1. Scar Around Implant - If a scar develops around the implant, this can result in a firmer feel and a less-than-natural appearance. I routinely use an antibiotic rinse in the implant pocket during the augmentation to combat this problem and have seen the occurrence of this capsular contraction around the implant to be much less frequent.
2. Over the Muscle vs. Under the Muscle - I have a personal preference to place the implant beneath the chest wall muscle. In the 1,500 breast augmentations I have performed I have placed the implant in the space beneath the muscle in 95% of my patients. My reasons for sub-muscular placement are as follows:
- A more natural appearance
- Easier to detect any breast lumps, which may appear at a later date
- Less concern with breast feeding
- Less of a chance of scarring around the implant
- Less of a chance of seeing rippling on the side of the breast
3. Silicone vs. Saline - 90% of my patients has chosen Silicone over Saline for their implants. A significant number of patients that have chosen Saline over Silicone return in 1 to 3 years and request an exchange to Silicone implants. My rationale for choosing Silicone over Saline is:
- Silicone is much more natural feeling
- In my experience, there is less of a chance of leakage
- There is a smaller chance of detecting rippling on the side of the breast with the use of Silicone.
4. The Size of the Breast Skin Envelope - This is a less-mentioned, but very important factor. If the breast skin has been stretched during pregnancy, it is more difficult to obtain a natural feel and appearance without doing a breast lift at the same time as the augmentation. The lift coupled with the augmentation produces a much more natural appearance and a more perky appearance of the breast.
5. Smaller Normal Breast Tissue vs. Larger Normal Breast Tissue - The amount of breast tissue prior to the augmentation contributes significantly to a natural feel after augmentation. The implant is more easily hidden in the larger breast tissue and takes on a more natural feel and appearance.