Breast Augmentation

If having fuller breasts would help you feel more feminine, beautiful, and confident, you’ve come to the right place! Breast augmentation is one of the most popular plastic surgery procedures that our experienced plastic surgeons perform here at Boston Plastic Surgery, and it’s also one of the most rewarding for our patients who choose to have the procedure.

We love to see our patients’ big smiles and happy faces after having breast augmentation. Our patients report benefits such as:

• Increased confidence about their body
• Positive impact on well-being
• Ability to fit better into clothes, bathing suits, etc.

As you do your research, you’ll find that there are quite a few decisions to make about your breast augmentation in Boston! The good news is that we’ll help you every step of the way, answering your questions and discussing your options in your consultation. We’ll help you make the choice that is best for you.

Choosing Saline or Silicone

Is a desire for the most natural-feeling implant at the top of your list? Or do you want the smallest incisions possible? How much existing breast tissue do you have now? These are all questions that Dr. Samaha or Dr. Phelan will review during your consultation to help you choose what type of breast implants you would like to have: saline or silicone.

Silicone is a more popular choice due to its natural feel, but many patients decide that saline implants are better suited to their goals. What is most important is finding the right fit for your body.

Silicone Gel Breast Implants

Silicone breast implants are the most popular choice in the United States for breast augmentation. They quickly outpaced saline implants since their re-introduction in 2006, following a design improvement and FDA approval. Composed of a silicone shell filled with highly cohesive silicone gel, they closely mimic the characteristics of natural breast tissue. Some patients call them “gummy bear” implants.

Pros & Cons of Silicone Gel Implants:

• Silicone breast implants are generally smoother, softer, and lighter than saline implants.
• They have a softer, more natural feel and appearance.
• Silicone implants are less prone to rippling, and are well-suited to patients of all body types 
• Since they come pre-filled from the manufacturer, silicone implants usually require a slightly larger incision. We still aim for the shortest incision possible, and this is facilitated by the use of devices like the “Keller Funnel”
• Routine monitoring is recommended to detect implant rupture. We offer Ultrasound imaging in our office, free of charge to our patients, according to the FDA-recommended schedule.

Saline Breast Implants

In the 1990s, the majority of breast augmentation surgeries used saline implants, as access to silicone implants was limited. The outer shell of a saline implant is made of a strong, flexible silicone shell and the inside is filled with saline, a sterile saltwater solution.

Since the re-introduction and FDA approval of silicone implants, fewer women choose saline implants these days, as they have significant limitations. Dr. Samaha or Dr. Phelan will help you decide at your personal consultation.

Pros & Cons of Saline Implants

• They are slightly heavier and firmer, and feel less natural than silicone gel breast implants.
• Saline implants can be more prone to visible wrinkling, particularly in thinner patients with little natural breast tissue to cover the implant.
• Because they are filled during surgery, saline implants can provide some adjustability in implant volume.
• Should the contents of the implant enter the body for any reason, the body can safely absorb the saline.
• If the saline implant ruptures, it is noticeable right away as that breast will deflate. No additional ultrasound or MRI imaging is required to monitor breast implants beyond routine mammograms.

Are silicone breast implants safe?

Even now, after FDA approval, misinformation still prevails about silicone implants. The truth is, silicone breast implants were used widely from 1963 to 1992, in literally millions of patients. During this time, they had some design flaws which caused some local problems. However, media reports that tried to correlate connective tissue diseases with the use of silicone breast implants were not backed by scientific evidence. 

In 2006, the restrictions were lifted based on new, re-designed “cohesive gel” implants, and surgeons once again are able to utilize silicone implants. With the improvements in silicone implant technology, several excellent options are now on the market.

Keller Funnel Certified

An advancement in silicone breast augmentation delivery, the Keller Funnel™ is a soft, sterile device that many plastic surgeons use throughout the United States. Because the Keller Funnel reduces necessary incision size, it allows for more precise implant placement and reduces the risk of implant damage. Continue reading »

Breast Implant Sizing: Getting to the right size takes a personalized approach

This is what many patients consider to be the fun part of their breast augmentation process: choosing what size they want to be.

With all of the advancements in implant technology, we now have an unprecedented array of choices. Silicone gel and saline implants come in a variety of shapes and sizes. Dr. Samaha and Dr. Phelan begin the implant sizing process by first concentrating on what you would like the end result to look like. If you have goal photos to share with us at your consultation that helps us to understand your vision and design a surgical plan tailored to you.

We will help you narrow down your choices based on three major factors:

• Your desired breast size after surgery
• Your individual anatomy: height, weight, chest width, and other important measurements
• Your current breast size, shape, and degree of symmetry

Choosing Breast Implant Size

During the consultation, we will first make sure to understand the size and shape that you would like to achieve. We then take measurements, which are used to guide the choice of implant type, shape, and size. We make every effort to help our patients get a realistic idea of what they will look like after surgery. We incorporate personalized breast implant sizing to help our patients choose the ideal implant size.

Choosing Implant Profile

Implants come in a variety of “profiles,” ranging from wide low-projecting implants to “High Profile” implants with a relatively narrower diameter. The choice is made based on your desired outcome, tissue characteristics, and natural breast dimensions. A mastopexy or breast lift performed at the time of augmentation is another factor influencing profile choice.

Incision options for safety and scar-minimizing techniques

There are several techniques that Dr. Samaha or Dr. Phelan can utilize for the placement of implants. No matter which incision option is chosen, rest assured your scars will be:

• Difficult to detect by anyone except you and perhaps a close partner
• Easily hidden beneath clothing, even a bikini
• Made as small as possible

With proper care, your scars should also fade significantly over the first year following surgery. Our staff will provide you with all the information you need regarding breast augmentation recovery and aftercare, including scar care.

Breast Implant Placement: Over or under the muscle?

During breast augmentation surgery, breast implants are placed under the breast tissue or beneath the chest wall muscle. With either location, the implants will be properly centered under the nipple. The two placement options are defined as the following:

• Subfascial placement: under the breast tissue and under the lining of the pectoralis muscle, but over the muscle itself.
• Submuscular placement: below breast tissue and partially beneath the pectoralis muscle. This is commonly known as a “dual-plane” technique, as the muscle would cover the upper portion of the implant.

The placement option chosen will be largely determined by the patient’s body type, tissue thickness, and lifestyle requirements. There are benefits and disadvantages associated with each location, but they differ in each case, so your plastic surgeon will discuss your options thoroughly in your consultation.

Dual Plane Breast Augmentation (Under the Muscle): Pros & Cons

For this placement option, the lower part of the pectoralis major muscle is released from the chest, and this muscle covers the top portion of the breast implant. This option:

• Provides better coverage for the upper portion of the implant, which is helpful in patients with thinner tissues.
• Reduces the chance of visible rippling and implant palpability (ability to feel the implant edges) in some aspects of the breast, but not so much in the lower and outer aspects, where there would be no muscle coverage.
• May help to visualize the breast tissue during a mammogram

This technique requires patience during the recovery period while the implants “settle” into their final position, which can take a few months. Additionally, you may notice some movement of the implant when you flex your chest muscles.

Subfascial Augmentation (Over the Muscle): Pros & Cons

Subfascial implant placement has regained favor among surgeons and patients. There is a growing consensus that its safety profile is similar to dual-plane augmentation. For many patients, this technique offers an easier recovery and less risk of the breast twitching or moving with activity or exercise, which is known as an animation deformity. In subfascial placement, the pectoralis major muscle is left intact, and just the thin lining over the muscle (fascia) is elevated to cover the implant. Not every patient is a candidate for this technique, particularly if your tissues are very thin.

Breast Surgery Recovery: We want you to enjoy your new look as soon as possible!

At Boston Plastic Surgery, we use techniques that can greatly reduce the postoperative discomfort of this surgery. Many of our patients need to use very little (if any) narcotic pain medication, thus avoiding potential side effects and experiencing an easier recovery.

What to Expect During Recovery

After breast augmentation, it is normal to feel tired and sore. During your recovery, you will wear a soft, supportive surgical bra. You are able to shower after 48 hours. Most patients experience minor soreness and are able to go about their normal activities–except for lifting– shortly after surgery. Swelling, bruising, and changes in skin sensation are also normal and should subside in the weeks that follow.

• Get post-op instructions for breast augmentation & more

Returning to Normal After Breast Augmentation

Every patient heals at a slightly different rate, but in general, you can expect to return to your usual activities after your surgery along the following timeline:

• Rest at home the first 1 to 2 days after surgery.
• Shower 2 days after surgery; follow your post-op instructions!
• Depending on the activity level required for your job, returning to work may be possible within a few days.
• Wear a soft, supportive bra (sports bra) for the first several weeks
• Gradually return to exercise after 3 to 4 weeks

Your breasts may be sensitive to direct stimulation for about three weeks, so avoiding physical contact is recommended. Ask your plastic surgeon when you should resume any exercise and normal physical activity.

Scars from breast augmentation will be firm and pink for six weeks or longer. They will gradually flatten out and fade over time, becoming less and less noticeable. Breast augmentation scars are well-concealed in the natural contours of your breast and/or easily hidden by clothing. Scar management techniques are available to speed the scar healing process and minimize the appearance of scars. Scar management is customized based on your skin type and your history of scar healing.

Long Term Considerations

Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group. The mammography technician will use a special technique to ensure that you get a reliable reading. Most imaging centers are well-equipped and experienced in performing mammograms on women with breast implants, but be sure to tell the physician ordering your mammogram and your mammography technician that you have had breast augmentation.

For silicone breast augmentation, it is recommended to obtain a breast ultrasound or MRI first 5-6 years after surgery and then every 2-3 years thereafter to detect implant rupture. Many women have no symptoms if there is an implant rupture, so this monitoring is important. We perform complimentary in-office breast ultrasounds for our breast augmentation patients, making your post-augmentation monitoring as simple and easy as possible. 

If you need more details about recovery from breast augmentation, contact Boston Plastic Surgery to schedule a consultation with Dr. Samaha or Dr. Phelan.

We hope you find this information helpful! Feel free to contact us or call our office at 617.786.7600 if you have any questions.

More Breast Augmentation Techniques

Fat transfer to the breast

Fat transfer breast augmentation (also known as “Butterfly” breast augmentation) is an excellent choice for women who are interested in improving their breast shape and adding a small amount of volume, but prefer to avoid a breast implant.

Fat is harvested from the abdomen or thighs, processed, and grafted to the breasts in layers to improve shape and cleavage. Approximately 60% of the fat grafted takes, and the percentage of fat that takes stays permanently. 

After 1-2 months, initial swelling and minor bruising resolve, and final results are visible. Fat grafting can also be performed more than once to add additional volume if desired.

Breast asymmetry correction

If you have breast asymmetry, breast asymmetry correction may be customized to your anatomy and goals and included in your procedure plan:

• For many patients, this may mean a breast lift/breast reduction on one or both sides, removing different amounts of tissue from each side to adjust volume differences. 
• For patients who want to add volume, this may mean differential breast implant sizing. Fat grafting can also be used to treat breast asymmetry, and may require more than one session to achieve the desired result. 

It is important to understand that it is never possible to achieve perfect symmetry. Breasts are always asymmetric to some degree both before and after surgery, but correction can offer improvement. 

Tuberous breast correction

Tuberous breast is a congenital difference that features a high breast fold (below the breast); a narrow, constricted breast shape; small breast size; and areolar herniation (puffiness of the nipple). Women may have some or all of these features, and the condition frequently presents with significant asymmetry, as well. 

This is most commonly treated with a combination breast implant and a breast lift through a periareolar incision approach. This condition may require more than one stage for surgery, depending on your anatomy.

To learn about your breast augmentation options, schedule a consultation with one of our skilled plastic surgeons, Dr. Samaha or Dr. Phelan, by calling 617-786-7600.

Areas Served:

• Quincy
• Boston