Choosing the Perfect Breast Implants

All women considering having a Breast Augmentation are primarily concerned with exactly how their breasts will look afterwards. If this applies to you, you are likely asking the following questions with regard to how your ideal breasts might look:

  1. How big should my breasts be?
  2. Where on my chest should my breasts sit?
  3. What shape should my breasts have?
  4. What should my cleavage look like?
  5. How pert should my breasts be?
  6. Where should my scar be hidden?

The definition of ideal breasts is, however, highly subjective – it is based on each individual’s opinion and every woman will have her own unique goals and expectations. While some women want their enhancement to be subtle in order to give a natural look, others wish for a more noticeable or fake look. Neither goal is more correct than the other; there is no right procedure for everyone. In answer to all the above questions, therefore, your procedure can be tailored to achieve a look that meets your realistic expectations and compliments your existing body shape and size.

Preparation is key towards having a beautiful, natural enhancement to your femininity.

Breast Implant Options: Size, Shape, Volume,
Texture, Manufacturer

content-13Breast implants are manufactured by different companies in many varieties of content (or filler),base width (diameter), volume, shape and surface texture to suit your individual needs. Choosing the right implant and manufacturer is therefore key to a successful breast enhancement surgery. As part of the pre-operative consultation process at the Toronto Cosmetic Surgery Institute, Dr. Jugenburg, as a Breast Augmentation expert, will use his extensive experience and cosmetic artistry to help you choose the perfect implant. The following factors will each play a role in the decision making process:

  1. Body shape and size
  2. Existing (or natural) breast size and shape (breast anatomy)
  3. Desired look – natural or fake
  4. Amount of sagging or drooping (ptosis) of existing breasts
  5. Amount and integrity of natural breast tissue
  6. Lifestyle and physical activity

During your consultation, Dr. Jugenburg will measure your chest and breast size, as well as your height and weight. These measurements will be used to recommend the right implant to fit your existing proportions, a method known as Dimensional Breast Augmentation. You will also be given an opportunity to look at, feel and try on samples of the various implants available to you (known as breast implant sizers). This is the most effective way to determine which implant is best for you and what you will look like after your augmentation surgery.

What Profile Should I Choose?

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The profile of a breast implant refers to the distance an implant will project forward from your chest wall. A low profile implant is very flat, while a higher profile implant will protrude forward (stick out) from your body and create a more prominent breast. How much do you want your breasts to stand out?

To help you decide which breast implant profile is most appropriate for your body, Dr.Jugenburg will consider both the existing size and shape of your body and breasts, and the look that you desire. Some women ask for ultra-high profile implants because they aspire for the very bubbly, push-up bra look (the Fake Look). Other women wish to have the very subtle enlargement of a lower profile implant (the Natural Look).

When choosing your breast implant profile, your existing breast width is a key factor. In order to achieve a natural, proportionate appearance, it is important to ensure that the implant is equal to or marginally smaller than your existing breast width. Women with very little existing breast tissue and a narrow chest (described as petite) are therefore often limited to implants that are much smaller than they had imagined their ideal size to be. In such situations, keeping the implant diameter small, but increasing the profile of the implant (i.e., the extent to which the implant protrudes forward), permits the use of a larger size implant without it being too wide for the patient’s frame.

Further information on breast implant profiles and placement is given here.

What Size Should I Choose?

The most common and important question among pre-operative Breast Augmentation patients is: “what size should I choose?”. However, choosing a breast implant size is often also the most difficult decision for a patient. It is not unusual for women to spend a lot of time alternating their decision between various sizes, especially since implant sizes do not correspond to traditional bra cup sizes. Breast implant size is instead measured based on volume in cubic centimeters (often referred to as cc’s); the larger the implant, the greater both the volume of cc’s and the projection from the chest wall (for a given implant diameter).

By consulting the breast implant volume sizing charts that will be shown to you during your consultation and trying on various sizers (or samples) you will have in-person visualization of how different implant sizes will affect your shape. When making your decision it is important to consider that larger implant sizes typically give a fake-looking augmentation, may be problematic for women having a more active lifestyle (e.g., participating in sports, jogging and yoga), and are associated with a greater risk of complications, such as bottoming out (an unfavorable downward movement of the implant).Dr. Jugenburg will also evaluate your existing breast tissue to determine if you have sufficient tissue to cover and hide your chosen implant size.If the size you have chosen is too big,the implant edges may become visible following your surgery.

Try, Test and Simulate

In addition to trying on various implant sizers, Dr. Jugenburg will also perform a 3D simulation to give you an idea of what you will look like after surgery. A variety of bras are available for you to use, and if you also bring a tighter fitting t-shirt or top, this will allow you to determine how your breasts might look under clothing. Should you currently have very little existing breast tissue, any size may seem big at first, but you will become quickly accustomed to the new, larger size.

One piece of advice Dr. Jugenburg gives to all his patients is to find the size that you think suits your body, and then choose a slightly larger size. All implants tend to look smaller once they have been placed under your breast tissue. This effect is more pronounced if an implant is placed below the chest muscle (pectoralis muscle). The muscle compression will further shrink the size of the implant and should therefore be taken into consideration when making your decision.

Ask Your Friends

If you have any friends who have had a breast enhancement, knowing their implant sizes may help you judge what will be best for you based on your respective body proportions. Remember, the higher the number in cc’s, the larger the implant (an increase of 150 to 200 cc’s equates to an increase of approximately 1 to 1.5 cup sizes). Bear in mind, however, that every woman’s anatomy is different, and that the results attained by one woman with a given implant size may not necessarily represent the results you will obtain with the same implant size.

Look at Photos

When consulting with a Plastic Surgeon, it is wise to take photos of cosmetic results in other patients that approximate your personal goals. For this purpose, there are numerous websites that show Before and After photos of Breast Augmentation patients. During your consultation with Dr. Jugenburg, you will also be able to look at Before and After photos of previous patients at the Toronto Cosmetic Surgery Institute. By looking through these photos it should give you a better idea of the size and shape you are hoping to achieve.

Should I Go Over The Muscle Or Under The Muscle?

content-10Breast Augmentation involves the creation of a breast pocket that allows for the placement of the breast implant. Implant placement with respect to the chest muscle (pectoralis major) impacts on the shape and position of an augmented breast.

The breast pocket can be made in one of two places: under the breast itself (sub-glandular or sub-mammary), or under the chest muscle (sub-muscular or sub-pectoral). There are advantages and disadvantages for both approaches; a below the muscle placement can also be performed using one of three different variations.

either approach is appropriate for all patients; each patient, being different, has different requirements and different desires. DDuring the consultation process, Dr. Jugenburg will first examine your existing breast anatomy and discuss your personal goals with you, before recommending which breast implant placement will be most ideal for you.

Below the Muscle (Sub-Muscular)

The advantages of an implant placement below the chest muscle:

  1. More natural look
  2. Less visible implant in the upper breast
  3. Lower risk of Capsular Contracture (undesirable implant hardening)
  4. Lower risk of implant bottoming out (unfavorable downward movement)
  5. Less visible implant rippling/wrinkling (natural folds in the shell of an implant;  further information is given here)
  6. Mammograms are easier to read (which can be beneficial for a woman with a family history of breast cancer)

The disadvantages of an implant placement below the chest muscle:

  1. More discomfort during post-surgical recovery (this is minimal and should not be used as a determining factor in which approach is used)
  2. Longer time for breasts to settle down into their optimal position and shape
  3. implant and breast movement during physical activity (when flexing chest muscles)

Above the Muscle (Sub-Glandular)

The advantages of an implant placement above the chest muscle:

  1. Less discomfort during post-surgical recovery
  2. Quicker post-surgical recovery
  3. Final (optimal) size and shape seen earlier
  4. More bubbly, rounded (or push-up) look (known as the Fake Look)

The disadvantages of an implant placement above the chest muscle:

  1. Higher risk of Capsular Contracture
  2. Higher risk of implant bottoming out
  3. Implant more visible
  4. Implant easier to feel
  5. implant rippling/wrinkling more visible in the upper breast
  6. Mammograms are harder to read (further information is given here)

What Type of Breast Implant Should I Choose?

In addition to breast width, projection, and volume, the following options are also available and must be chosen accordingly for your Breast Augmentation in order to meet your personal goals and give you the best possible result.

  1. Implant surface: Smooth or Textured
  2. Implant shape: Round or Shaped
  3. Implant content or composition: Silicone (Cohesive gel or Gummy Bear) or Saline
  4. Implant manufacturer: Allergan or Mentor

During your consultation with Dr. Jugenburg, you will be able to look at and feel the various types of breast implants to allow you to make a decision based on the feel of the implants. Dr. Jugenburg will guide you through every step of this process and ensure that you are fully informed on all of the options that are available to you, and the disadvantages and advantages of each.

Smooth or Textured?

The surface of a breast implant (implant shell) can be smooth or textured (rough, Velcro-like). First generation implants were first manufactured using a smooth shell; a textured shell was later developed in an effort to decrease the likelihood of Capsular Contracture (implant hardening).

Textured implants have a thicker shell to compensate for their intentionally rough surface, which has the disadvantage of more visible implant rippling/wrinkling and a harder feel. In order to achieve a better aesthetic result and natural feel, Dr. Jugenburg therefore prefers to use Smooth implants whenever possible

Round or Shaped?

Breast implants can be Round or Shaped (also known as Teardrop or Anatomic implants). Round implants are symmetric, while Shaped implants have more volume and projection on the lower half, therefore creating a teardrop shape. A teardrop shape gives a more natural look; however, in our experience, most women prefer the fullness of a Round implant.

Dr. Jugenburg uses Shaped implants only for Breast Reconstruction in cancer patients when the recreation of a natural breast shape is important. For women who have Breast Augmentation for purely cosmetic reasons and already have a natural looking breast, exaggerating the teardrop effect with a Shaped implant does not create a sexy, full breast look.

Silicone or Saline?

Saline and silicone implants both have advantages, and both types of implants can produce excellent Breast Augmentation results.

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Saline breast implants are comprised of a silicone shell that is filled at the time of surgery with saline (salt water). Since the silicone shell can be inserted into the breast area and then filled with saline once inside, saline implants require a smaller incision than silicone gel implants and can be customized. Virtually any volume of saline can be added to moderate the required implant profile and size, and the right and left breast implants can be filled differently to adjust for any mild asymmetry in existing breast volume.

The main disadvantage of saline implants, however, is that they feel less like natural breast tissue and are more prone to rippling/wrinkling than silicone (silicone implants also ripple, but not as prominently as saline implants). Over-filled saline implants have less rippling, but feel more firm.

Silicone breast implants feel and look more natural than saline implants and are available in pre-existing sizes (it is not possible to adjust their size during surgery). They have a solid silicone shell and a cohesive silicone gel filling. The density or thickness of the silicone fill, although more similar to that of natural breast tissue than saline, can be varied to give softer (more prone to rippling) to harder (less prone to rippling) implants (such as Cohesive gel implants as compared to Gummy Bear implants).

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Implant Manufacturer

The two main FDA-approved manufacturers of breast implants are Allergan and Mentor; implants from both manufacturers are available at our clinic.

Allergan and Mentor have years of research experience and a high safety standard. A wide range of reliable and durable silicone and saline implants that vary by implant density, profile, shape and/or texture are available from each manufacturer.

For further information on Allergan breast implants, please refer here, and on Mentor breast implants, here.

Breast Implant FAQ

The following questions and answers will give you an insight into other common concerns regarding the appearance and feel of augmented breasts among pre- and post-operative patients. If you have a question that is not answered here, please contact us.

  • There is no good correlation between breast implant cc's and cup sizes. A cup size measurement is a very imprecise way to measure a breast and there is no standardized sizing among bra manufacturers. A C cup, for example is a much smaller volume on a petite woman, then a C cup on a large woman.

  • Choosing a breast implant profile (width and projection) that matches your existing breasts and body shape is the best way to ensure that you will get a natural look.

  • Every woman knows every part of her body and you will always be able to feel your breast implants. Women with very little natural breast tissue, in whom the skin and tissue is stretched more to cover their implants, will likely be more aware of the implant edges. If you are extremely slim and can easily feel your ribs under or to the side of your breasts, you will also be able to feel the edges of your implants.However, if the implants that you have chosen are appropriate for your body, over time they will become a seamless part of you. A degree of natural rippling/wrinkling on an implants surface is relatively common and can be felt, particularly when a woman leans forwards; however, this effect is similar to the folding of natural tissue in larger breasts (without implants).

  • Yes, improvements to breast asymmetry are always addressed during Breast Augmentation. In more pronounced cases of breast volume asymmetry, Dr. Jugenburg may need to modify the chosen implant profile and/or size between your breasts to adjust for this asymmetry.

  • A fake look refers to the very round, bubbly Breast Augmentation where the outline of the breast implants can be seen. The implants and breast sit high on the chest, cleavage is tight, and the impression of a permanent push-up bra effect is created.

  • A natural look can also be achieved with a Round breast implant. Placing the implant below the chest muscle can create a natural teardrop effect without actually using Teardrop implants. This will depend on the existing characteristics of your breast, such as the amount and integrity of your existing breast tissue. If you have very little existing breast tissue, a Teardrop implant may be required to give the shape of a natural breast. In the case of cancer mastectomy patients, a Teardrop implant is always required to reconstruct a natural-looking breast.

  • When properly selected to fit your body, a breast implant should be covered by your existing breast tissue. However, there are many women who have little natural breast volume and/or wish to have a fake-looking Breast Augmentation (in which the implant edges are typically visible). If you pinch your breasts and the pinch is less than 2 cm thick, you may not have a sufficient amount of existing tissue to hide an implant if positioned above the chest muscle. In such cases, an implant placement below the chest muscle is preferred as the compression and contours of the muscle will better disguise the implant and create a more natural look.

  • Health Canada has approved silicone breast implants for Breast Augmentation that are manufactured by two companies: Allergan and Mentor. An extensive review by the Institute of Medicine in the United States concluded that: "There is no evidence that silicone implants are responsible for any major diseases of the whole body. Women are exposed to silicone constantly in their daily lives.”Silicone is commonly found in hair conditioners, shampoos and styling products, and as coatings on pharmaceuticals pills.

  • There are physical limitations on what size breast implants can be used in certain women. In order to answer this question, therefore, it is important to distinguish between what is a high profile implant and what is an over-sized implant. Over-sized implants are implants that are not in proportion with the size and shape of your existing breasts and the rest of your body. Complications that are typically associated with high profile implant are:

    1. Bottoming out
    2. Visible rippling, wrinkling and ridges (with insufficient breast tissue coverage)
    3. Stretchmarks

    Over-sized implants may also increase the risk of:

    1. Tissue, fat and muscle thinning (Pressure Atrophy) that leads to a reduction in size of the natural breast tissue
    2. Reoperation

    This does not mean that higher profile implants will necessarily lead to a greater risk of such complications; there is no evidence to suggest otherwise. High profile implants are useful in the right women. The process should be to first choose a size that is appropriate for your body, and then to select the implant profile that best matches the base diameter of your natural breasts. This may be high, moderate or low profile.

     

  • One of three small incisions can be used to insert your chosen breast implants: through the armpit (Trans-Axillary), through the breast fold (Infra-Mammary), or through the Areola (Peri-Areolar). The technique that is chosen will depend on your existing breast anatomy and personal goals, the content of the implants (whether saline or silicone), the size of the implants, and the intended position of the implants above or below the chest muscle.

    Further information on Breast Augmentation incisions and scars (and techniques) is given here, and specific to the armpit approach, here.

     

  • Saline implants are more prone to rippling/wrinkling, but it can also occur even with higher density silicone gel implants (particularly Textured implants). Patients with insufficient skin thickness, breast tissue and/or muscle coverage to disguise the natural implant folds that occur are more prone to visible rippling. Dr. Jugenburg will advise you on what compromises in implant selection you will need to make in order to obtain the best results. For example:

    1. Implant type: Choosing silicone gel implants instead of saline implants may help reduce rippling.
    2. Implant profile: Choosing a smaller implant profile to allow for better breast tissue coverage may make any rippling that occurs less visible.
    3. Implant location: For women with thin skin or breast tissue, placing the implant below the chest muscle may help reduce visible rippling.

Your Breast Augmentation Consultation

Dr. Jugenburg is a highly experienced plastic surgeon who always takes the time to get to know his patients and their needs before committing to any kind of surgery. At your consultation, you will have the opportunity to meet with Dr. Jugenburg, and let him know about the look you want to achieve. The doctor will guide you through the whole breast augmentation process: from the preparations you will need to make, through to the surgical procedure and aftercare. You will have the opportunity to ask any questions and raise any concerns you might have with Dr. Jugenburg and his team of highly qualified and friendly healthcare professionals.

Meet Your Doctor, Dr. Martin Jugenburg

Get in touch with Toronto's foremost plastic and reconstructive surgeon

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