With a high-profile implant, the liquid volume is the same as a standard implant but its diameter (footprint) is narrower and the projection (the amount it protrudes out and away from your body) is greater.

Most women are better candidates for standard implants. If the diameter of the implant size (standard implant) you selected is about the same as, or smaller than, your measured breast diameter, then a standard implant is your best choice. If the diameter of the desired breast implant size is larger than your breast diameter, then a high-profile breast implant is best.

The FDA has recently approved silicone gel breast implants for use in primary breast augmentation for any woman over the age of 22. The main disadvantages include a possible higher rate of capsular contracture, the incision to place the implant is larger than the one needed for placement of a saline implant, and the cost is substantially higher then saline breast implants. On the other hand, they provide the most natural look and feel ideally suited for women with a modest amount of breast volume.

Breast implants are available in various sizes ranging from 200 – 600 ml. The range 300 – 450 ml is the most common. Choosing your desired size can be a difficult decision – it is highly personal.

You can determine the size you want by placing breast implant sizers in your bra and then putting on a sweater, blouse or a t-shirt. You’ll want to decide your cup size and that will determine how large your implant will be. A 400 ml implant placed in a woman with an A cup will produce a C cup. The same implant placed in a woman with a B cup will produce a D cup. Bring the pictures of your desired size (take a look at a lingerie catalog or swimsuit pictures) to your consultation. Take the time to decide what you will be happy with so you don’t feel the need to undergo a second surgery.

Each saline implant must be overfilled by an additional 25-30 ml. This technique decreases the risk of deflation, rippling, and sloshing. There are no disadvantages to overfilling. Implants are meant to be overfilled, and the implant manufacturers recommend surgeons to overfill them.

Textured implants are rough, similar to sandpaper. They were developed to decrease the risk of capsular contracture. However, studies have not shown a consistent advantage over smooth implants regarding capsular contracture. They have an increased risk of rippling, have a higher deflation rate and are firmer than smooth implants. They are also more expensive. Most breast cosmetic surgeons favor smooth implants.

Round implants are shaped like jelly donuts. They are not affected by rotation and cost less than teardrop implants. There are no disadvantages to round implants. It is favored by most cosmetic breast surgeons. Teardrop implants are shaped more like the breast. The teardrop implant may rotate, creating a distorted breast shape. It also requires a textured surface to prevent rotation.

The standard placement of breast implants, regardless of the incision site, is essentially a blind operation that makes intraoperative visualization of the surgical area difficult for purposes of dissection of tissue planes, for the accurate division of muscle fibers, and the control of bleeding. The use of illuminated surgical retractors has offered only a partial visualization solution

The introduction of the endoscope has substantially improved the accuracy and predictability of breast enlargement with breast implant surgery. The addition of the endoscope has been is a major breakthrough in the area of cosmetic surgery including breast augmentation.

The ideal incision site to perform breast endoscopic augmentation is the armpit. The endoscopic transaxillary augmentation allows the cosmetic surgeon to create crease symmetry, muscle division, implant positioning and bleeding control under total endoscopic visualization with great control and ease.

The performance of a safe and effective endoscopic transaxillary augmentation procedure requires expertise with the use of the endoscope. Drs. Pelosi pioneering work and expertise with endoscopic surgery (laparoscopy, hand-assisted laparoscopy and hysteroscopy) are recognized worldwide.

Although Drs. Pelosi consider the armpit the best approach for the endoscopic breast augmentation, at a patient’s request, they are also able to perform the endoscopic surgery using the inframammary and the belly button incisions.

The options for site of incision are underneath your breasts (inframammary), around the nipple (periareolar), in the armpit (transaxillary) or through the belly button (TUBA or trans-umbilical breast augmentation). All these approaches have advantages and disadvantages.

Underneath the breast (inframammary)
The inframammary incision under the breast is placed within or near the crease beneath the breast, the scar is usually hidden under the breast. This incision can sometimes become lumpy and could become very visible.

The inframammary incision under the breast is placed within or near the crease beneath the breast, the scar is usually hidden under the breast. This incision can sometimes become lumpy and could become very visible.

Trans-umbilical Breast Augmentation (TUBA)
When the incision is placed through the belly button (TUBA), the incision is hidden inside the belly button. The technique requires an experienced surgeon in order to avoid breast implant rupture during placement, undercorrection of certain breast asymmetries, incomplete control of shape, and bleeding. When properly performed, it is an excellent scarless alternative to the other type of incisions.

The transaxillary approach is extremely popular with many patients because the incisions can be made smaller and they are almost invisible (they are hidden in the skin crease in the top of the armpit.)

Advantages:

• Less interference with a mammogram
• Less rippling appearance in the upper half of the breasts
• More cushion between the implant and the skin
• Ideal for thin and small-breasted women

Disadvantages:

• Not well suitable for large breasted women
• Worse cosmetic result are seen in athletic women

Advantages:

• Less postoperative discomfort and swelling.
• Lower chance that the breast will appear to move when the patient exercises the upper body.

Disadvantages:

• Greater risk of visible rippling appearance of the breast.
• Worst cosmetic results are seen in women with small breasts.