While the ultimate goal of any breast augmentation procedure is to enhance the aesthetic appearance of the breasts, there are different types of breast augmentation procedures. They involve different incision sites, different types of implants, and different areas of breast implant placement (on top of or underneath the chest muscle). Let’s examine each of our options for breast augmentation.
Broadly speaking, there are two different implant types: silicone and saline. At Image, we highly recommend silicone breast implants. They generally have a much more natural feel, and they significantly lower the risk of seeing “ripples” under the skin. However, ultimately, the choice is yours when it comes to your preference of silicone or saline breast implants.
Within each type, especially with silicone, there are many different options including shaped (i.e. teardrop), projection (how far your breasts will stick out), textured or non-textured, and a wide variety of sizes. Implants are not only for women who want to dramatically increase the size of their breasts. We can use them to make relatively small, more subtle changes in breast fullness as well. All of these options can be discussed in detail at your consultation.
While it’s obvious the implant will be placed within the breast, the decision of whether to place the implant above or underneath the chest muscle is important. Rarely will Dr. Harris recommend placement above the muscle. There are several reasons for this:
- When the implant is placed under the muscle, it provides a more natural look since you will have both muscle and breast tissue covering all or part of the implant. It will also provide a more natural feel.
- Implants placed below the muscle will typically maintain their position longer since your chest muscle will help hold the implant in its place. When implants are placed above the muscle, the chest muscle does not provide any support for the implant, so the implants can sometimes “bottom out,” making the breasts appear heavy and less youthful.
- If you are getting a breast lift at the same time as your breast augmentation, it is critical to place the implant below the muscle so that the nipple and areola will have a more robust blood supply. Placing an implant above the chest muscle will disrupt many of the important blood vessels that supply nutrients and oxygen to the nipple and areola.
Now let’s examine the different incision sites that can be used for breast augmentation.
- By far, the incision location we use most often at Image is the inframammary fold (the fold under the breast where it meets the upper part of the abdomen). This is our preferred incision site because it disrupts only a minimal amount of breast tissue, allows for easy access to the chest muscle, and provides Dr. Harris with the best view of the tissues he needs to see for proper implant placement. The incision is very well hidden under a bra or bikini top, and generally no one will see it unless you want them to.
- Another possible incision location is the periareolar incision. This incision is placed in a semi-circle that follows the contour of the lower half of the areola (the darker skin surrounding the nipple) where it meets the skin of the breast. This incision does not provide the visualization Dr. Harris desires, and it disrupts much more breast tissue as part of the procedure.
- Another location that can be used is the axillary incision. The axilla (arm pit) incision has a relatively high rate of wound break down, in which some of the sutured skin reopens. In addition, the tissue dissection is not as precise as with the inframammary incision site, and the implant does not have the ability to settle into a more natural position as you recover.
- The fourth incision site is through the belly button. There are significant limitations to this approach. Only saline implants can be used, and the dissection is completely blind, meaning the surgeon cannot physically see the tissue being dissected. Furthermore, the implant must be placed above the muscle. At Image Surgical Arts, we do not offer this option.
While augmentation aims to enlarge breasts, the concern for many women is sagging. We usually associate this with pregnancy, breast-feeding, and aging (or with overly large and heavy breasts), but even teenagers can have naturally saggy breasts. The amount of droop can range from minor to severe, and it can be physically uncomfortable as well as aesthetically disappointing.
A breast lift can correct sagging, and for some women simply restoring a more youthful shape and position will also make the breasts appear somewhat larger. However, Dr. Harris often recommends adding implants to produce the most aesthetically pleasing result.
There are different incision patterns that can be used for a breast lift, depending on the final result desired. However the ultimate goal is to elevate the position of the nipple and areola so they are facing forward rather than downward, by removing excess skin as well as some breast tissue. If needed, Dr. Harris can also reduce enlarged areolae to produce a more visually balanced result. Which type of procedure is right for you depends is very personal and something you will discuss with Dr. Harris during your consultation.
Whatever the details of your surgery, incisions do leave scars, though they will fade over time. Dr. Harris takes special care to make the smallest incisions possible without sacrificing his ability to do his best work for you. The exact location of your scars will depend on the specific method he uses for your breast augmentation and/or lift.
The Extra Step that Makes a Big Difference
We also mentioned above that Dr. Harris is one of the cosmetic surgeons who pioneered something we call the Image Surgical Arts Post-Implant Fit Check. This technique is tremendously valuable to produce the best possible visual results as well as to reduce potential scarring. Here’s why.
Plastic and cosmetic surgeons never guess about what they are going to do, they literally draw lines on your body before they begin to outline their incision and reshaping plan. This variation of “tailor-tacking,” is an interim procedure that allows Dr. Harris to check his work before he finalizes the breast lift procedure.
Prior to removing excess skin (and after he places the implant, if there will be one), he uses temporary skin staples to hold the breast in place. Is it just right, or does it need to be refined a little? If not enough skin is removed, you will still have loose skin and some sagging. If too much skin is removed, the incision can stretch as it heals, leaving a more pronounced scar. While we always remind patients that there is no “perfection,” Dr. Harris always strives to get as close as possible for every patient.
This technique is essentially the same as trying on your wedding dress for a fitting, and the results are just as important. That said, not all cosmetic surgeons take the time to add this extra step.
Another step we take at Image is to inject Platelet Rich Plasma (PRP) into our incision sites. We have found that this not only speeds up the healing process, but decreases scarring and wound complications as you heal.