Breast augmentation when done well is not just about increasing the size of your breast but also optimizing its appearance. The goals are not simply to have more fullness in your bra but also to have an elegant and beautiful appearance of the breast out of clothing. Often photos are shown with an exaggerated appearance in a bra or swimsuit that can have an unnatural appearance out of clothing. As a general rule in plastic surgery our goals should be to create a beautiful, natural look, not a distortion.
Choosing an implant size
Selecting the proper implant size and projection is critical. If the implant is much wider than the existing width of your breast, it can look artificial or “fake”. This can result in an overly round look that doesn’t appear natural out of clothing. The position of the nipple on the breast mound is critical. A plastic surgeon recently presented a study of youthful breasts suggesting that 45 % of the breast volume should sit above the nipple and 55% below the nipple. The ideal proportion can vary but if too much volume of the implant is above the nipple then the breast can look unnatural. If too much volume is below the nipple, then the breast can appear “bottomed out”. So the implant size and projection needs to be selected to complement the existing position of the nipple on the breast. If the distance from the breast fold to the nipple is too long, then you may need a breast lift. If the distance is too short, then the fold may need to be lowered. But lowering the fold to accommodate a larger implant can increase the risk of “bottoming out” or a “double bubble” so it is usually more predictable to choose an implant size that complements your existing breast.
Choosing between smooth and textured
Your breast implants come with smooth or textured surfaces. Texture can give the implant more grip and decrease its tendency to slip to the side (lateral shift) or to slide down on the chest (bottoming out). Texture can also help to prevent a shaped implant from flipping or turning, so when a shaped implant is used, it comes with texture. Texture may also decrease the risk of a capsular contracture, the tightening of scar tissue that forms around the breast. So if your breasts are “looser” after pregnancy or weight loss, then a textured implant can give more stability to your result with less risk of the implant moving where we don’t want it to go (implant malposition). But certain problems are increased with texture. The more aggressive textures have a higher risk of late seromas (fluid collections) and pseudo-capsule formation (extra capsules of scar tissue forming around the implant) as well as the rare condition of Breast implant associated ALCL, a very rare type of lymphoma that can be found around a textured implant. BIA-ALCL has not been shown around smooth implants and it seems to be less common around implants with a much lighter texture. (micro textured implant). So there are cases where it still may make sense to use micro texture such as after pregnancy where the breast is looser and more at risk for shifting of the implant.
Choosing your implant material
The material of your implants is another important decision you will make during the breast augmentation planning process. There has been a long-running debate over which is better – saline or silicone. But at the end of the day, both can be effective options depending on your goals. Silicone gel filled implants can feel the softest and most natural but it can be hard to tell when they leak without a special test such as an MRI or an ultrasound. Traditional Saline filled implants are easy to tell if they leak but can feel unnatural like a baggy filled with water. But many patients like the peace of mind of knowing that the saline material can be safely absorbed by the body in the rare case of a rupture and that ruptures are not “silent” with a saline implant- the breast goes flat and it is easy to tell without a special study.
Dr. Hall understands that your piece of mind AND achieving the natural results you want are important. That’s why he also offers the IDEAL implant, an implant composed of saline, but with a multi-shell structure. This gives it the structure of silicone for a natural appearance with a reduced risk of complications like rippling, capsular contracture, and rupture. It is still filled with saline however so it is easy to tell if it leaks.
Dr. Hall will be there for you to assist with all your decision-making. During your consultation, he will discuss the pros and cons of your options and recommend the best solutions for your unique concerns and goals. To start customizing your breast augmentation procedure, contact our office and schedule your consultation with Dr. Hall.