Option analysis for breast augmentation

Your options for breast augmentation are basically: the type of implant and filler; the size of the implant; placement of incisions; and the placement of the breast implant. In general, with an augmentation your choices are:

Saline-filled or silicone breast implants
The size of the implant necessary to achieve your desired final breast size
The shape of the implant
The type of implant shell: smooth or textured
If saline, whether the implant is pre-filled or filled at the time of placement
Incision placement
Just in or above the natural crease of the lower breast
In the axilla (underarm area)
Along the lower perimeter of the areola (the dark skin surrounding the nipple)
Placement of the implant
Sub-mammary (also called sub-glandular) placement: below the breast tissue and on top of the pectoral muscles
Submuscular (also called sub-pectoral) placement: under the pectoral muscles

You might have an idea of what you wish your final breast size to be. Trying on various implant sizes in your bra may be helpful, or trying on various bra sizes and padding them is helpful, too. But you and your cosmetic surgeon together should consider a few things before making a decision: your body frame and proportion, the stability of your weight, the current amount of your natural breast tissue, and skin elasticity. You must have ample breast tissue to cover the implant even if the implant will be placed under the muscle, or the results may include rippling, stretch marks, an unnatural appearance, extrusion of the implant (it becomes visible on the surface), or an increased risk of capsular contracture. If your weight fluctuates significantly, so too, can your breast size and shape fluctuate. Incision placement often depends on the type of implant placed, where it is placed, and the techniques used.

Most common is a 2-3 inch incision depending on implant size, just a hairline above the natural breast crease.
Breast implants placed through a 1.5-inch incision or smaller in the axilla, and may be placed through the use of an endoscope (a hollow surgical tube) and then filled with saline once positioned.
Breast implants placed along the bottom edge of the areola. There is an alternative method called TUBA (transumbilical breast augmentation) that uses an endoscope placed through an incision in the navel to place and fill saline breast implants. This is highly controversial and should not be considered a routine incision site for the placement of breast implants.

Sub-mammary placement of the implant (below the breast tissue) generally has a somewhat shorter recovery. During upper body activity and exercise, sub-mammary placed implants can be somewhat obvious. Placement of the implant under the pectoral muscle has a somewhat longer recovery, and a more naturally sloped appearance. Sub-muscular implants may also make post-augmentation mammography easier to interpret. The choices you have are not yours alone to decide. This is a job for you and your cosmetic surgeon to discuss, and then to decide on together. You must have confidence in your cosmetic surgeon, the choices you have made, and in your overall decision before you proceed with breast augmentation.

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Option analysis for breast augmentation

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