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Breast Augmentation Options

What are the choices that you will need to make for your Charlotte breast augmentation?

The decision to undergo a breast augmentation is a very personal one, and it’s one of the most important decisions a woman can make. However, once she has decided that breast augmentation is right for her, she will have more decisions to make. Breast augmentation is a very individualized procedure, and each patient can choose the options that are right for her. Dr. Miles will spend a great deal of time at the consultation with each patient, helping her to gather the information she needs to make her own decisions.

Implant type: Saline vs Silicone

The first decision most women make is whether they prefer saline or silicone implants. Each choice has its own advantages and disadvantages.

Saline is salt water. A saline breast implant is filled with the same sterile saline that is routinely given as I.V. fluid.  Some women prefer saline implants because they desire to use only natural substances in the body. If a saline implant ruptures, the saline will simply be absorbed. After a rupture, the patient will realize right away that the implant has developed a problem. The breast will then have a “deflated” appearance until the implant is replaced.  It is important to realize that the saline is contained inside of a flexible silicone shell, so there will still be some silicone in the body even if you choose saline implants. In addition, saline implants tend not to feel as natural as silicone, and may be more likely to cause rippling or palpable edges, particularly if placed above the muscle.

Silicone implants are filled with a silicone gel. Originally, this was less cohesive, which could be problematic if the implant leaked because it was difficult to clean up all of the silicone from the surrounding breast tissue. However, as technology has progressed, the silicone used in implants is now more “cohesive,” meaning that it is far thicker. The characteristics of these implants is sometimes compared to that of a gummy bear.  This means that a ruptured implant will generally not cause problems in the surrounding tissues. However, it is also more difficult to detect an implant rupture. Silicone implants are currently much more popular than saline implants, mainly because of their more natural feel. The FDA has approved silicone breast implants after many years of research showing that these devices are safe and do not cause general health problems.

Implant shape and texture

Saline implants are almost always round (there are some textured , shaped saline implants that are seldom used). However, with silicone implants, there is a choice between a round implant or a shaped implant. With a shaped silicone implant, the bottom of the implant is fuller than the top. This “teardrop” shape is intended to mimic the shape of a natural breast, which is fuller at the bottom when a woman is upright.

A shaped silicone implant is also textured on the outside. This causes the body to adhere strongly to the implant, holding it in place. Round implants may also be textured, or they may be smooth, which allows them to rotate within the implant pocket. A smooth round implant may respond to gravity in a more natural-appearing way. A textured or shaped implant will generally appear natural when a woman is upright, but may look less natural when she is lying down or moving through space (such as dancing), because the implant can’t move as much in response to gravity.

In addition, implants may be of moderate to high profile. The profile of the implant is how far it will stick out from the chest after placement. In general, high profile implants provide more cleavage, but tend to look less natural on most women than moderate profile implants. As implant size increases, the projection must generally increase as well in order for the implant to fit correctly on the chest wall.

Implant size

Most women come to their consultation with an idea of how they want their figure to look. Some women want a dramatic enhancement of their bust line, while others prefer a more moderate, natural-looking size increase. Often, a woman will have an idea of what cup size she would like to be. However, implants do not come in cup sizes, but rather in sizes that indicate the volume of filling material inside of the implant. Each size of implant will create a different result for different women, depending on your individual anatomy. You will work with Dr. Miles to determine what size implant would be most likely to get the results you prefer. See our breast augmentation size page for more information.

Implant location

Implants may be placed either behind or in front of the pectoral muscle at the front of the chest. Looking at the chests of male bodybuilders gives many people the idea that the pectoral muscles are large and thick, but these are actually very thin muscles in most people, especially in most women. When breast implants are placed below the muscle (submuscular placement), this can help to conceal the edges of the implant, creating a more natural-looking result.

There is typically minimal detriment to the performance of these muscles when the implant is placed beneath them, and most women won’t notice the difference. However, for female athletes who perform at high levels, preserving the optimal function of the pectoral muscle may be important. In this case, placing the implants above the muscle (subglandular placement, beneath the glandular tissue of the breast) may be preferred. In addition, placing the implants above the muscle avoids the problem of “motion artifact,” in which movement of the chest muscles causes movement of the implants in an unnatural-looking way. Fitness instructors, dancers, and others who regularly perform chest muscle movements may prefer subglandular placement for this reason.

Incision location

Breast implants are inserted through a small incision for each breast, typically smaller than most patients expect.  Saline implants are inserted in a deflated state, and the saline fluid is added once the implants are in the pocket.  The incision size is independent of implant size with saline implants.  Silicone implants are inserted at their full volume, so a larger incision is sometimes required.  Silicone shaped implants are also harder to squeeze through a small incision.  Dr. Miles uses a Keller funnel to insert all silicone implants.  This device allows for implant placement through a smaller incision.  I also requires less implant manipulation and is thought to reduce the risk of infection and capsular contracture.   There are three incisional approaches used by Dr. Miles.

An inframammary incision is located at the fold under the breast, where the breast tissue meets the chest. This type of incision is very well-hidden by a typical bikini top or bra, although it could be detectable on close inspection. An inframammary incision gives the surgeon optimal visibility and access to the breast during the procedure, which allows for more precision with placement and makes it easier to achieve optimum results.  Secondary or revision procedures are most often done through this approach, regardless of the initial incision location.

A periareolar incision is located around the nipple (at the border of the areola, the dark or

pinkish circle around the nipple). In many cases, the transition between different types of skin at the edge of the areola obscures the scar, so it will not be easily visible. However, it may still be possible to see the scar after healing. Periareolar incisions sometimes affect the sensation of the nipple or breast. It may also be more likely to interfere with breastfeeding later on.

A transaxillary incision is located in the axilla (armpit), where the scars will be hidden in the folds of skin. Many women select this incision because it is very discreet, since the scars are not located on the breasts at all. However, there will be a scar that will not be concealed by certain clothing.  This type of incision requires the implants to be placed from a distance, which can make precise placement more challenging in some cases.

Some women ask us about the TUBA (transumbilical breast augmentation), in which the incision is placed in the umbilicus (belly button) and the surgeon tunnels up through the abdomen to place the implants. The idea is to create a breast augmentation with no visible scars. Unfortunately, this procedure has had inconsistent, and often unsatisfying, results, because it is very difficult to place the breast implants precisely when doing so through a long tunnel. Dr. Miles does not perform TUBA procedures, because he wants to get the best results for every patient and the TUBA simply cannot offer that at this point.  Breast implant warranties are not always honored by the manufacturer when this approach is used.

Help from your plastic surgeon when planning your Charlotte breast augmentation

If all of the information about your choices for your breast augmentation seems overwhelming, do not worry. We know that most people would like expert guidance when making important decisions, and Dr. Miles is here to help. At your consultation, he will discuss all of your options with you and answer any questions you may have. After learning more about your goals for your appearance, he will also make recommendations about which choices will be most likely to provide your desired results.

As you prepare for your Charlotte breast augmentation, Dr. Miles and all of our office staff want to help you feel completely confident and empowered to make the choices that are right for you. If you would like to schedule a consultation, please call us at (704) 896-5556 or contact our office online.

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