The Surgeon Minute

The Four Major Breast Augmentation Decisions

The Four Major Breast Augmentation Decisions

It is a great time to be a breast augmentation patient. The surgical techniques that plastic surgeons use continue to be refined and improved upon, in addition to a big boost in technology. There are more breast implants on the market than ever before, making it much easier for patients to find a selection that specifically fit their individual needs. Safety, function, and final results have all been elevated.

However, an abundance of choice can feel overwhelming. Board certified plastic surgeon Dr. Adam Hamawy of Princeton, NJ walks us through the four major decisions that every breast augmentation patient should make with her surgeon.

Breast Augmentation: Incision Placement

Thanks to the continuing advancements and innovations in breast implants themselves, as well as surgical techniques, breast augmentation patients can achieve a very natural-looking result. This is currently the aesthetic that most women desire. Furthermore, the surgery itself is safer than at any other time in the history of breast augmentations. Surgeons today understand why problems may have occurred in the past and they’ve taken the necessary steps to correct them.

There are really four main decisions that the surgeon and patient must make together. The first involves incision placement. Any surgical procedure requires cutting of the skin, meaning there will be an incision. With a breast augmentation, this line can be on the breast:

  • around the areola
  • under the crease of the breast in the inframammary fold

Or the line can be off the chest:

The right choice for you is going to depend on your anatomy, needs, and personal preference.

Incision locations.

Where to Place the Breast Implant?

The second major decision is where to put the implant itself. A breast implant can be placed either above the muscle or below the muscle. Each option has its pros and cons. Above the muscle placement tends to fill out the breast more, but it also may make the implant more visible if you don’t have enough natural breast tissue for cover. Below the muscle placement is better for patients with very little breast tissue because it gives a buffer for the implant, protects the skin and reduces the risk of implant visibility or rippling. The right choice is going to depend on who you are and how much tissue you have.

Implant placement.

Silicone vs. Saline Breast Implants

One of the more controversial decisions that you need to make will be between selecting saline or silicone breast implants. While silicone breast implants have gotten a bad rap in the past, they are literally, “the most studied device that the FDA has ever looked at,” says Dr. Hamawy. Patients can rest assured that the latest generation of silicone breast implants are completely safe. Additionally, they also come in a wider range of cohesivity or thickness, opening up even more doors to further customize breast augmentation to individual patient needs and anatomy. The plus side to silicone is that most patients think it feels more natural. The downside is that if there is a rupture, you will not know about it unless you have an ultrasound or MRI. “Silent ruptures” are not necessarily a bad thing, and may not even have much of an aesthetic impact, but are, more or less, invisible.

Saline vs. silicone breast implants.

On the other hand, if a saline implant ruptures, you will know immediately as the breast deflates. Saline is just salt water so having it floating around in the body is no danger. However, there can be a higher incidence of rippling with saline implants. And, most saline implants don’t feel or look as natural as a silicone breast implants. The exception is the new IDEAL implant. It has multiple layers which helps to give it more of a “silicone look and feel,” explains Dr. Hamawy.

What Size Breast Implant?

The final and perhaps most important decision for most breast augmentation patients is size. Dr. Hamawy uses 3D virtual imaging to give his patients a very accurate picture of how each different implant will look on their specific body. “This has taken a lot of the question out of what size [to choose],” shares Hamawy. In the past, patients would have to use bags of rice to replicate chest volume, or they’d stuff the different implants under their bra. However, neither technique was a great indicator of your end result. They could give you a feel, but not a good idea of the look.


And, really, it all comes down to the look. Dr. Hamawy tells his patients to completely forget about the numbers and letters and just focus on the look. Once they find a 3D image of themselves that they like, then he’ll unveil the size. Letting go of the numbers can be hard for some patients; most have done a lot of research and typically come in talking about a friend who got x size and how they want the same thing.

Breast augmentation results - Dr. Hamawy.

It’s important for breast augmentation patients to realize that everyone is different. Furthermore, the surgeon must work within the confines of your individual anatomy and personal preferences.“Looking at your own body on that screen is a better gauge of where we should go,” explains Dr. Hamawy.

Breast Augmentation Recovery

While everyone heals at her own rate, most women are back to work within 3-5 days. If you have a very physical job where you do a lot of lifting, you may need more time off. In general, however, recovery is very quick. Dr. Hamawy had a hair dresser who went back to work the next day!


Most patients do very well, but you know yourself best. If you are someone who has a low pain tolerance, or doesn’t heal particularly fast, then plan accordingly. This is why it can be a good idea to speak with someone who has had the procedure. There are a number of women in Dr. Hamawy’s who have had a breast augmentation; he will usually have potential patients speak with one of them. It’s a different perspective than what he can give as a surgeon. “I take care of a lot of people but I haven’t gone through it myself,” he shares.

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