A Breast Augmentation Journey: Part II - Deciding on Implants & Placement

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To continue with my series about breast augmentation, today I will be talking about the myriad of options there are for types, sizes and placements of implants. If you haven't read Part I,  I would recommend reading that first to get an introduction about BA surgery and how to do research.

Before beginning, I'd like to clarify that I'm only focusing on implants in this piece. While fat transfer augmentation is a great option for some women, it's fairly recent and comes with a very different set of decisions and complications, so I don't be discussing it here. If you do want to read about it, the American Society of Plastic Surgeons is a good resource.

Also, the information presented here is just what I deemed important and relevant during my own BA. It is incomplete and there is a ton more information out there, so please don't take this as a single source of truth.

With that out of the way, let's talk about some important characteristics of breast implants - type, shape and size.

Type

Breast implants fall into two basic categories - silicone and saline.

Modern-day saline implants have a silicone outer shell and are filled with a saline solution to achieve the desired fullness. They are placed inside the body while empty and filled after they are in place. When talking about saline implants, you might see, for example, that a 300cc implant was 'overfilled' to 325cc, which will give a firmer and rounder appearance less prone to rippling. Because saline implants are filled inside the body, they can usually be placed through a much smaller incision than silicone implants. They are also significantly cheaper than their silicone alternatives, so they are a good option if you're looking to minimize cost. Although many women love their saline implants and claim they feel soft and natural, they are filled with water and can have a bit of a 'water balloon' feeling. Also, saline implants rupture more frequently than silicone implants and can deflate inside the body.

Unlike saline implants, silicone implants are filled with a highly viscous gel and their volume cannot be changed. Because of this, they must be placed through an incision that is large enough to accommodate the implant. They can often feel more natural than saline implants since they are made of a soft gel. Silicone implants are a more expensive option than saline, but they are less likely to rupture.

In some countries, polyurethane implants are also available but since they aren't an option in the United States, I haven't done enough research to provide any insight.

Another facet of implant type is the type of shell that encompasses the filling. Both saline and silicone implants are available with smooth or textured shells and each have their benefits. Smooth implants are more common and usually feel softer and are less prone to rippling. The risk of certain complications like capsular contracture  is increased with smooth implants. Textured implants have a surface that attaches to the tissue on the outside of the implant, forcing it to stay put. They also reduce the risk of capsular contracture but increase the risk for rippling if the tissue underneath attaches in an uneven way.

Personally, I went with textured silicone implants because I felt both saline and silicone options at my surgeon's office and there was no contest - silicone felt so much softer and more natural to me. Also, I decided a bit of rippling was a much lesser evil than capsular contracture, which can require a second surgery.

Shape

Implant shape has two facets - the shape of the base and the projection.

Most implants are round, but recently, high cohesive anatomical implants have come on the market. This means that they are shaped more like a natural breast and are a great option if you are going for the most natural look possible by minimizing upper pole fullness.

Source: implantforum.com
I originally chose anatomical implants but later changed my mind because due to their shape, they can only be placed through a crease incision. The high cohesive anatomical 'gummy bear' material also is a bit firmer than traditional silicone implants. Additionally, many sources say that round implants settle into a natural breast shape once inside the body.

The other important parameter of implants is projection. Just like we talk about projection in natural breasts, this is an important facet of implants because it greatly alters the final appearance of the breasts.

Source: breastcanswers.com
An implant with the same base diameter can vary greatly in size based on the amount of projection, or how far the implant sticks out of the body. The lower the profile, the shallower the appearance of the breast. Many brands also offer a 'moderate plus' projection option, which is between moderate and high. I ended up going with this option for myself since it seemed like a perfect middle ground.

Size

Implant size is probably the category that most women spend the most time thinking about. Implant volume is typically measured in cubic centimeters (cc) and the width of the base is usually measured in centimeters (cm). During a consultation for BA, the plastic surgeon will usually take a set of measurements to determine what size range will work best. Two important measurements in deciding implant size are breast width diameter and fill volume. Breast width diameter is how wide each breast is from end to end and this determines how wide the base of the implant should be. Ideally, the implant width should be within 1cm of the width of the breast. Fill volume determines how large of an implant can be placed in a first-time BA patient without over-stretching the skin or causing excessive complications.

Within the range of possibilities given by your measurements, size choices are entirely up to your own preferences. Usually, about 100cc equals one standard cup size so thinking about how much bigger you want to look can help you determine implant size. For reference, one tablespoon holds about 15cc, in case you are agonizing over size. I found this chart very helpful when I was deciding.

Source: bustyresources.wikia.com
My pre-op size was between 28DD and 28E, so probably around 430 cc. I am now wearing a 28F or 28FF, which lands me in the 590-710 cc range. This is actually really accurate in my case, because my implants were around 250cc.

Specifically, my breast width diameter was about 11.5cm and my fill volume was about 350 cc. However, I wanted a more modest size increase and I had a small asymmetry in my pre-op breasts so I ended up with 253 cc (11.6 cm) in my larger right breast and 272 cc (11.8 cm) in my smaller left breast.

Now that you have a good introduction on implant type, the next important decision is where to place the implant and through which incision. Many surgeons specialize in a specific combination of placement and incision, so if you have you heart set on something specific, I would suggest looking for a surgeon that does a lot of those surgeries.

Placement

An implant can be placed under the pectoral muscle (subpectoral), under the glandular tissue (subglandular), or under the fascia (subfascial), however the first two are more common.

Source: makemeheal.com
Subpectoral implants are covered by the pectoral muscle for the most part and are harder to feel when touching the breast. Recovery time is longer for this type implant but many women prefer this placement because they worry about feeling the implant too much through the skin.

Subglandular implants go above the muscle and are closer to the surface of the skin. The recovery time is quicker and pain from surgery is usually much less than subpectoral implants.

First I went with subpectoral implants, but after some research I found out that it can be difficult for some women to do chest exercises after surgery. I really enjoy working on my upper body and was put off by the idea of never doing a good pushup again (though this isn't always the case) so I changed my mind at the last minute.

Incision

The last choice you will have to make is where you would like your surgical incision to be. The possibilities are through the crease under the breast (inframammary), through the areola (periareolar), or through the underarm (transaxillary), though the last option is less common.

Source: dbreath.com
Scars heal over time and beautiful results are possible with each type of implant, but your tolerance for scars is also a personal preference. Since I have very light skin and scars usually heal white or light pink, I decided the areola incision would be the least noticeable for me. Additionally, I didn't think I would have enough of a breast crease to fully cover a crease incision.

One thing to note is that areola and transax incisions have implant size limitations since they are smaller, but any size implant can be placed through the crease incision.

Whew, that was a lot of information, but I strongly believe you should be as informed as possible when going into a cosmetic procedure like BA. You should know all your options and do extensive research on every option available.

Stay tuned to find out what it's like to go under the knife and what recovery was like in Part III.



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