We consider the following factors to be important in choosing implants: your physique profile, height , weight, and especially the dimensions of your chest wall. It is our goal to make the implants look like they belong to your body. We normally try to keep the implant inside the chest wall plane so that it doesn’t stick out to the sides so that it looks over-stuffed. We will normally try to give a high profile implant and create a higher pocket because we know the implant will start to drop over time. We also aim to center the nipple towards the middle of the breast mound, but we will go a little higher to create a perky look if the patient desires this.
The size and shape of your breast now. This would include how ptosis or sagging your breast has, which may require a lift procedure at the same time as the implant. We specialize in the superior crescent lift, which creates the least amount of visible scar, but can give a very large lift with an implant properly p[laced. Normally we can accommodate most average sagging with the superior crescent lift. If there is a large amount of sagging, sometimes we use a lollipop incision, which can be safely done with an implant.
Choosing between saline and silicone implants can be a difficult decision. We have been using both implant types for thirty years and have not found there to be a big difference in the feel or appearance of either one. Some of the concerns about saline implants having more rippling and less natural look has been addressed by careful placement of the implant and filling of the implant to a slightly over-filled volume during surgery. Silicone implants are very nice and have a gel feel when you hold them in your hands. But if a woman has any breast tissue, the more she has, the less the feel of gel can be appreciated compared to saline. Even thin women with minimal breast tissue have had beautiful long-lasting results with saline. The biggest concern with silicone, even with the new generation implants, is the possibility of the silicone leaking out into the tissue. The leakage of silicone into the tissue is a permanent, disabling of the soft tissue and sometimes cannot be reversed. Silicone adheres to the breast tissue and causes big and little lumps that are possible sites of small bacterial infections in the tissue. While this subject has been debated for a long time, just the globules of silicone sticking to the tissue are a problem. Therefore, in most cases, we consider saline to be much safer, but are happy to use silicone if the patient desires. Another very important factor that needs to be decided on by the patient is the placement of the implant above or below the muscle. The plastic surgery community thought at one time that all implants should be under the muscle. This is no longer the case. There are several good reasons to put the implant above the muscle. With women becoming more and more involved in athletics, it’s important to disclose to the patient that there may be loss of pectoralis muscle strength from going under the muscle, which necessitates cutting the muscle away from the sternum at the lower portion. We have several female athletes: a body builder, power lifter, firefighter, and tennis player, who liked the appearance of the implant under the muscle, but clearly noted some loss of performance after surgery. This has been noted in other patients, as well, who are very active. While the difference may be small, in a competitive sport, it can be critical. The recovery is also much quicker above the muscle, and in almost all cases, can give a natural look. However, some women still request going beneath the muscle, and we happily accommodate this request.