Breast Implant Incision for Women with Small Bust

Around 20 million women have breast implants worldwide, a clear proof of the devices’ popularity among patients who want to improve their appearance or reconstruct their breasts following mastectomy or cancer surgery.

If used for cosmetic reasons, the common goal of patients wanting to have breast implants is to increase their bust size.

The bust size and appearance, natural tissue and fat, type of implant used, goals and expectations, and doctor’s expertise determine the appropriate incision sites in breast implant surgery.

Women with very small breasts (AA cup) should bear in mind that in breast augmentation, the “bigger the better” principle does not apply because of certain risks.  For instance, it is unreasonable and even precarious to use large implants that would give them DD cup due the higher chance of rippling and wrinkling.

And more often than not, small breasts are usually associated with small areola complex, making this incision site not ideal with the use of silicone implants, particularly large ones, because of the higher risk of visible scarring.

Silicone implants require longer incisions than saline implants because they are only available in pre-filled version.

By contrast, saline implants are filled with a sterile mixture of salt and water once inside the breast, for this reason small-breasted women may choose the areola incision if this type of implant is used.

Another good option for women with small bust is the breast crease incision, which is the easiest technique because it allows plastic surgeons to work close to the breasts unlike the armpit and navel incision sites.

However, there is one concern with the use of breast crease incision to augment a small breast.  First and foremost, women with AA cup often lacks a defined “fold” that separates the base of the breast from the chest; for this reason, there is a chance that the scar sits too high or too low that makes it visible.

But because most plastic surgeons are very adept with breast crease incision, low- or high-riding scar rarely occurs.

Meanwhile, the transaxillary or underarm incision is another good substitute for women with small breast and areola particularly if they choose saline implants.  While it is possible to use silicone implants, ideally they should come in small size so they can easily fit into the surgical slit.  

But whether a woman has small or large breast, the transaxillary technique is not used if there is an existing deformity because the distance between the incision and chest area can make the surgery extremely more challenging.  The same is true with the navel incision site. 

Silicone Breast Implants Do Not Increase the Risk of Cancer

In the early 1990s, silicone breast implants were pulled out of the market due to concerns that they might increase the risk of breast cancer and systemic diseases.  But in 2006, the US Food and Drug Administration has lifted the moratorium after extensive studies found no link between using the devices and serious illnesses.

The FDA’s decision to lift the moratorium is supported by many oncologists; in fact, silicone breast implants are increasingly becoming popular among post-cancer patients who have breast deformity following their mastectomy (partial or complete removal of their breasts).

Meanwhile, leading LosAngeles plastic surgeon Dr. Tarick Smaili believes that silicone breast implants are reasonably safe both for cosmetic and reconstructive surgeries.

“Silicone breast implants have been subjected to the most rigorous examinations which have proven that they are reasonably safe.  Another bonus is that they can provide a very natural appearance since they are filled with a cohesive silicone gel that replicates the feel and look of breast tissue and fats,” Smaili said.

Because post-cancer patients who had mastectomy often have a limited amount of tissue, silicone breast implants are usually more ideal than saline implants which have a watery consistent (because it is only filled with a sterile mixture of salt and water).

The mastectomized breast has a very low risk of cancer recurrence so placing implants during reconstructive surgery has become a common practice.

However, Smaili warns that breast implants can make it difficult to conduct mammogram and “physical” breast examinations.

“A breast augmentation patient should go to a technician who has an extensive experience in conducting mammogram screening on women with breast implants.  Also, more views are necessary to get a more accurate and clearer result,” Smaili said.

But despite more difficulty to do mammography, the plastic surgeon advised women with breast implants aged 40 years and older to undergo screening at least every year.

“In this way, their doctors can immediately diagnose any cancerous lumps even before the condition gets worse,” he added.

Meanwhile, mammography is not only performed on older women (with or without implants) but also on younger patients with silicone breast implants that are prone to “silent leak,” a condition in which the cohesive gel drips out of a damaged or ruptured shell without causing any visible signs.

But in the long run, silent leak can lead to inflammation of the tissue, pain, and visible breast deformity.

The FDA recommends mammography every two years for patients with silicone breast implants; on the other hand, this is not a requirement for younger women with saline version because a rupture would immediately show visible signs. 

Preventing Breast Implant Rupture

While there is no guaranty that breast implants will last a lifetime, plastic surgeons have come up with different techniques to at least prolong the devices’ lifespan and lower the risk of implant rupture.

In the event of implant rupture, the only solution is a revision breast augmentation; this procedure may involve replacing the implants with new ones or removing them without any replacement.

Meanwhile, these are some of the basic rules which can help patients prevent or at least lower the risk of implant failure.

* Choosing silicone implants over the saline version

Currently available silicone breast implants are less likely to rupture than saline because they are not prone to sloshing and wrinkling which are known to affect the shell’s stability.  Another advantage is that the silicone gel does not evaporate (unlike the saline) which means the patients can maintain their breast volume unless in the event of rupture.

The latest version of silicone implants—which have a more cohesive silicone gel than the one currently used—is almost immune to implant failure.  However, these breast implants, called the gummy bear implants, are not yet approved in the US although these are already used in Europe and Canada.

* When using salinei mplants

Rippling, which can compromise the shell’s stability, can be prevented in saline implants by slightly overfilling them.  However, this should be carefully done because too much filler can cause abnormal pressure on the device.

On the other hand, underfilling saline implants only has negative results because it can cause creases, leading to weak areas in the shell.

* Avoiding high trauma to the breast

Modern breast implants are very strong although they are still subjected to the effects of physical force.  Impact from car collision, sports injuries, and accidental falls may compromise the shell’s stability or may even lead to rupture.

* Consider the implant placement

Some doctors say that submuscular implant placement (placing the device under the pec muscle) poses a slightly higher chance of shell damage than the subglandular technique (positioning the implants over the muscle).  A good compromise might be the subpectoral placement.

* Use of Keller Funnel technique

In this technique, plastic surgeons place the breastimplants in a cone-shaped device and then squeeze it so the implants are transferred into the breast pockets.  Doctors use less force in this method than if they push the devices using their fingers.

Can Silicone Breast Implants Correct Mild Drooping?

Silicone breast implants are increasingly becoming popular these days as they provide a more natural result than saline implants.  This is not surprising because they are filled with a cohesive silicone gel designed to replicate the “feel” and move of glandular tissue and fats; another bonus is that the filling does not evaporate—unlike the saline solution—which means the patients can maintain their breast volume unless in the event of leak or rupture.

The good news is that breast implants—particularly the silicone-filled versions—can correct mild or pseudo ptosis (sagging) which is caused by breastfeeding.  It happens when the mammary glands put pressure on some glandular fats, but after the enlargement resolves, the breasts somewhat “deflate.”

On the other hand, true ptosis is caused by stretched and damaged suspensory ligaments in the breasts.  Oftentimes, the problems can only be addressed by mastopexy or more commonly referred to as breast lift; this can be performed as a standalone procedure or as a complementary to breast implantsurgery.

To correct mild or pseudo ptosis, it is highly recommend to use small implants (300 to 350 cubic centimeters would be the right range) because introducing large ones can aggravate the problem as the tissue is forced to carry the extra weight.  And over time, the stretched tissues will worsen.

By using large implants, there is a higher chance that the patients will need breast lift sooner rather than later.

It is important to note that even small implants can provide upper pole fullness in the breast, the area which is often affected by childbirth and breastfeeding.  But as mentioned earlier, silicone implants are better than the saline versions because they do not have a natural deflation rate.

By contrast, saline implants have been found to lose about 10 percent of their volume after a decade because of evaporation and other factors.  This simply means that patients with these devices are more likely to need revisions sooner than those who have silicone implants.

Meanwhile, there is still a debate whether the subglandular or submuscular implant placement provides more lift.

In the subglandular implant placement, the device is positioned above the muscle which is believed to provide a more lifting effect.  But one downside is that only the tissue and skin support the implant, something which may aggravate the ongoing ptosis.

On the other hand, the submuscular implant placement is said to prevent future ptosis because the device, which is positioned under the pec muscle, is being supported not only by the tissue and skin but also by a thick amount of muscle.

Patient Options in Breast Augmentation Surgery

The primary goal of breastaugmentation is not just about increasing the bust size but also making the result as natural as possible.  Fortunately, this is easier nowadays as breast implants come in different sizes, shapes, shell, filling, and projection, in addition to a wide range of surgical techniques used by plasticsurgeons.

Nowadays, three options in breast implant placement are available for patients: complete submuscular (under the muscle), partial submuscular (partially under the muscle), and subglandular (behind the tissue).  These surgical techniques have their own pros and cons which are carefully explained to women so they can decide for themselves.

The complete submuscular implant placement results to longer recovery and more pain during healing period because the pec muscles are stretched and pushed.  However, the technique provides countless of benefits such as more coverage to reduce the risk of implant wrinkling; more lifting effect; better mammogram reading; and lower risk of capsular contracture, which is a condition resulting to hardening of the scar tissue around the implants.

On the other hand, the subglandular implant placement results to shorter recovery because the pec muscle remains intact.  But since no muscle covers the implant shell, the technique is only ideal for patients with enough glandular tissue, fats, and skin.  Another consideration to make is that an ongoing ptosis (drooping) may be further aggravated because of the lack of strong “support.”

Meanwhile, the partial submuscular combines the benefits of subglandular and complete submuscular implant placements.

Aside from the implant placement, the type of implants can also have a significant impact on the final result.  For instance, women who want to achieve more cleavage are advised to choose round implant rather than the teardrop-shaped version, although the latter is more notable for simulating the natural contour of the breast.

Breast implants are either filled with saline or silicone gel.  For those who want to achieve a more natural “feel” and “look,” and women with a limited glandular tissue, the silicone implant is a better option; however, one downside is that the patients are required to undergo MRI screening every two years to detect any asymptomatic or “silent” leak.

On the other hand, women with saline implants are not required to have a regular MRI screening because a leak is easily manifested by deflated-looking breasts, making it possible to immediately seek revision breast augmentation.

Regardless if saline or siliconeimplants are used, their size should not only be based on one’s goal but also on her body-frame, amount of tissue and skin, and chest width.  It is important to note that a good plastic surgeon will not push the body’s limit by introducing implants that are too large for it.

Breast implants can be inserted via four incision sites: axillary (armpit), TUBA (navel), breast crease, and areola complex.  Patients should remember that the best surgical technique largely depends on their goals, acceptable risk level, and type and size of implants.

The axillary and TUBA incision sites require the use of an endoscope, which is a fiber optic camera attached to a large monitor.  Through this instrument, plastic surgeons can insert an empty saline shell inside the breast pocket and then fill this with a sterile saltwater solution.

But because the axillary and TUBA incisions work farther away from the bust area, there is a greater margin of error.  By contrast, the breast crease and areola incision sites provide surgeons with greater control over the final result of the surgery, making them a more popular choice.

Since there are many surgical options and type of implants available for women, breast augmentation typically involves lengthy consultation between patients and plastic surgeons.  In this way, doctors can also determine if the goals and expectations of a person with the surgery are plausible and achievable.