Breast augmentation is the most commonly performed cosmetic surgery procedure in the United States, and one of the most misunderstood. The decisions involved — implant type, size, profile, placement, and incision — are interdependent and require careful individualization. This guide provides the foundation you need before your first consultation.
Implant Types: Saline vs. Silicone
Both saline and silicone implants have established safety records spanning decades. The primary differences:
- Silicone gel implants feel more similar to natural breast tissue. Modern cohesive gel implants ("gummy bear" implants) hold their shape even if the outer shell is compromised. They are the most commonly chosen option.
- Saline implants are filled after insertion, allowing a smaller incision. Rupture is immediately detectable (the implant deflates visibly). They may feel firmer and are more prone to rippling in thin-tissued patients.
Choosing the Right Size
The most common mistake patients make is approaching size selection with a cup size target rather than a volume calculated for their specific anatomy. Cup sizes are not standardized and vary by bra manufacturer.
Dr. Fern uses the High Five tissue-based planning methodology: precise measurements of your chest width, breast base diameter, tissue thickness, and nipple-to-fold distance to identify the range of implants that will work within your anatomy. Size is then selected within that range based on your goals.
The key principle: an implant that matches your anatomical measurements will look natural. An implant that exceeds them will look augmented.
Implant Placement
Submuscular (under the muscle) provides more tissue coverage, reducing rippling and improving mammogram accuracy. It may produce animation deformity — visible implant movement when the chest muscle contracts — in some patients.
Subglandular (over the muscle) is appropriate for patients with adequate natural tissue for coverage. It avoids animation deformity and has a faster recovery.
Dual plane places the implant partially under the muscle (upper pole) and partially under the breast tissue (lower pole). It offers the coverage advantage of submuscular placement while reducing animation issues in the lower breast.
Incision Options
- Inframammary (under the breast): most common, most direct access, well-hidden scar
- Periareolar (around the areola): scar camouflaged at the color transition; increases risk of sensation change and slightly increases capsular contracture risk
- Axillary (in the armpit): no breast scar; more difficult surgical access; appropriate for select patients
Recovery: What to Expect Week by Week
Days 1–3: Pressure and tightness are the primary sensations. Pain is typically well-controlled with oral medication. Rest, with walking encouraged.
Days 4–7: Discomfort decreasing. Most patients are comfortable enough to return to sedentary work by day 5–7. Drains removed if placed.
Weeks 2–4: Upper body exercise remains restricted. Implants are high and firm — they have not yet settled into their final position.
Months 2–4: Implants settle. Final shape becomes visible. Sports and full upper body activity resumed at 6 weeks.
Long-Term Considerations
Breast implants are not lifetime devices. The FDA recommends MRI at 5–6 years post-implantation for silicone gel implants and every 2–3 years thereafter to screen for silent rupture. Implant replacement may become necessary due to rupture, capsular contracture, or the desire to change size — but many patients go 15–20 years or more without intervention.
Schedule a consultation with Dr. Fern at our Greenwich or Manhattan office to discuss which approach is right for your anatomy and goals.