There is no particular “best age” for considering breast augmentation surgery. Silicone implants are FDA approved for placement in patients 22 years of age and older. Many factors contribute to a patient’s decision to seek surgical intervention. The most important one is that the patient is physically and emotionally mature enough to undergo a surgical procedure. A patient with underdeveloped breast anatomy, for example, would not be the ideal candidate and may be recommended to wait before considering surgery.
Another consideration would be how the patient’s age has affected the quality of their skin and surrounding structures. An older patient seeking to replace lost breast volume because of aging may likely need more than just the addition of breast implants. Their skin will also have to be lifted and “tailored” to optimize the more-youthful appearance they seek from surgery. This procedure is called augmentation-mastopexy (breast lift with implants).
What to Consider When Getting Breast Implants
Breast augmentation can offer a new aesthetic, renewed confidence after pregnancy, improvements after a weight loss journey, or restored breasts after a mastectomy.
Your options depend on the desired outcome and lifestyle considerations. Here are a few important items to consider.
Breast augmentation uses either saline or silicone implants, and different implant materials yield different results.
Silicone implants are the most popular option and are often preferred to saline for their more natural look and feel. They also usually require slightly larger incision sites than saline options, and ruptures can be more difficult to detect without an MRI.
Saline implant insertion sites are generally smaller, and more easily detected ruptures. Some people also find saline implants to be less natural-looking on the average person and can sometimes show wrinkles or ripples over time.
Implants come in two standard shapes: round and teardrop (anatomic). Round implants are the most common and provide the most upper pole fullness. Teardrop implants are less common due to their specific use and risk of mispositioning within the breast pocket. A thorough evaluation and discussion of your goals will be key in determining which shape may suit you best.
In most patients, breast implants are placed behind the pectoral muscles (or subpectoral placement). Certain patients with specific anatomy may also be placed above the muscles behind the breast tissue (sub-glandular or sub-fascial placement).
Several factors determine how to best approach your breast augmentation with implants. Sub glandular implant surgery is more straightforward and has a less painful recovery. But there’s a tradeoff—these implants may look and feel less natural. A professional athlete, for example, may benefit from this approach due to the level of dynamic muscular activity they experience regularly.
On the other hand, subpectoral implants create natural-looking breasts with less risk of visible aspects of the breast implant. They are also good for patients worried about how their implants will hold up over time: implants placed behind pectoral muscles fall more naturally into the breast pocket, show less obvious rippling, and have lower rates of capsular contracture.
A “dual-plane” approach which places the top 80-90% of implant below the muscle, and the bottom-10-20% of the implant directly below the breast tissue. This is achieved my allowing the pectoralis muscle to “window-shade” up. A dual-plane approach imparts the benefits of both pre-pectoral and sub-pectoral implant placement. All the benefits of sub-pectoral implant placement are achieved, plus, the ability for an implant to drop as the breast ages, providing for a longer, more natural-looking result.
Your incision location is decided based on your recommended implant type and size, your anatomy, and any concern about preserving nipple sensation.
A breast crease incision is hidden underneath the breast fold and is the most common incision. The majority of patients are best suited with this incision. In women who have a natural breast crease, this is often the most hidden incision. Additionally, the breast crease incision provides the best visualization for the surgeon, the best control over symmetry and implant position, and carries the lowest risk of capsular contracture.
A periareolar (nipple) incision is the second most common type. An incision is made along the bottom edge of the areola. This incision provides an excellent ability to hide the incision in women who have a poorly defined breast fold and are, therefore, not great candidates for a breast crease incision. Women with a well-defined areolar border are better candidates as opposed to those with watershed pigmentation where a fine-lined incision would be more obvious. Due to proximity to the nipple, a periareolar approach can affect nipple sensation.
What Types of Implants are Best?
99% of our patients choose smooth, round silicone implants. Often called gummy-bear implants, silicone implants feel and look more like natural breasts, last longer, and maintain their shape even after micro-ruptures.
The only benefits of saline implants are their comparatively lower cost and the fact that they can be placed with a smaller incision. Ruptures are also immediately detectable as the affected breast will deflate within hours.
Choosing the right implant size is both an art and a science, which is why we custom order implants for all our patients. Implants are measured in multiple ways, including width, volume, shape, projection, viscosity, and fill pressure. A careful balance of each of these factors, combined with your own goals, plays a critical role in achieving a natural, aesthetically pleasing breast augmentation.
After taking detailed measurements of your chest wall to determine basic implant dimensions, Dr. Maman works with you to select the implant options that meet your needs.
Schedule a Consultation with Dr. Maman
The first step to schedule a consultation would be doing thorough research. There are many ways to find a plastic surgeon. Arguably the best way would be to receive a referral from another physician, such as primary care, dermatologist, or OB-GYN. These providers often see multiple patients with good results and can attest to those by referring their own patients somewhere. Friends are a secondarily good referral source, especially if they are patients themselves. When it comes to advertising, the most essential consideration is the plastic surgeon’s education, board certification ONLY by the American Board of Plastic Surgery, and before/after gallery. If those components match your desired outcome, then they would be a good source of information to seek in consultation. You will often come across taglines such as “no downtime surgery” or “no anesthesia required”. If it seems too good to be true, it probably is. There are no shortcuts to SAFE plastic surgery.
The next step would be contacting the office of a board-certified plastic surgeon to find a time to meet them. First impressions last a lifetime, so pay attention when speaking to the receptionist upon calling. Should you decide to have surgery, this is the team you will be dealing with multiple times per month for at least a year. The administrative team is a direct reflection of the surgeon’s ways of working. Another thing to clarify would be a potential timeline for surgery. This is sometimes best done before reaching out to qualified providers because they are booked one to six months out, on average. Knowing well enough in advance will give you adequate time to interview surgeons, get any preoperative lab work done, and feel confident moving forward with your scheduled procedure.