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. Dr. Yates is a board certified Utah plastic surgeon who specializes in breast augmentation and has performed well over 1,000 of these surgeries.

One of the most important considerations is desired breast shape. Are you interested in a more natural breast augmentation result or more of an augmented look. The important decisions that must be made to help achieve the desired breast augmentation result are 1) implant size and dimension, 2) implant type (saline vs. silicone), 3) below or above muscle, 4) breast implant shape, 5) incision choice.

Natural-breast-art-150x150Do I want natural or augmented looking breasts?

The perfect breast shape for natural breasts should have a little more breast volume below the nipple than above with nipples tilted slightly upward. Often patients who want breast implants like a greater degree of upper fullness than natural. What you consider your ideal breast shape requires careful consideration and discussion with Utah plastic surgeon, Dr. Yates. We have provided a lot of useful information on breast shape . Choosing the proper implant type, size, and position to match your shape goals is very important. In general tear drop (anatomical or gummy bear) breast implants can help many patients achieve a more natural shape with a smoother upper breast shape while round implants give more rounded cleavage.

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. Dr. Yates will help you pick the ideal breast implant size based on breast dimensions, skin envelope and desired shape. This is the starting point for sizing. You will then “try on” external implants of various sizes based on ideal fill and desired goals to help you and Dr. Yates fine tune your goals. Looking at a simulated result with 3D breast imaging helps with this communication.

“What will I look like after breast augmentation”. Dr. Yates is one of the few Utah plastic surgeons 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 shape and size before surgery.

Generally, if women are unhappy with their choice of breast implant size, they wish they had gone larger. However, there are definitely disadvantages to going too large, with higher complication rates associated with larger implants. Larger implants certainly look and feel less natural as well. This is what makes this decision so difficult.

Breast implant type (saline vs silicone?)

1) Round silicone breast implant
Advantages : Silicone breast implants are more natural feeling than saline implants. Silicone implants have a lower risk of breast implant visibility and rippling. Silicone implants can have a more natural shape, particularly for very small breasted women. Ruptures are less common. Generally silicone breast implants have a higher patient satisfaction. Every year more and more of our Utah patients are choosing silicone over saline.

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 rarely lead to breast hardening or deformity which can be difficult to improve surgically.

2) Tear drop shaped breast implant (anatomical or gummy bear)
Since their FDA approval for use in the U.S. these have become very ”hot”. These implants have the ability to give a more natural shape even with larger sizes and have lower rates of rippling and capsular contracture than traditional silicone implants. The scar is a little larger with these implants (2?) and they are a little more expensive and firmer.

3) 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”.

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. In reality, this is a “dual plane” approach with some muscle release.

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. In the event that a subglandular implant is desired, for example in a woman with very well developed pectoral muscles, an anatomical cohesive gel implant can help reduce rippling and capsular contracture rates.

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.

What is the dual plane technique?

The dual plane technique of breast augmentation is a technique where the implant is placed in a partial submuscular pocket and partial subglandular pocket to maximize some of the advantages of placement below and above the muscle. In simple terms the lower pectoral muscle is released from both the chest wall below and the breast tissue above. The muscle lifts above the lower part of the implant which helps to elevate a slightly droopy breast. The upper muscle coverage helps reduce risks of contracture and improve implant coverage.

Dr. Yates uses a simple dual plane technique for most breast augmentation surgeries and a more aggressive version in specific cases to help release a tight lower pole or improve mild droop. A dual plane technique is not a substitute for a lift for a patient with significant droop.

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 and it is a passing fad.

2) Axillary (armpit) incision – The advantage is a scar off 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. This is losing popularity and many plastic surgeons no longer offer this incision due to these risks.

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 (1-1.5?) and can be relatively short (1.5-2?) even for silicone implants. For anatomical implants the scar is slightly longer than 2?.

*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.

sientra-implants.-300x1731Breast implant shape? Round or tear drop?

The two basic breast implant shape choices are round and teardrop or anatomical. Teardrop shaped implants have recently been approved for use in the U.S. Round implants are more commonly used than teardrop shaped implants in the U.S. but with time and experience shaped implants will gain popularity. Shaped implants are already more popular in countries where they have been available. The main advantage of a teardrop shaped implant is that a more natural shape may be achieved. Additionally, because these breast implants are more cohesive (more solid than liquid) there is a lower risk of rippling and potentially lower risk of capsular contracture. However, the trade-off is less upper pole fullness, longer scar, firmer result and more expense.

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

Breast implant surface. Smooth vs textured?

silicone-implant1To decrease the risk of contracture, textured implants were developed in the 1970?s. The contracture rate may 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.

A textured implant can help in certain situations where a smooth implant is more likely to migrate such as pectus deformity and slanted chest wall deformity.

Tear drop shaped gummy bear implants require texturing to prevent turning in the pocket.

Breast implant profile?

Many patients state they desire a certain breast implant profile, for example high profile implants. The profile is the projection of the implant in relation to the diameter of the implant. A high profile implant has a smaller diameter and greater projection (away from the chest) 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. Moderate and moderate plus profile implants give a more natural result than high profile.

Breast implant brand?

There are three FDA approved implant manufacturers in the U.S., Mentor, Allergan and Sientra. There are subtle advantages and disadvantages of all three brands. Some plastic surgeons are loyal to one implant brand for ease of use and familiarity. A comparison of some of the pros and cons of the different implant manufacturers can be found

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