Breast Augmentation- Implants

“Now I have breasts!” were the first words I heard from one of my breast augmentation patients as she awakened from anesthesia. It was a statement that made a lasting impression. Soon after surgery many patients psychologically and physically incorporate their breast implants as their breasts. Many patients tell me that breast augmentation makes them feel “complete” and enhances their self-confidence. These women have had breast augmentations that are natural in appearance and complement their body shape. They feel empowered in professional and social situations with both women and men. For many women who make the decision to have a breast augmentation, it is something they had wanted for a very long time.

Performing breast augmentations is one of the most gratifying procedures that I do. Establishing a dialogue and good communication with my patients is key to understanding what they want and achieving an optimal result.

-Michael C Bruck MD.

While it may seem like a “simple” procedure, achieving beautiful results takes judgment, skill, and a keen aesthetic eye.

According to the American Society for Aesthetic Plastic Surgery, breast augmentation has been among the most popular cosmetic procedures. In recent years, averaging more than 300,000 annual breast augmentations

performed—of which approximately 90% were with silicone implants and 10% with saline implants (statistics may vary slightly depending on source).

What does breast augmentation do?

  • Increases self-confidence
  • Increases breast volume
  • Improves breast shape
  • Improves breast symmetry
  • Patients look better in clothes
  • Feel better when wearing swimwear
  • Empowering- makes you more comfortable in professional, social and sexual situations

Getting “The Look” you desire – choosing the right implant

Some women want only enough of an augmentation so that they will not have to use padding in their bras while others will say that they want to be a “full” C, but want to look “natural.” Occasionally some patients express a desire to go “very large.” Terms like “natural” or “ very large” mean different things to different patients. At the time of your consultation show your surgeon photos of “the look” you want. Be sure that you consult with a surgeon who is certified by the American Board of Plastic Surgery.

Sizing is a very individual process. A given size implant make look very different from one patient to the next. Factors that are considered when determining implant size include:

  • The height and width of your breast
  • The ease with which your skin stretches
  • The amount of your natural breast tissue
  • Your body shape

Some surgeons use a “try-on” system where silicone sizers are placed in a bra to give the patient an idea of how they might appear with different size implants. Also, there are simulation tools that some surgeons use that enable you to visualize a facsimile of how you would appear after breast augmentation. Based on your communication, breast measurements, quality of your skin, how much natural breast tissue you have and your overall body shape, your surgeon will recommend a size and type of implant. The final decision is yours, the patient.

At the time of surgery, once a pocket has been created for the implant, your surgeon may insert a sizer, a temporary implant with dimensions and shape equal to the implant selected. Based on the intraoperative assessment with the sizer in place, a final decision is made regarding implant size. While this adds a small amount of time to the procedure, it helps ensure an optimal outcome.

What about shape of the implant, am I better with a teardrop or round implant?

Implants come in a variety of shapes, volumes, dimensions, and textured and non-textured surfaces. Breast implants can be round or teardrop shape. While it may seem that the teardrop shape gives a more natural result, this is not necessarily the case. Numerous studies have documented that in the majority of instances, board-certified plastic surgeons, when reviewing before and after photos of breast augmentation patients could not identify which patients had round implants and which patients had shaped or tear drop implants.

Which is better silicone or saline?

Whether you choose silicone or saline implants, you can have breasts that have the “look” you desire. In general, however, breasts augmented with silicone implants tend to feel more natural than breasts augmented with saline implants. There is a greater tendency to feel and sometimes see rippling with saline implants, especially in the thin patient with little breast tissue. The choice ultimately is the patient’s.

Are silicone implants safe?

The answer is YES. In 1992 silicone implants were taken off the market. After several years of investigation by the FDA, the FDA concluded that there was no cause and effect relationship between the presence of breast implants and health problems. In 1999, the moratorium on silicone breast implants was lifted, but with strict guidelines for their use. After further investigation, in 2006, the FDA cleared the use of Silicone implants for all patients age 22 and older. Follow-up guidelines included periodic breast MRI and the usual and customary requirements for mammography. Additional information on breast implant safety can be found on these websites: and

Which is the best place to have an incision?

Incisions can be made in one of four locations: In the fold under the breast (inframammary); in the lower part of the areola where the areola skin meets the normal breast skin (periareolar); in the fold in the armpit (axillary); within the belly button (transumbilical). The most common incision sites are the inframammary and periareolar. Very few surgeons use the transumbilical incision. During your consultation discuss the advantages and disadvantages of each incision site.

Is it better to have my implants above or under my muscle?

Placing breast implants under the muscle (pectoralis muscle) is a more common practice than placing the implants over the muscle. While historically it was thought that placing implants below the muscle reduced the incidence of capsular contracture, more recent data suggests that when protocol designed to reduce the incidence of capsular contracture is followed, there is no significant difference in the rate of capsular contracture for silicone implants placed above or below the muscle. This is not true for saline implants.

Saline implants placed below the muscle:

  • Added layer of tissue covering the implant minimizing visible and palpable wrinkling
  • Less likelihood of ripple that can be seen or felt
  • Upper pole of implant border softer in appearance
  • Decreased incidence of capsular contracture
  • Submuscular position is preferred for mammography

Silicone Implants placed below the muscle:

  • Added layer of tissue covering the implant minimizing visible and palpable wrinkling
  • In thin patients, below muscle has less obvious interface upper implant border
  • Below muscle has disadvantage of
    • Animation deformity
    • Possible double bubble
    • Lateralization of implant with chest exercises
  • Submuscular position is preferred for mammography

Silicone Implants placed above the muscle:

  • Preferred in young athletic women
  • Above muscle has advantage of
  • No animation deformity
    • No possible double bubble
    • No lateralization of implant with
      chest exercises
  • Preferred in bodybuilders


Will I have to have my breast implants replaced at some time?

Breast implants are a manufactured device, and like any manufactured device will, at some point, have to be replaced. A leak or rupture of a saline implant will result in deflation of the breast. If there is a rupture of a silicone implant, there may not be a noticeable difference in the appearance or feel of the breast as the silicone gel tends to maintain its shape. FDA guidelines recommend an MRI three years after silicone breast implant surgery, and periodically after that.  Should an implant rupture, depending upon the manufacturer’s warranty, the replacement of the implants, as well as some of the associated costs, may be covered.

Where is the surgery performed and what type of anesthesia is used?

Breast augmentation is usually performed under general anesthesia in an accredited office, ambulatory, or hospital facility.

What about mammograms?

Screening mammograms is recommended at age 40 and every year thereafter.  However, these guideline may vary.  Therefore, discuss this with your physician.  For women who are at higher than average risk of developing breast cancer due to a family history or who are known to carry a gene that increases the possibility of developing breast cancer (BRCA gene), mammography may be indicated at an earlier age.  This should be discussed with your surgeon.  In patients who have had a breast augmentation, special additional views are performed. In addition to screening mammography, women should perform self-breast examination monthly and have physician breast exams as well.  Your plastic surgeon should also perform a breast exam prior to your surgery.

IMPORTANT: Many patients who seek consultation for a breast augmentation learn that in addition to an implant a breast lift is necessary which they did not anticipate.  They are concerned about the additional incisions and scars. The outcome of an attractive, firm shapely, youthful breast with a well-positioned nipple areolar complex far outweighs the additional incisions which generally heal well.

Give us a call at (212) 308-4600 to learn more about Breast Implants or click here to schedule an appointment.