Breast implant decision guide

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 theoretical risk of infection from bacteria in the milk ducts.

4) Inframmamary (below the breast within the crease) - The most popular choice for breast enhancement in our practice. 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 even for silicone implants.

*Dr. Yates prefers inframammary or periareolar incisions. At the time of your consultation, Dr. Yates will help you decide which may be best for you.

Breast implant type (saline vs silicone?)

1) Silicone breast implant

Advantages : Silicone breast implants are more natural feeling. Less breast implant visibility and rippling.

Disadvantages: Silicone breast implants are more expensive. Because they come pre-filled the incision and scar are longer. There is less adjustability if the breast size is different. There is an increased risk of hardening of the breast implant (contracture). If the 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. There is a decreased risk of contracture. If there is a failure, the 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 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 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. Exceptions to this rule would include professional body builders and patients with abnormal development of chest wall muscles. In this case silicone implants would generally be used above the muscle.

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 proved no 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.

Breast implant profile?

Many patients come into my office stating that they want 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.

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. 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 however. This is what makes this decision difficult.

New for 2010 – 3D breast 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.

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

last modified on May 21, 2010 @ 12:56 am