Breast Augmentation

Learn About the Most Popular Variations of Breast Augmentation in Ohio

Breast augmentation surgery is one of the most popular cosmetic procedures in the United States and worldwide. Importantly, studies show it has one of the highest long-term patient satisfaction rates of any surgery.

Although breast augmentation has a high success rate, there are important long-term considerations for anyone considering the procedure. As with any surgery, you should do research and then consult with a qualified, experienced, compassionate, board-certified plastic surgeon to make sure this is the right choice for you.

Dr. Goldman is triple board certified (Plastic and Reconstructive Surgery, Facial Plastic Surgery, and Head and Neck Surgery/Otolaryngology), is a fellow of the American College of Surgeons and of the American Academy of Facial Plastic and Reconstructive Surgery, and is a member of multiple national societies, including the American Society of Aesthetic Plastic Surgery, the American Society of Plastic Surgeons, and the American Academy of Facial Plastic and Reconstructive Surgery.

He is a key opinion leader and speaker in facial plastic surgery and plastic surgery and has received a multitude of awards and recognition. He is nationally recognized for breast augmentation, rhinoplasty, facelifts, and mommy makeovers.

Factors to consider in breast augmentation

Getting incredible breast implant results isn’t just about choosing a silicone or saline implant. In fact, for many patients, this is a relatively minor consideration. There are multiple relevant implant characteristics, including saline versus silicone, high versus moderate versus other profiles, smooth versus textured surfaces, and round versus anatomic.

There are multiple surgical considerations, including under or over the muscle, what type of implant pocket is used, and whether a mastopexy (breast lift) is needed. And, of course, the choice of implant size is also important to achieving your ideal result.

The end result, esthetically, will be influenced not just by the implant but also by factors like how large the patient’s breast is, whether there is droop, how loose or dense the tissue is, whether the patient has breastfed, whether the skin is tight or loose, and other factors.

Implant and cup size

Cup sizes aren’t standardized, so one company’s size may have a different volume than another’s. And since different women prefer different fits of bra, even if your breast size is similar to that of your friend, you might wear different bra sizes.

Also, the wider the chest, the larger the cup, so a 32-C has a much smaller cup volume than a 42-C bra. When discussing cup size with your surgeon, consider these inconsistencies.

Note: Your final breast size depends on the implant size you pick, plus the amount of breast tissue you have. For instance, a 360-cc implant may produce a small C-cup size in a patient with a relatively small amount of breast tissue but may result in a D-cup for a patient with more tissue.

Types of breast implants

Breast implants may be filled with either saline (salt water) or silicone.

Silicone breast implants

Silicone implants contain silicone gel, as the name implies. The FDA has approved silicone for patients who are over 22 years old and for breast reconstruction for patients of any age. Silicone feels softer and more natural than saline for most patients.

Saline breast implants

Saline breast implants have a silicone shell filled with sterile saline solution. Saline breast implants are filled after being inserted into the body. Since they are inserted before inflation, saline implants are inserted through smaller incisions than silicone.

Saline implants tend to give a more round, augmented look than silicone. A significant advantage of saline is that patients can generally tell if the implants leak, soon after leaking. If an implant does leak, the body absorbs the salt water and excretes it.

Surgical Techniques

The pectoralis major muscle is the largest chest muscle, easily seen in male bodybuilders. The female breast rests on top of this muscle. Breast implants can be placed under or over the pectoral muscle.

Under versus over the pectoralis major muscle

Subpectoral breast implants are placed below the muscle and on top of the rib cage and the pectoralis minor muscle.

Subglandular implants are placed directly under the breast tissue and on top of the pectoralis major muscle. There are multiple advantages to subpectoral versus subglandular placement: a higher, more youthful look, less rippling, better medial fullness (cleavage), less droop long term, and likely a lower capsular contracture rate.

Dr. Goldman also has many patients who are weightlifters, bodybuilders, or otherwise strength train, who have no functional or esthetic issues with under-the-muscle implants.

Incision site choices

The available incision sites for breast augmentation surgeons are:

  • Inframammary – The inframammary fold is the most common option by far. Dr. Goldman uses an incision just over 1 inch long in the crease below the breast. This “keyhole” approach leaves minimal scarring and is well hidden in the fold underneath the breast.
  • Periareolar – The periareolar incision is relatively hidden at the outer edge of the areola. This is the second most common incision. It occasionally heals as a noticeable scar. When used repeatedly, the lower pole of the breast can become hard or flat because of dissection through this area to get to the lower border of the breast for implant insertion.This is the main reason that Dr. Goldman does not prefer this incision, although it may be used if a periareolar (circular) breast lift is also performed. Some studies suggest the rate of capsular contracture is higher with this technique because of trace bacteria in the breast tissue that comes into contact with the implant.
  • Transaxillary – The transaxillary incision goes through the armpit, keeping scars off the breast. However, the scar may be visible in the armpit when the arms are raised. In large studies, this incision has a higher bleeding rate, and patients may have more pain with this approach, so it is used less commonly than in the past.
  • Transumbilical breast augmentation (TUBA) – This approach hides the incision in the belly button but can only be used for saline implants, cannot be used with the rapid recovery technique, and is less precise than other techniques because of the remote incision. These factors have led to infrequent use.

In Dr. Goldman’s opinion, the inframammary incision is the most well-hidden, facilitates the use of the rapid recovery technique, and is the most precise. It is the most widely used incision in the U.S. and worldwide.

Smooth vs textured implants

All breast implant shells are made from silicone plastic, but some are smooth, and some are textured (have a rough surface). Natrelle’s textured implants were taken off the market by the FDA and the European Union because they have been associated in rare cases with a type of lymphoma (ALCL, anaplastic large cell lymphoma).

Sientra and Mentor textured implants can still be used, but in the U.S. most surgeons use them seldomly or not at all because there have been cases of ALCL with these brands, although in much lower numbers than Natrelle’s.

Smooth implants tend to feel softer and more natural than textured ones. The main advantage of textured is that they have a lower incidence of malposition, shifting over time because they adhere to the surrounding tissues, so they move less.

High, moderate, or low-profile

Implant profile refers to how high or tall the implant is compared to its width. A low-profile implant is wide and flat. A high-profile implant is narrow and tall. Different implant companies classify their profiles similarly but differently. A high-profile implant from one company may have a similar profile to a moderate plus from another company. Furthermore, saline implants look higher in profile than silicone; in essence, have a water balloon-like feel that gives them a higher profile look than silicone.

Dr. Goldman most commonly uses moderate plus Sientra gummy bear silicone implants but tailors the choice of implant profile and size to each patient’s goals and needs.

Round vs. teardrop-shaped

Round implants are the most common implant choice in the U.S. They are circular and symmetrical, which gives a rounder and fuller appearance. Teardrop or anatomic implants are used when the patients have short or deficient lower breasts to give a more natural look.

However, anatomic implants must be textured so that they don’t rotate. Since textured implants are associated in rare cases with ALCL, they are used less commonly than in the past.

Breast augmentation risks

Some of the possible breast augmentation surgery complications include:

Medical and anesthetic risks

Every surgery carries slight risks of bleeding, infection, and anesthetic complications. For breast augmentation, this is well under 1%. Bleeding can necessitate a return to the operating room to stop bleeding and can even require a blood transfusion.

Infection around a breast implant usually necessitates the removal of the implant. It can generally be replaced, but only after the infection is cleared.

Anesthetic complications can involve allergic reactions to medications, pneumonia, blood clots, heart attacks, and other issues. Although these complications are rare, we take them all seriously.

Implant leak

For saline implants, the leak rate is about 15% of implants, at 10 years after surgery. Silicone has a slightly lower leak rate. If saline implants leak, the patient will notice the deflation almost immediately, and the body will absorb the fluid.

But if silicone leaks, the implant will maintain its size and shape for months or years, so patients and surgeons may not detect an early leak. Therefore, the FDA recommends periodic MRIs to look for leaks. All implants require long-term follow-up for leaks and other issues and cannot be considered lifetime devices.

Nipple sensitivity

Temporary changes in nipple sensitivity are common after breast augmentation. Many patients notice hypersensitivity, which usually subsides after several weeks. A small percentage of patients will experience permanent nipple numbness in one or both nipples. This is more common if a breast lift is performed with augmentation.

Capsular contracture

Any implant (breast implant, artificial joint, etc.) placed in the body will induce the formation of a surrounding scar tissue layer. This is made of collagen and is referred to as a capsule. In a small percentage of breast augmentation patients, this normally thin layer becomes thick and hard, forming a capsular contracture.

Dr. Goldman uses a minimal touch technique, antibiotic irrigation, and additional methods that have allowed him to achieve a minimal capsular contracture rate.

Mammography after breast implants

Mammograms are more difficult to read after breast implants are placed. Special views are required. Large studies have shown no delay in breast cancer diagnosis in augmented patients compared to patients without implants. Still, patients are more likely to require ultrasonography or MRI if any abnormalities are seen on mammograms.

Breastfeeding after breast augmentation

Breast augmentation does not interfere with breastfeeding as long as the nipple sensation is normal. However, patients who have implants may be more likely to require subsequent breast lifts if their breasts enlarge with pregnancy and lactation because the combination of breast enlargement from an implant and lactation causes more stretch on the skin.

Breast revision surgery

Implants are not lifetime devices. Although they can and do last for decades in some patients. Leak, shifting of the implants (malposition), desire for size change, or other issues may lead patients to seek additional surgery, which is referred to as a revision.

Patients may develop breast ptosis (droop) with aging, weight loss, or childbearing; this may necessitate a breast lift (mastopexy) with or without implant replacement. Capsular contracture or other factors may need to be addressed surgically.

There is no guarantee of cup size

Cup size varies between all bra companies. It is also subjective: what one patient or bra salesperson considers a C-cup may be sized as a B-cup by another, so cup size cannot be guaranteed. Although it is more common for patients to feel that they “could have gone larger” after surgery, patients who feel too large are generally more concerned with their appearance.

Patient satisfaction depends on the overall appearance of the breasts, including not just size but shape, contour, symmetry, and youthfulness; nonetheless, most patients do feel that they achieve the size they desire. Breast augmentation has very high, long-term satisfaction rates in studies.

Who is a good candidate for breast augmentation?

Good candidates for breast augmentation understand their own goals, have realistic expectations, and understand that implants are not lifetime devices and, therefore, will most likely require further surgery over one’s lifetime.

Patients should be decisive about their desire for augmentation and be in good health. Of course, patients can have questions about saline or silicone, specific implant size, whether they need a lift, or other issues as they research the procedure.

Ultimately, the decision for surgery is made with an experienced, compassionate, communicative, artistic board-certified plastic surgeon, like Dr. Goldman. Patients should feel comfortable with their prospective surgeon after meeting him or her.

Consult with Dr. Goldman

Dr. Goldman has a special interest in breast augmentation. He has extensive experience in plastic surgery of the breast that began with breast cancer (mastectomy) reconstruction, which he performed while he was acting Chief of Plastic Surgery at the University Hospitals of Cleveland.

The challenge of rebuilding breasts that needed to be removed due to cancer gave Dr. Goldman a comprehensive understanding of the subtleties of breast anatomy and form. This understanding and experience allowed Dr. Goldman to establish a reputation for excellence in reconstructive surgery and cosmetic breast surgery, including straightforward augmentation and highly complex cases that involved congenital issues or multiple prior surgeries.

A large part of Dr. Goldman’s practice involves revising or correcting previous breast augmentation. Dr. Goldman also utilizes a rapid recovery augmentation technique.

If you have any questions or are ready to have a consultation (or second opinion), please contact our office at (216) 514-8899 or

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