Monthly Payments Available
Breast Augmentation: The Decisions That Actually Determine Your Result
Most breast augmentation research starts and ends with size. It’s the most discussed variable and the easiest one to talk about — but it’s not the variable that most determines whether a patient is satisfied with the outcome years later.
The decisions that matter more are the ones that get less attention: implant placement relative to the muscle, implant type and profile, incision approach, and whether the patient’s existing anatomy calls for augmentation alone or augmentation combined with a lift.
At Avance Plastic Surgery Institute in Reno, Dr. Erez Dayan approaches these decisions as an integrated plan built around each patient’s specific anatomy and goals. Here’s what each one involves.
Implant Placement: Above or Below the Muscle
- Submuscular (under the pectoralis major) provides more soft tissue coverage over the upper portion of the implant. This produces a more gradual upper pole transition and reduces visible implant edges and rippling, particularly in patients with thin tissue. It also has a lower documented rate of capsular contracture. The tradeoffs: a somewhat longer initial recovery, and animation deformity — visible movement of the implant when the pectoralis contracts, which matters more for patients who lift heavily or are athletic.
- Subglandular (above the muscle) avoids animation deformity entirely and has a shorter early recovery. It works well for patients with adequate existing breast tissue to cover the implant. In patients with thin tissue, it carries higher risk of visible rippling and palpable implant edges.
- Dual plane is a hybrid — the implant sits partially under the muscle superiorly and in contact with breast tissue inferiorly. This is the most commonly used approach in modern practice because it captures upper pole coverage while allowing better lower pole expansion and improved implant-to-tissue relationship.
The right choice depends on existing tissue thickness, breast shape, activity level, and the specific look the patient wants.
Implant Type
- Saline implants are filled after placement, allowing a smaller incision. If they rupture, the deflation is obvious and the saline is harmlessly absorbed. They tend to feel firmer and show more rippling than silicone, particularly in thin patients.
- Silicone gel implants more closely approximate natural breast tissue in feel and movement. Modern cohesive gel formulations hold their shape and don’t behave like older-generation devices. Rupture is less immediately obvious, which is why periodic imaging surveillance is recommended.
- Highly cohesive (“gummy bear”) implants hold their shape most firmly and are typically shaped rather than round. They provide strong shape control in specific reconstructive and revision scenarios and in patients seeking a particular contour.
Profile — the Variable Most Patients Have Never Heard Of
Two implants can have identical volume and produce noticeably different results depending on profile.
Profile describes the relationship between the implant’s base width and its projection. A low-profile implant of a given volume is wider with less forward projection. A high-profile implant of the same volume is narrower with more projection.
Base width has to match the patient’s chest wall dimensions. An implant wider than the breast footprint produces lateral fullness toward the armpit and, in some cases, visible edges. An implant narrower than the footprint leaves a gap laterally.
This is why volume alone is an incomplete way to choose. The correct implant is the one whose base width fits the patient’s anatomy, at the profile that produces the projection they want. Dr. Dayan’s planning starts with measurement of chest wall dimensions and breast footprint rather than with a target volume.
Incision Approach
- Inframammary — in the fold beneath the breast. Provides the most direct surgical access and the most precise control over pocket dissection. The scar sits in the natural fold and is typically well concealed. This is the most commonly used approach.
- Periareolar — around the lower border of the areola. The scar blends into the color transition. Access is more limited, and there’s a somewhat higher documented rate of capsular contracture and of changes in nipple sensation.
- Transaxillary — through the armpit, leaving no scar on the breast. Requires endoscopic technique for accurate pocket creation, and revision through this approach is more difficult.
Augmentation Alone, or Augmentation With a Lift
This is the assessment that most affects patient satisfaction and the one most frequently misunderstood before consultation.
An implant adds volume. It does not meaningfully lift breast tissue that has descended. Patients with significant ptosis who receive augmentation alone often end up with a fuller breast that still sits low — sometimes with the implant sitting high and the natural tissue draping over it, a result sometimes described as a “double bubble.”
The clinical assessment centers on nipple position relative to the inframammary fold. When the nipple sits at or below the fold, a lift is generally indicated alongside augmentation to reposition the tissue over the new volume.
Combining the procedures adds incisions and complexity. It also produces a result that augmentation alone cannot achieve in that anatomy. Patients told they need both are receiving an honest assessment, not an upsell.
What Implants Require Over Time
Breast implants are not lifetime devices. Manufacturer data and clinical experience suggest many patients will need or choose a revision at some point.
The reasons vary: capsular contracture, implant rupture, changes in personal preference, or age-related tissue changes that alter how the result looks over time.
The FDA recommends periodic imaging surveillance for silicone implants — typically MRI or high-resolution ultrasound — beginning several years after placement and at intervals thereafter, since silent rupture isn’t clinically obvious.
Planning for augmentation with an understanding that a future revision is possible is realistic rather than pessimistic. Patients who go in expecting a permanent, maintenance-free result are the ones most surprised later.
Schedule Your Consultation at Avance Plastic Surgery Institute
Dr. Erez Dayan and the Avance Plastic Surgery Institute team welcome consultations for patients throughout Reno, Lake Tahoe, and Northern Nevada at 5588 Longley Lane, Suite A, in Reno. Virtual consultations are available for patients outside the immediate area. Call (775) 800-4444 or visit avanceplasticsurgery.com to schedule.
The consultation that begins with measurement and anatomy — rather than with a number — is the one that produces a result that still looks right years later.
This blog is educational. Breast augmentation involves individual risks that should be discussed during a comprehensive consultation with a board-certified plastic surgeon.
Medically reviewed by Erez Dayan, M.D. on
Posted on behalf of
5588 Longley Ln Ste A
Reno, NV 89511
Phone: (775) 800-4444
FAX: (775) 205-8322
Email: [email protected]
