Breast augmentation with saline or silicone implants has become an increasingly popular option for women either born with a small chest of for those who suffer from the effects of child birth or have gained and then lost a lot of weight. Breast imperfections compiled with the societal preference for a larger bust have caused the most frequently performed surgeries done by plastic surgeons to be the breast augmentation. The operation can be a challenge to perform as there are a number of decisions the patient and surgeon must make to obtain the best results.
The first and most basic decision is the choice of breast size and the possible need for a breast lift or mastopexy in addition to augmentation. Next, the type of implant should be explored. Some people desire the “natural” feel of silicone implants and others prefer the improved projection and lifting obtained with saline implants. The surgeon will usually recommend that the implants be placed in the sub-muscular position (beneath the pectoralis muscle) although on very rare occasions sub-mammary (beneath the breast tissue and on top of the pectoralis muscle) placement may be indicated.
Finally, the incision location is discussed. There are basically four different incisions available: axillary (armpit), peri-areolar (around the nipple/areola), infra-mammary (under the breast), and umbilical (through the belly button). Most surgeons will know 2 or 3 of these approaches with the “TUBA” or trans-umbilical approach being the least performed incision. In many instances the trans-axillary is recommended due to its location in the armpit away from the breast itself, the quality of the scar in the hair-bearing skin of the trans-axillary and the fact that early implant manipulation to keep the implants in position perfectly in the sub-muscular pocket without putting pressure on the breast incision.
Price shopping breast augmentation is a calculated risk as one is shopping a general anesthetic also. New plastic surgeons performing breast augmentation are generally a “one trick pony.” That is, they tend to offer implants and rarely breast lifts (which are harder to do), nor do they offer a selection of breast incisions as the infra-mammary incision seems to be the easiest for the amateur surgeon to perform.
The caveat is to always check the credentials of your surgeon as there are no “weekend” courses to teach breast augmentation. Also, beware of the “less is more” argument. That is, minimal training as a “cosmetic surgeon” is somehow better than completing a full plastic surgeon residency resulting in American Board of Plastic Surgery Board Certification as a REAL Plastic Surgeon. Breast augmentation gone wrong is very difficult to reconstruct and shopping for the cheapest surgeon does not guarantee board certification, clinical judgment, or experience.