dr. jugenburg

Breast Augmentation Options

Side by Side Comparison of the Many Options You Have

I created this page to help you navigate the many options you face and help you decided which breast implant will best fit your needs

Breast augmentation is a procedure that has many options from which you can chose to get the best possible result.  Because there are so many options, it is easy for you to get confused and overwhelmed.

There is a lot of information on the internet, not all of it correct, and not all of it applicable to your particular situation.

Breast augmentation is one of the most common cosmetic surgeries world wide, but it is also one that creates greatest amount of pre-surgery anxiety as there are many different options you can chose from and the diversity of these option can be overwhelming.  There are multiple combinations that one can chose from and so you wouldn’t be alone if you get overwhelmed and do not know how to proceed.

Options:

  1. Implant type: – Silicone vs Saline
  2. Implant shape : Round vs Anatomic
  3. Implant Projections: low, moderate, high (and everything in between)
  4. Implant surface: smooth vs textured
  5. Implant position: over the muscle, under the muscle, dual plane
  6. Implant volume: an endless range of volumes – this is where most women spend time obsessing about the exact volume they want even though anything less than 50cc increments are almost invisible
  7. Incision site: breast fold, areola, armpit, belly button
Breast implant shapes

Implant type

Whether you chose a silicone or a saline implant, both types have the EXACT SAME outer surface.  The outer shell (the bag that is filled with either saline or silicone) is exactly same – a solid silicone polymer.  In on instance, the silicone shell is filled with saline – salt water, in the other instance the shell is filled with medical grade silicone.  But on the surface, they are both made of silicone.  The difference is in the feel.  Most women ask which one looks better, and the truth is you can’t really tell a silicone implant from a saline one.  Some people may tell you silicone looks better – I have yet to prove that theory.  Silicone ripples less, but once implanted into a body, the difference is imperceptible.  The difference between them is in the way they feel.  Silicone implants feel soft and are supposed to feel very much like natural breasts.  Saline feels different.  A saline implant is adjustable, and can be made super soft to a point where you totally do not feel that there is an implant in your body, to a very hard feel.  It depends on how much the implant shell gets filled.  Under-filling a breast implant makes it very soft, but it ripples a lot.  Most people overfill saline implants to minimize rippling, but that then makes them feel harder which is why you will read on the internet that saline implants feel harder than silicone.  Truth is, the feel is adjustable and you want to chose the best balance of softness and rippling.
TABLE Silicone vs Saline

FeaturesSalineSilicone
Scar sizeSmallerLarger
Correction of breast volume asymmetryBetter suitedLimited
Feel/SoftnessAdjustableSoft
RipplingMoreLess
(yes, even silicone implants ripple!)
RuptureSaline leaks out, harmlessly absorbed by your bodySilicone not absorbed by your body, stays in place

You may go on for years without realizing it ruptured (Silent Rupture)

Ultrasound or MRI is required to diagnose a rupture
Capsular contractureSlightly lower than siliconeSlightly higher than saline
Risk of silicone granulomas (small droplets of silicone diffused out of the breast implant)NoneUncommon but possible
HealthCanada/FDA approvalYesYes
Fill VolumeAdjustable
Fine adjustments can be made during surgery for optimal symmetry and look
Set volume, no adjustable
A decision to select a specific implant volume is made before surgery. It is not possible to adjust volume of a silicone implant. The only way to change is it to replace it with another silicone implant
Warranty against implant leak or ruptureLifetime warrantyLifetime warranty
Risk of rupture or leak7%6%
Implant ShellMedical grade siliconeMedical grade silicone
Implant contentSaline
Saline is salt water, the exact same solution that is given intravenously to patients who are dehydrated, or who need intravenous fluids, medications.
Medical Grade Silicone
Medical grade silicone differs from industrial silicone in that toxic components have been removed. The silicone is made ‘cohesive’ meaning it sticks together like a gummy bear candy. It feels soft.
Implant insertionImplant is inserted empty
Because they are inserted empty, smaller incisions are required. Once inserted, they are filled with saline to any volume desired.
Pre-filled implant is inserted
A larger incision is required
We use a “Keller Funnel” to be able to squeeze the implant in through a smaller incision than traditional silicone implants require, but it’s still a slightly larger incision than saline implants would require.
AppearanceSameSame
(Impossible to tell if an implant is a saline or silicone by just looking at it)
Detectability to touchMore
(if you have more than 2cm pinch thickness of skin over the implant, you won’t be able to tell the difference)
Less
(if you have more than 2cm pinch thickness of skin over the implant, you won’t be able to tell the difference)
Palpable 'knuckle"RarePossible
Spontaneous deflationPossible (7%)
Requires implant replacement (covered by the implant warranty)
Does not occur
However if the implant is ruptured, it should still be replaced (covered by the implant warranty)
Silent ruptureNever5%
Recommended follow upNone requiredPeriodic Ultrasound or MRI
Surgery costLessMore
MonitoringNone requiredUltrasound or MRI
AppearanceAdjustable
Can look very natural, but can also be made to look very round and fake (if desired)
Depends on the selection of the implant profile
High/Full profile implants look less natural then Moderate profile

Implant Shape

The shape of the implants can be ROUND or ANATOMIC.  Another term of Anatomic Implants is ‘Shaped’ or ‘Teardrop’ implants

 RoundAnatomic
Upper pole fullnessBetterLess to none
Incision optionsAnyBreast fold or Areola
AppearanceMay look less natural
(can be made to look very natural if size not excessive)
More natural
SoftnessSofterHarder
Implant size selectionGreat
Wide variety of sizes can be used
Limited
Implant size selection is restricted by your existing breast dimensions
Implant rotationHas no impactRequired correction
(may require additional surgery)

Implant Projection / Implant Profile

BreastImplantProfiles

A low projection implant is usually used in women who are undergoing a breast lift and just need a little extra volume.

Moderate implant gives a natural augmentation without really affecting the overall breast shape.

A Full/High profile implant creates a rounder look, and although is less natural than the Moderate profile, many women chose this because it creates more cleavage, and has more upper fullness (push up bra look)

Extra high profile implant are used when a woman wants a large volume but does not have a wide enough rib cage to handle a large implant.  This implant has a very fake look, but more importantly, if it ever flips it looks weird.  For that reason we do not offer this implant profile/shape to our patients.

Implant Surface

Implant shell is made of a solid silicone polymer that can have smooth surface or a ‘textured’ surface.  The textured surface feels like velcro and it has been developed to lower the risk of capsular contracture, and it also functions to create adhesions between the implant and the surrounding tissue so that it sticks to it like velcro.  This limits the implant mobility

 Smooth SurfaceTextured Surfaced
Implant 'stuck on'NoYes
Implant moves, feels more naturalyesNo
Implant can move out of position (bottoming our or lateral displacement)More likelyLess likely
RipplingNot made worse by the smooth textureMore obvious
Risk of capsular contractureUnchangedDecreased
(if implant over the muscle)
Risk of ALCL (anaplastic large cell lymphoma)NoneVery rare

Implant Volume

Implant volume refers to cc’s or ml’s of fill.  Some women think in terms of cup size and wish to achieve a certain cup size as their end result.  Surgeons (and implant manufacturers) think in dimensions: volume, width, height, and projection of implants.

The ideal implant is the one who’s dimensions closely fit your existing breasts.  More you deviate from this rule, more fake the breasts will look.

Another important fact to remember is that as implants get bigger, they get wider.  As they start getting too wide, ‘side boob’ becomes significant and some women do not like the feeling of their arms rubbing against their breasts as they walk or reach forward.

Breast Implant Placement

Breast implants are place under the muscle, over the muscle, or in ‘Dual Plane’.  They are never ‘inside’ a breast.  The breast tissue always sits on top of the implant and is pushed forward by the implant.

 Sub-GlandularSub-MuscularDual Plane
Implant positionAbove the muscleUnder the muscle
(very rarely is a sub-musclar augmentation truly completely under the muscle, there is almost always a part of the implant that is exposed thus really making it a dual plane)
Upper part of the implant is covered by the muscle, the lower part stick out from under the muscle and is covered by the breast tissue
(Most sub-muscular augmentations are really dual plane, but surgeons and patients just refer to them as ‘unders’)
Upper pole fullnessMore LessLeast
Round lookMore likelyLess likelyLeast likely
Risk of Capsular Contracture3%1%1%
RipplingMore visibleLess visibleLess visible
Animation deformity
(implant moves outward and upward when flexing your pec muscle)
NoYesMinimal

Incision Site

 Breast foldAreolaArmpitBelly Button
Inframammary foldPeriareolarTransaxillaryTrans-umbilical
Silicone implantsAny sizeOnly if areola >3cmNot ideal
(possible up to 450cc)
Not possible
Saline implantsAny sizeOnly if areola >2cmAny sizeAny size
ScarHidden in larger overhanging breastsIdeal for women with darker areolasIdeal for saline implants, scar are virtually invisibleScar invisible
Accidental scar visibilityIf your bikini top slides upOnly when nakedWhen you lift your arms upNone
Ideal patientWomen with B+ cup size, well developed breast foldWomen with areolas >2-3 cm, dark coloured areola, tubular breastsWomen with small breasts wishing saline implantsWomen with small breasts wishing saline implants
Poor candidatesmall cup size with no existing breast fold
Tuberous breasts
Small areola (<2cm)
Pale coloured areola
Thick glandular tissue
Women wishing silicone implants
Sagging breasts
Asymmetric breast position
Tubular breasts
Women wishing sub-glandular implants.
Women with larger breasts
Women wising sub-Glandular implants or silicone implants
Breast asymmetry
Tuberous breasts
Breast fold asymmetry correctionGoodGoodDifficultImpossible
Shaped implant usePossiblePossibleVery difficultImpossible
Round implant useEasyEasyEasyEasy

What is Implant Rippling?

Implants are a silicone bag filled with either salt water or gummy-brear like silicone polymer.   If these implant bags (shells) were filled 100% or even overfilled beyond 100% of their normal capacity, they would feel very hard.  So the manufactures (for silicone implants) and surgeons (for the saline implants which are filled during the breast augmentation surgery) attempt to keep their implants soft by underling them.  As a result, the implant bag/shell is not fully filled, is not fully stretched out and when standing upright or leaving forward, these implant bags collapse as demonstrated in the image on the right, thus creating ripples and folds.

While all breast implants ripple, rippling is NOT seen in all women.  Typically, rippling of the breast implants is seen in women who are thin and have very little fat padding the implants.

Steps to minimize rippling are: going under the muscle, using silicone implants or overfilling saline implants, fat grafting, or using alloderm

ImplantRippling