the implant. A high profile implant has a smaller diameter and greater projection (tall and skinny) at a certain volume whereas a moderate profile has larger diameter and less projection at the same volume. In reality, the best way to choose the profile is to match the correct diameter to the dimensions of the patient and choose which profile is best based on the volume of implant. For example a thin patient who desires large implants is going to need a high profile breast implant.

Dr Yates is very experienced in breast augmentation providing service to the Salt Lake City metro area in Utah.