This article will dwell on breast enhancements surgery types. The topic of breast enhancement, also dubbed augmentation mammoplasty and boob job, is largely talked about these days. And thank God, because now patients can finally make an informed choice as to their surgery options. A nicely done breast augmentation can boost self-image and reduce self-consciousness.

Of course, it carries risks and this should be taken into account as well and maybe even regarded as part of a packaged deal. The sooner you realise how big this is, the better decisions you can arrive at. Anyway, let’s get straight to the point. Here are the main plastic surgery types.

Different types of breast enhancement surgery

Breast Implants

a pair of breast implants on purple surface

Breast implants are artificial prostheses used to add more visible cleavage to the chest. There are different textured implants that vary in implant size and shapes so they can meet a variety of needs. The outer shell is more often than not made of silicone, whereas the contents, or filler gel, could be composed of different materials. That said, there are two main types of breast implants, saline and silicone. They can be employed with the help of a surgeon for both breast augmentation and breast reconstruction surgery after pregnancy or mastectomy in women who’ve had cancer.

Silicone gel implants. It’s easy to figure out that these implants are filled with silicone. This is the most common implant type. Basically, it’s been around since the beginning. There are no surprises here: they are entirely made of silicone, both the shell and the inside of the prosthesis. Because of that, they create the most natural feel and shape, and women generally love the results.

However, it’s also because of that that silicone implants run a risk of capsular contracture or leakage into adjacent areas. There are both round and teardrop shapes. The latter are known as gummy bear implants. They come with a cohesive gel that makes it difficult to seep through the surrounding tissues if the outer shell is punctured.

Saline breast implants (salt water prosthesis). As the name so clearly points it out, a saline implant is filled with sterile saline solution (salt water). This feature gives the product an edge over silicone implants in terms of leakage. If the breast implants rupture, the liquid will be absorbed by the body in a breeze and no health problems will occur.

The decision between saline implants and silicone-filled breast implants is not to be taken lightly, as it affects the shape and feel, implant longevity, and the aesthetics. Women wishing to undergo this procedure have to give it some serious forethought. In fact, a board-certified plastic surgeon will usually give augmentation patients a 10-day timeframe, or longer, to really brood on the matter before taking the plunge.

Breast Implant Pocket Placement

Now, aside from the type of implants, placement is another crucial factor to think of during breast implantation surgery. It involves the pectoralis major and pectoralis minor muscles in the chest. According to the American Society of Plastic Surgeons, there are three types overall, so let’s see where they stand on the preferences scale.

I Subglandular Placement (Over the Muscle)

With this method, the surgeon performs the breast implant procedure under the breast tissue and on top of the pectoralis major muscle. It is appropriate to use in certain occasions. Here are the main aspects to consider.

Benefits of over-the-muscle placement during breast surgery:

  • When the chest muscles are flexed, no ‘animation deformity’ takes place owing to the position of the breast implant.
  • This type of placement creates a more natural look.
  • The recovery process is quite faster because the muscle is left intact rather than stretched out during the insertion of breast implants.
  • The so-called ‘double-bubble’ deformities are avoided alongside other breast deformities that could ensue when the implant is popped below the muscle.
  • The procedure is done in a single step and there is no need to provide injections repeatedly over time to expand the pecs so there is enough room for the implant.
  • The normal function and anatomy of the muscle are preserved, which reduces the risk of complications.
  • More cleavage can be obtained using this method.
  • The implant is placed much more easily this way and a smaller incision is required.

Disadvantages of the subglandular implant placement:

  • As it messes with the milk ducts, it prevents women from breast feeding; what this means is that female patients intending to have breast enhancement surgery should have a discussion with a specialist regarding their options
  • Women with smaller breasts might lack sufficient skin to overlay the implant which may create unsatisfactory results
  • The risk of capsular contracture is amplified, as the scar tissue that forms is thicker.
  • There also seems to be a risk of growing breast implant-associated anaplastic large cell lymphoma.
  • Despite the high satisfaction rate, the breast shape and breast symmetry may be ruined with this method more than with the other ones.

II Submuscular Placement

This method entails the surgeon sliding a breast implant filled with a sterile solution or silicone under the pectoralis major muscle (between the pectoralis minor and major one, that is).

Pros of submuscular placement:

  • The American Society of Plastic Surgeons says this technique reduces the occurrence of capsular contracture.
  • The results are more natural than with subglandular placement in the breast tissue.
  • Breastfeeding is possible here.

Cons of this method:

  • Since the muscle has to be involved in the breast augmentation procedure, it takes longer to heal, so the recovery process is affected after all.
  • Not all incision folds can be used for this placement type. An incision around the nipple could work best. For more information, keep reading.

III Dual Plane Implant Placement

As board-certified plastic surgeons began using the above methods, they soon discovered that there are some flaws in them that make the breast implants shift toward the armpits or lead to breast asymmetry. Hence, they came up with another type of placement, one that combines a little bit of both techniques. In this placement, part the implant sits on top of the chest muscle and the other part is positioned below it.

The upper part is covered by the pectoral muscle and the lower part remains under said muscle, allowing for a more natural position. Both the patients and doctors have found that a combination of subglandular and submuscular breast pocket placement works the best so far.

Types of Surgical Incisions in Breast Augmentation

Male surgeon prepares woman for breast augmentation surgery in clinic

Now, before the implant is slipped inside the chest, the surgeon makes a small cut has to be made that would accommodate it. Here are the different incision options available.

Inframammary fold – This one is created under the breasts and is the most popular surgical incision in breast augmentation since it gives the plastic surgeon more visibility of the pectoral muscles. It can be applied to silicone gel implants and saline implants alike.

Periareolar fold – The incision is made around the nipples. It leaves no visible scarring and allows for greater surgical control. This method enables the doctor to place the prosthesis anywhere in the chest, both under and above the muscle. However, the size of the silicone implants matters. Bigger prostheses will not fit through the nipple hole.

Transaxillary fold – Here the incision is carried out in the armpit. It’s far less common than the inframammary and may be employed with implants filled with sterile water. When it comes to a silicone implant, it may not be a suitable fit. Breast augmentation surgery is more rarely done using the transaxillary fold today.

Trans-umbilical breast augmentation (TUBA) – With this one, the incision occurs at the navel area and the implant is inserted endoscopically. These days, the method is no longer used. It works for saline implants, especially if they come empty. In these cases, implants are filled on the spot. As for silicone breast implants, the technique is not recommended.

Breast Enlargement via Fat Grafting

If you are not already familiar with fat transfer breast augmentation, it’s worth mentioning this method is much appreciated for its low-complication profile and faster healing times. The main thing about it is that the patient is injected their own fat tissue to enhance the breasts rather than placing a breast implant. It is harvested from areas with plenty of fat deposits that don’t normally disappear as a result of diets and exercise. This does double duty by increasing the cleavage and sculpting the body via extra fat removal.

How does breast enlargement work? Once an exam has been made and all medical aspects discussed, women have to undergo liposuction which is used to obtain the desired fat. The surgeon will mark the regions from which the body fat will be harvested prior to the procedure. As the patient is given sedation, the surgeon will make tiny cuts in the skin and place a thin cannula inside for that suction action. When the fat is obtained, it is placed in medical jars where it sits around while the surgeon is preparing the breasts for the transplant.

Then, once the area is ready to use, the breast filler fat is injected into tiny holes using a syringe, previously made by the surgeon. The breasts are shaped with precision so they look alike.

Pros of fat grafts for women

  • This type of breast augmentation benefits your whole body since it involves harvesting fat from areas where they are in excess and inserting them into the chest. So, some regions lose fat and get a better definition whereas the breasts become fuller. You end up with a flatter tummy and a bigger cleavage. You don’t get this with silicone breast implants, right?
  • Fat transfer breast augmentation is ideal for those struggling with the idea of putting foreign objects in their bodies. It will not pose a risk of infection in the future once the wounds heal, plus the results will be completely natural. You don’t have to worry about the fat affecting the aesthetics of the breast or showing through the skin when you are lying down or doing exercise unlike silicone gel-filled implants.
  • Unlike breast implants, fat will not deflate, rupture, or move around, disrupting the appearance of the chest of messing around with your health state. Revision plastic surgery is just as expensive as the initial procedure, other than the stress and hassle of going under the knife again.
  • Fat grafting procedures require tiny punctures into the skin as opposed to breast implants that take an incision to be performed. Hence, visible scarring is less of an issue here.

Cons of fat grafting breast augmentation procedure

  • Using fat transfer to alter breast size is a costly cosmetic surgery given that two procedures are involved – breast augmentation and liposuction (liposuction itself is exorbitant). Since it’s not covered by the government, patients have to pay for the entire procedure themselves. Those who need breast reconstruction after mastectomy may be eligible for a free procedure.
  • The treatment does nothing about saggy breasts and can in fact make sagging worse. So, if you are hoping for a breast augmentation with a lift, you need to look at other options. By contrast, breast implants naturally provide a breast lift and a nice shape of the breast.
  • The desired outcome of fat grafting breast augmentations can be diminished after a while due to fat reabsorption. Here is the thing. When you get fat transfer, some of the tissue you receive doesn’t stick on for very long. In most cases, we’re talking about 30% of the transplanted fat going to waste in the first 6 to 12 months following the procedure. Unfortunately, even with the best of plastic surgeons, it happens and there is nothing you can do about it. That’s just the body’s natural mechanisms.
  • And finally, breast augmentation via fat transfer gives minor changes only and you shouldn’t settle for it unless that’s what you are looking to get – minor changes. It is estimated that you can augment your breasts by up to one cup size, and that’s all. As compared to breast implants, it can only provide subtle cosmetic alterations in appearance.

Bottom Line of Breast Implants and Breast Augmentation via Fat Grafts

Please note that regardless of the advantages and disadvantages of these methods, one will be suitable for some women and another will be recommended to other patients. A lot of things have to be considered.

Like, do you want smaller modifications in breast size or a full-blown change? Are you looking to also get breast lifts (check out our post on what you can expect) or just increase the size of your boobs? Do you prefer a natural breast shape or are you more into round implants? Gummy bear implants or saline-filled implants? Smooth or textured implants? Are you considering significant weight loss? What other procedures do you have in mind?

Hence, you and your plastic surgeon of choice should have a thorough conversation prior to the cosmetic surgery where they will give you an honest account of what’s going to happen, what risks are involved, and how your unique body features and medical state need to be taken care of. There is no single technique that works for everyone.

So, it’s not just a matter of ‘I want this and that.’ The choice you make should be based on knowledge and examination. Still, you should be aware that some variables are uncontrollable and unpredictable. Needless to say, expecting women should not undergo breast augmentation surgery. On that note, before you decide whether to have breast implants or fat grafts, you ought to come to a resolution whether you want to have children first.