Tammy Wu, MD  |  Calvin Lee, MD  |  (209) 551-1888  |  www.SurgeryToday.com 
Mon-Fri 8am -5pm  •  4754 Dale Road, Modesto, CA 95356

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Breast Augmentation Information

Written by Dr. Tammy Wu, MD
Modesto Plastic Surgeon, Surgical Artistry
Breast Augmentation Specialist


editing by Calvin Lee, MD

Modesto Botox Injector, Surgeon, and Acupuncturist

Picture of Model for Breast Augmentation web page, not actual patient
Picture from Model, not actual patient


What is breast augmentation?  How long of a surgery is breast augmentation?


Breast augmentation, is a procedure designed to enhance the volume and the contour of the breasts with implants.


Breast augmentation is a surgery that is usually performed as an outpatient procedure, meaning that the patient will usually go home after surgery. The surgery usually takes approximately 1 to 1.5 hours or so to do. If additional surgeries are performed, such as a breast lift, at the same time, the surgical time may be longer.  We now, as of March, 2019, have our own certified surgery center adjacent to our office on Dale Road.


What are breast implants?  Who are the major makers of breast implants in the USA?

Breast implants are medical devices that are manufactured and designed specifically to be used for implantation in a human body to increase the breast volume. They are often made of a silicone polymer shell that is soft yet strong. The ‘filling’ or the inside of the shell can be of saline or silicone gel.


There are currently two major manufacturers of breast implants in the United States: Allergan and Mentor (which is now under Johnson and Johnson). Allergan is the same company that manufactures Botox and other popular products such as Juvederm (for filling in fine lines on the face) as well as the eyelash grower Latisse. Allergan is also the company that took over Inamed and McGhan implants of the past.  Allergan calls their breast implants Natrelle.


The breast implants made by Mentor are all made in the USA in their factory in Texas. The implants made by Allergan are made in the USA, as well as other countries in the world. Both companies’ implants have to meet the standards imposed by the FDA regardless of their country of origin.


What about Saline vs. Silicone gel breast implants?

This is a question that I am asked by my patients who come in for breast augmentation consultation. What are the differences between the two types of implants? Which one is safer? Which one is better?

      Saline implants


A saline implant has a shell that is made of silicone polymer. What makes a saline implant saline is that the inside of this implant shell is filled with the same saline solution in the IV bags that contains sterile salt solution that we get in our IVs when we go to the hospital.  The implant is usually placed into the body as an empty shell at first, then the surgeon will fill the implant with saline using a special transfer kit that directly transfers the saline in the IV bag to the implant.

A saline implant is usually ‘overfilled’, in order to minimize ‘rippling’, or wrinkling on the surface of the breast implant that may show through one’s skin.

Overfilling’ means that the implant will be filled with more saline solution than its stated volume. For example, a 300cc saline implant will usually be filled to 325cc of normal saline. The purpose of the overfilling is to place an appropriate tension on the implant shell surface, in order to minimize potential wrinkles that may result from ‘underfilling’. ‘Underfilling’ can cause spontaneous rupture of the implants due to the frictions of the implant surfaces rubbing against each other.  Therefore, all the manufacturers of saline implants recommend overfilling of the implant shell to minimize the chances of spontaneous rupture. If the saline implant were to rupture, one will be able to tell right away, because one may be able to see the breast implant deflate as it is happening.


Rippling’ is a term used to describe wrinkles on the surface of the implant that shows through the skin, causing a “wavy curtain” type of appearance, which is usually not very attractive. As one can imagine, if an implant is underfilled, as described above, the shell may collapse in certain areas. The folds from the shell’s partial collapse can then show through as ‘wrinkles’ or ‘ripples’ on the skin. This is a side effect of the breast augmentation surgery that we definitely want to try and avoid. However, underfilling is not the only cause of rippling. There are other causes (will expand this section at a later date).


B.      Silicone gel implants

Silicone gel implants have similar silicone polymer shells as the saline implants though usually they are not of the exact same composition. The main difference between the two types of implants, however, is what is on the inside of the implants. The silicone gel implant is filled with proprietary silicone gel that is manufactured and placed into the shell at the factory site before the implants are shipped to the doctors’ offices to be used for augmentation or reconstruction purposes.


Therefore, the silicone gel implants will come in whatever size and volume one orders. One does not alter the volume or shape of these silicone gel implants. They are ready to be placed into the body as they are out of the box.


Therefore, oftentimes, to place a silicone gel implant into the body, it requires a slightly longer incision versus a shorter incision that is often used to place the saline implants (usually a 4.5cm incision for most silicone gel implants vs. 3.5cm incision for saline implants). 


C.      Are breast implants safe?

This question stems from the controversy surrounding the silicone gel implants back in the late 1980s and early 1990s where the FDA took the silicone gel implants off the shelves for augmentation purposes due to the uncertainty and unknown safety profiles of the silicone gel implants.


Since that time, numerous studies around the world have been conducted looking at the safety of silicone gel implants and saline implants. All the studies have pointed to the inert nature of silicone as an element and its safety data inside the human body.


Breast implants, both saline and silicone gel, have been proven to be safe for augmentation and reconstruction. The FDA mandated the implant companies to conduct extensive long-term studies looking at the safety profiles of silicone gel and saline implants. Both implants have been show to have no cause-effect correlation to autoimmune conditions, connective tissue problems, or breast cancer.  While the silicone gel implants were taken off the shelves back in the late 1980s and early 1990s, they have been approved by the FDA and are now available for augmentation purposes due to the safety profile.


Am I a candidate for breast augmentation?


The purpose of breast augmentation is to enhance one’s appearance by augmenting the volume.


Therefore, if you wish to increase your breasts size and volume, breast augmentation can do that for you. However, if you like the size of your breasts, but just want a lift to put them “back where they belong”, then a breast lift (link to breast lift topic) would be the procedure of choice. Breast lift, or mastopexy, (link again) can be done with or without implants to enhance and improve the appearance of the breasts.


What if I feel that my breasts are too large and they are causing me upper back and neck pain and shoulder grooves? Then you would consider a breast reduction, or reduction mammoplasty, (link to breast reduction topic) , in which the volume of breasts is reduced along with the skin envelope to not only make the breasts smaller but also to lift the breasts.


How is the breast augmentation procedure done?


The breast augmentation procedure is usually done as an outpatient procedure under general anesthesia. There are several different ways to place the implants: inframammary or submammary, periareolar, transaxillary, and transumbilical. Personally, I do not use the transumbilical approach due to the high complication rate as well as the limited ability of this approach to achieving an optimal outcome. The American Society of Plastic Surgeons, or ASPS, which is the official organization for board certified plastic surgeons in the United States, do not sanction this particular approach, once again, due to the high complications rates that have been reported.


The pros and cons of the different ways to place the implants - different incisions


1.      The inframammary of submammary incision is located above the inframammary fold, or the natural curvature at the bottom of the breasts that define the inferior border of the breasts. This incision is quite inconsipicuous due to its location in most people. It is not visible on anterior view, or when one is looking in the mirror, and because it is located just a short distance from the bottom fold of the breasts, it is usually not visible when one’s bikini top rides up upon raising one’s arms.


2.      The periareolar incision is located as a semi-circular incision along the lower border of the areola, right at the natural skin color change. Due to this natural characteristic of the color change, this incision is “well-hidden” and can be almost imperceptible if the scar heals well.  We specialize in techniques to minimize scar formation.


3.      The transaxillary approach requires an incision in the axilla or the armpit. This approach may be good in someone who prefers to not have scars on the breasts and who prefers a subpectoral placement (or under the muscle placement- which we will talk more later) of only saline implants,.  The reason that this particular approach can only accommodate the saline implants is because of its remote location. One usually cannot place a silicone gel implant through such a remote incision and the placement of the implants may not be as precise on one or both sides, resulting in a higher probability of implant malplacement or asymmetry.


4.      The transumbilical approach will not be discussed here since I do not perform this incision.


Placed Under or Over the muscle?


This is a question that most women considering breast augmentation will wonder and will have to decide before surgery. There are definitely some pros and cons to above vs. below the muscle for placement of the implants, or subglandular vs. subpectoral, as the medical terms describing the same issue.


1.      Under the muscle, or Subpectoral:


This is the more common of the two choices in my practice. Most women choose under the muscle or subpectoral for one of all of the reasons below:

a.       Easier visualization on mammogram

b.      Less chance of rippling

c.       Less chance of capsular contracture

For one or all of the above reasons, about 80% to 90% of my patients choose to go subpectoral. There is a misconception that if one’s implants are under the muscle, that the entire implant is under the muscle. This is not true. The implant is mostly covered by the muscle, especially along the top portion of the breasts; but the bottom portion of the breasts are in the same location as the subglandular placement, which is immediately below the breast or glandular tissue.


2.      Above the muscle, or Subglandular:

This is the less popular of the two choices. One may wonder why then, would anyone choose to go above the muscle? The reasons are below:

a.       Less pain, shorter recovery

b.      No manipulation of the pectoralis major muscles (link to Netter?) therefore, no weakening of the upper arm

c.       No movement of the implants with contraction of the pectoralis major muscles

These are all important reasons for one to choose above the muscle placement. Many of my patients who are athletes or who work out on a regular basis, body builders who may enter figure competitions, aerobic instructors, may prefer to have their implants placed above the muscle so that there is no manipulation of the muscle, therefore, minimal effect on their upper extremity strength, and therefore, allowing them to participate in the activities that are important to them.


3.      Patients whom I give no choice for the placement (to prevent complications)


There are patients whom I do not give a choice when discussing the implant placement above or below the muscle.  These are the extremely thin individuals who have less than 2cm or skin and tissue pinch in the upper pole of their breasts, and who are not body builders or athletes, and also those who have a positive family history of breast cancer in an immediate family such as parents and /or siblings. For these individuals, I recommend below the muscle placement, or subpectoral placement.


1. The thin individual - The reason for my recommendation for subpectoral placement for these two types of individuals is that in the thin individual, ripping and implant show are real possibilities. To minimize the implant edge showing through readily, and to decrease the chances of rippling and the possibility for an abrupt transition from the upper chest to the breasts, I recommend under the muscle placement for these individuals. The muscles will blunt that transition in a very thin individual, thereby allowing a more natural transition.


2. Individuals with positive family history of breast cancer - For those with a positive family history of breast cancer, under the muscle placement will allow easier visualization on mammogram, thereby minimizing the possibility that the implants will obscure portions of the breasts when doing a mammogram. As a plastic surgeon, I want my patients to be healthy first, and certainly would not want the augmentation surgery, which is designed to enhance their appearance, to affect the screening process for breast cancer. 


What is the cost of breast augmentation?

Continued at this detailed link:  Cost of Breast Augmentation


 I encourage you to call our office and come in for before and after photos for plastic surgeries (including breast augmentation before and afters), which you may view at your leisure during our normal business hours of Monday through Friday 8am to 5pm.


Breast augmentation is a procedure that is quite satisfying to the individual having the surgery done, but there are important decisions to make along the way to ensure the best outcome possible. I believe that a well-informed patient will make the best decision for herself.

If you are interested in getting Breast Augmentation with Dr. Wu, the information above will be most valuable.  This information was personally written by Dr. Tammy Wu in May 2012.  Please give us a call for any updates.


Tammy Wu, MD


Our other (older) breast augmentation web pages


Modesto Plastic Surgery  |  Why Choose Dr. Wu  |  Cost of Surgery

Breast Augmentation Introduction (and options)  |  Tummy Tuck


Surgical Artistry webpage is for information only, not medical advice. 
www.surgerytoday.com homemade website by Calvin Lee, MD and Tzuying Tammy Wu, MD, Modesto, CA
Date of edit: 04/24/2020