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In the case where a patient desires a fuller breast size, whether because of genetically petite breasts, as a result of underdeveloped breasts, or if breasts have decreased in size following pregnancy, breast augmentation, or “augmentation mammaplasty,” can be an ideal procedure. Inadequate breasts may lead some patients to feel self-conscious about their bodies, and a breast augmentation procedure can help patients gain the confidence they desire.

Implant Types

A topic of deliberation concerning breast implants is whether to get saline or silicone implants. Both types of implants are made of the same elastic silicone shell, but what differentiates the two is the implant filling. Saline implants are filled with a sterile salt water solution, and these implants will noticeably collapse in the case of rupture and the harmless solution will absorb into the body. Silicone implants, on the other hand, are filled with the same rubbery silicone as the outer shell and move and feel similar to natural breast tissue. In the case of a silicone rupture, the implant may not collapse and so it is important to visit an experienced plastic surgeon regularly to assess the condition of the implants. Both have certain advantages as well as disadvantages, and individual preference and circumstances will determine which option is the best for each patient.

Incision Techniques

There are several incision techniques available for breast augmentation, and an experienced plastic surgeon can evaluate patients to determine which technique is best suited for each individual. The four techniques that can be used to insert an implant differ depending on the location of the incision. The inframammary technique uses an incision in the fold under the breast. For the periareolar technique, an incision is made around the edge of the areola. An incision in the underarm area or armpit is used with the transaxillary technique. The final incision technique option is the transumbilical, which involves an incision at the naval and is only available with saline implants.

Placement Options

Another important decision to consider with breast augmentation is the placement of the implants. Subglandular or submammary breast implant placement is when the implants are positioned behind the breast tissue but over the pectoral muscle. Subpectoral or dual-plane placement is when the implant is placed partially subglandular and partially submuscular. With subpectoral, the upper part of the implant is positioned beneath the pectoralis major muscle, but the lower half of the implant is not covered by muscle. Fully submuscular implants are placed entirely under muscle; the upper half of the implant is positioned under the pectoral muscle, and the lower half is placed under related muscles below the pectoral. Although uncommon, subfascial placement is another option for implant placement. This is when the doctor separates the fascia, a layer of fibrous tissue over the chest, from underlying muscles and places the implant under this layer. Implant type and size, as well as the patient’s individual circumstances and amount of soft tissue available for implant coverage, determine the choice of pocket for placement.

Prior to Surgery

Breast augmentation patients are advised to stop smoking at least two weeks before the operation. Patients should also stop taking anti-inflammatory drugs, medications containing aspirin, as well as any herbal supplements for a couple of weeks before surgery to reduce the chances of excess bleeding. Prior to surgery, lab testing or a medical evaluation should be done to ensure that the person is healthy enough to undergo surgery. A mammogram also needs to be done before and after surgery to detect any irregularities or changes in breast tissue.

Types of Anesthesia

General anesthesia or intravenous sedation can be used for breast augmentation surgery. With general anesthesia the patient is generally not conscious and breathing is controlled by the anesthesia provider with an endotracheal tube. Narcotics are used at the end of the procedure to dull the pain and usually cause some nausea. Intravenous sedation blocks pain from the nerve fibers during surgery and the patient is more conscious of surroundings but will have little to no recollection of the surgical process. This sedation has less side effects as well as lower risks of lung complications, and recovery is usually quicker than with general anesthesia.


After breast augmentation surgery, medication will be prescribed to control pain. Activities will be limited for a few days and soreness and swelling will likely last for a few weeks. Over time, normal activity and exercise can be resumed and incision lines will continue to fade. The plastic surgeon will give specific instructions on how to care for the breasts following surgery.

Breast augmentation is one of the most requested plastic surgery procedures. It can help balance the proportions of a woman’s body, improve self-confidence, and possibly lead to a happier social life. To schedule a breast augmentation consultation with the Cosmetic Surgeons of Naples, call (239) 263-6766.

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