Used to increase, correct, or reconstruct the breast for cosmetic or post-operative purposes, there are many options available when considering breast augmentation. The first decision is the type of implant: Silicone or saline? Second is incision. To date, there are four common incision points to choose from. The final consideration is the placement of the implant: where is it going to be put within the breast? Because every person's needs and desires are different, the plastic surgeon will generally advise the patient on the optimal augmentation procedure.



There has been some controversy over the choice between saline and silicone implants. Saline implants are considered the safest and most popular choice to date, representing 83.4 percent of implants in 2005 and carrying FDA approval since May of 2000. On the other hand, silicone implants, approved by the FDA in November of 2006 after a 14 year ban arising from links between silicone implants and auto-immune illnesses, are considered more natural looking. According to infoplasticsurgery.com, a website dedicated to educating the public on plastic surgery procedures, silicone implants are virtually indiscernible from breast tissue, creating an effect that looks and feels more natural than saline. Furthermore, unlike saline, silicone is dense so the risk of 'rippling,' the unattractive wrinkling of skin over the implant, is unlikely.

Of course there are downsides to silicone implants. Unlike saline, silicone implants may rupture, causing a "capsular contracture," or thick scar, around the implant. Also, since silicone implants are pre-filled prior to insertion, they necessitate a 6-8 cm incision whereas saline implants require only a 3-5 cm incision. Finally, silicone implants are more expensive. According to infoplasticsurgery.com, a patient should expect to pay between $5000-6500 for a saline implant. Silicone costs approximately $6000-8000.

The type of incision is also an important factor. To date, there are 4 different types of incisions. The most popular incision, called an Inframammary augmentation, is made on the lower portion of the breast, near the crease where the breast meets the chest, so that any scar will be covered. Another common incision, called a Periareolar augmentation, is made on the edge of the areola, where the dark area around the nipple meets the skin. This incision is usually a semi-circle around the lower part of the areola. The third type of incision, called a Transaxillary or Axillary incision, is made in the armpit, and the fourth method, called a Transumbilical or Umbilical augmentation, involves inserting the implant through the belly button. Given the difficulty and potential for complication, this fourth method is not frequently used.

Positioning of the implant is either sub-glandular or sub-muscular. Whereas sub-glandular insertion places the implant beneath the breast tissue, but above the muscles, a sub-muscular placement sets the implant partially beneath the pectoral muscles. There are positives and negatives to both options. Situating the implant sub-muscularly costs more, requires more anesthetic and healing time, but it is also the most suitable option for women who have very small breasts. Furthermore, because a sub-muscular placement interferes less with mammograms, it is also the best choice for individuals with a history of breast cancer.

Though it's an outpatient procedure which takes only 1 to 2 hours to complete, breast augmentation surgery does require significant downtime. Side effects such as swelling, discoloration, fatigue and discomfort should be expected. Most patients will not be able to shower or work for several days and exercise should be avoided for about a month. As a rule, it is important for individuals with breast implants to have regular checkups and mammograms.

For women who are simply looking for perkier, firmer breasts with or without an implant, the breastlift or mastopexy is a good option. This surgical procedure raises and reshapes sagging breasts by removing excess skin, lifting the breast and relocating the nipple. Not unlike breast implant procedures, a mastoplexy does leave scars which are usually obscured by a bathing suit. Furthermore, having a breast lift won't keep you firm forever; pregnancy, aging, and fluctuations in weight are likely to effect just how long the results will last.

As the evolution of breast augmentation continues, more and more advances begin to surface. Although modern silicone and saline implants are the only options available today, there are other implants which are currently being researched. Among these are "gummy bear" implants and Elast-Eon implants, neither of which has yet to be FDA approved. Whereas gummy bear implants, constructed of a firmer, more cohesive silicone gel, are purported to be the silicone implant of the future, Elast-Eon is made of a bio-material which promises to be safer than silicone.

For more information on breast augmentation, please visit your plastic surgeon.