Longwood Plastic Surgery | Michael Tantillo, M.D.

Breast Augmentation Options

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Breast Augmentation Options Model Women considering breast augmentation at our Boston practice have many more options for breast implants than patients had even a few years ago. Board-certified plastic surgeon and breast enhancement specialist Dr. Michael Tantillo will assist you with selecting implants that best suit your cosmetic goals. Additionally, Dr. Tantillo recommends spending a considerable amount of time thinking over the implant size and insertion method to achieve the aesthetic results you've always wanted.

If you're ready to learn more about the breast implants available at our Boston, MA office, request a consultation online to meet with Dr. Tantillo or call our office at (617) 973-9700 to schedule an appointment.

Implant Materials

Breast implants are either filled with saline or silicone gel. Among the most recent options available to U.S. women are highly cohesive silicone gel implants, which have been nicknamed "gummy bear" implants because the texture is firm but pliable.

Implant Material

Pros

Cons

Silicone

Pros

  • Natural feel, especially in the lower part of the breast
  • Natural feel even when implant is large for breast volume
  • Can be placed above or below the muscle
  • Less risk of implant leak
  • Less risk of wrinkling
  • Lower rate of secondary surgery

Cons

  • Longer incision
  • Incision choice can be limited when choosing a very large implant
  • Implant rupture difficult to diagnose
  • More expensive than saline

Highly cohesive silicone gel ("gummy bear" implants)

Pros

  • Look very natural
  • Stay in place, avoiding complications associated with implants shifting in the pocket
  • Breast moves more naturally
  • Can be shaped to mimic the breasts' natural slope
  • Less susceptible to wrinkling

Cons

  • Some patients consider the feel too firm
  • Larger incision needed than for saline implants
  • More expensive than saline

Saline

Pros

  • Can be placed through any incision location
  • Shorter incision
  • Implant volume can be adjusted to compensate for asymmetry of breast size
  • Implant rupture easily diagnosed
  • Less expensive than silicone

Cons

  • Less natural feel than silicone, especially in the lower part of the breast
  • Higher rate of implant leak
  • Higher rate of capsular contracture when placed above the muscle
  • Higher rate of wrinkling

Silicone Implants

Silicone implants contain cohesive silicone gel and are also encased in a silicone shell. The silicone gel is "cross-linked," meaning that it holds together and is less prone to leaking in the rare event of a puncture or tear in the implant shell. Many women considering breast enlargement feel that silicone implants possess a more natural look and feel, as compared to saline implants.

Silicone implants are filled prior to surgery, which means that size cannot be adjusted during surgery; however, these implants are available in a wide range of volume and projection so even subtle breast asymmetry can be corrected with silicone implants. Often a slightly larger incision may be necessary to insert each implant. The FDA has approved the use of silicone gel implants for women 22 years of age and older; the use of silicone gel breast implants for aesthetic breast augmentation in patients ages 18 to 22 is considered an off-label use of the implants. Many patients in that age range choose silicone gel implants for their breast augmentation; this is a perfectly legal and rational choice.

Highly Cohesive Silicone Gel ("Gummy Bear" Implants)

Gummy bear implants at our Boston practice are becoming more popular. Only shaped highly cohesive gel implants are available in the U.S. The shaped implants gently slope and are wider at the base than the top to mimic the natural contour of breasts. Many women believe gummy bear implants have a more natural look and feel compared to other implants.

Saline Implants

Saline breast implants are encased in a silicone shell and filled with sterile saltwater. Because this implant type is filled during breast augmentation surgery, Dr. Tantillo can alter the firmness and overall feel of the implant by adding or removing saline solution. One of the benefits of saline implants is that if there is a leak or rupture, the saline solution will be harmlessly absorbed by the body. This implant type is available for women 18 years of age and older.

Implant Sizes

Implant size is one of the most important — and personal — decisions a woman choosing breast augmentation will make. Although looking at the results of other patients or friends helps in making a decision about size, no 2 women with the same sized implants will look the same. That's because your body frame, your breast tissue, and other physical characteristics are unique. Dr. Tantillo will help you determine how these factors will influence your possible results.

The overall size of implants is measured in cubic centimeters, and implant sizes generally range from 150 cc to 800 cc, depending on the amount of silicone or saline present in the implant.

Implant Incisions

You have 3 options for the location of your breast augmentation incision:

  • An inframammary incision is made under the breast, slightly above the crease where the breast connects to the chest.
  • A periareolar incision is made through the lower portion of the areola (the dark skin surrounding the nipple).
  • A transaxillary incision is made inside the armpit.

Once the incision is made, the implant is placed into a pocket Dr. Tantillo makes between the breast tissue and the ribs. Depending on a patient's body type, the type of implant, and the desired outcome, the implant will be positioned either above or below the pectoral muscle.

Incision

Pros

Cons

Inframammary

Pros

  • Provides excellent access to the breast implant pocket
  • Incision is usually not visible when standing or under clothing
  • Can place any kind of implant through this incision

Cons

  • Some anatomical differences can result in a more visible incision

Periareolar

Pros

  • Provides excellent access to the breast implant pocket
  • Ability to loosen a tight or constricted lower breast
  • Incision can be combined with a breast lift incision
  • Is not associated with increased nipple numbness

Cons

  • Pocket access can be difficult when the areola is small
  • Some silicone implants cannot be placed through this incision
  • If the scar is a light color when it heals, the scar can be noticeable, particularly if the areola is darkly pigmented

Transaxillary

Pros

  • Incision is located off the breast
  • Can be a good choice for placement of saline or small, smooth silicone implants

Cons

  • Access is farthest away from the pocket being created
  • Risk of implant malposition is highest
  • Increased risk of capsular contracture, the main complication following breast augmentation
  • Not all silicone implants can be placed through this incision
  • Secondary or revisionary surgery often cannot be done through this incision

Implant Placement

The "pocket" created by Dr. Tantillo can either be above the pectoral muscle (subglandular) or beneath it (submuscular). Subglandular, or subfascial, placement means an implant is placed between the breast tissue and the pectoral muscle. A submuscular placement is primarily located below the pectoral muscle, although the bottom and sides of the implant are not covered by muscle.

Placement

Pros

Cons

Subglandular

Pros

  • Quicker recovery with less discomfort
  • Can achieve a fuller upper breast appearance

Cons

  • Increased rates of capsular contracture
  • Less breast tissue visualized by mammogram

Submuscular

Pros

  • Decreased rates of capsular contracture
  • Less risk of feeling the implant

Cons

  • Longer recovery time; however, most patients recover within 48 hours
  • Implant may move during some upper body weightlifting exercises

Implant Shape

Implants are either round or teardrop-shaped (often called "anatomical"). The primary benefit of round implants is that they can be inserted through any type of incision. A concern for some women is that upper breasts may appear too full. Teardrop-shaped implants minimize the upper breast fullness. Shaped implants have a less than 1% risk of rotation.

Implant Texture

The shell of breast implants is either smooth or textured. Smooth implants require smaller incisions but may be more prone to capsular contracture than textured implants. Textured implants may provide a "one breast feel" as the implant is more closely incorporated into the patient's soft tissue and less prone to moving independently beneath the breast. Textured implants also may be less prone to bottoming out and lateral displacement over time. Anatomically shaped implants are textured, which helps prevent the implants from shifting or rotating within the breasts.

Fat Grafting

Dr. Tantillo offers a more natural form of breast augmentation with fat transfer breast enlargement. He uses liposuction to remove fat from unwanted areas, specially prepares this fat, and then places it in the breasts for a subtle enhancement without implants.

Once fat is removed from the body, it is then separated to ensure only the healthiest fat remains, and Dr. Tantillo injects the fat into the breast tissue. This form of breast augmentation is more subtle than implants, but it provides a great option for women looking for minor liposuction and naturally enhanced breasts. Fat transfer can also be used in conjunction with implant augmentation to treat breast asymmetry.

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Michael Tantillo, M.D.