The 7 Key Breast Augmentation Decisions

This in-depth guide explores the seven crucial decisions you'll make before getting a breast augmentation, from choosing the perfect implant type and shape to finding the most flattering size for your unique body. With expert insights from a Board Certified Plastic Surgeon, you'll gain the knowledge and confidence to make informed choices on your breast aug journey.

March 22, 2024
7 min
The 7 Key Breast Augmentation Decisions

Breast augmentation is a highly personalized procedure.  Understanding the array of options available can empower you to make informed decisions that best align with your aesthetic goals and lifestyle. With the help of Board Certified Plastic Surgeon, Dr. Aldona Spiegel, we’ll break down the key decisions for breast augmentation into simple terms, providing insights into the pros and cons of each choice.

1. Implant Type

Implant type refers to the material used to fill the implant shell. The two main types are silicone and saline. 86% of women chose silicone implants [1]. 

  • Silicone: Pre-filled with a silicone gel that feels more like natural breast tissue.some text
    • Pros: Tends to provide a more natural feel, comes in a variety of cohesions that allow for implants to feel more soft or more firm.  
    • Cons: Possibility of silent ruptures 
  • Saline: These implants are filled with sterile salt water after being placed, allowing for size adjustments during surgery.some text
    • Pros: Leakage from ruptures is easily absorbed by the body
    • Cons: May feel less natural compared to silicone.

2. Implant Shape

Implant shape describes the contour of the implant, which can be either round or teardrop (anatomical). 92% of women select round implant shapes [2].

  • Round: These implants are the same shape all over and tend to make breasts appear fuller.some text
    • Pros: Provides a more pronounced silhouette.
    • Cons: May not offer the subtlest natural look in all body types.
  • Teardrop (Anatomical): Mimics the natural slope of the breast, with more fullness at the bottom.some text
    • Pros: Offers a more natural contour.
    • Cons: Risk of implant rotation, which may lead to an unusual appearance.

3. Implant Surface

The surface of the implant can be either smooth or textured, which affects how the implant interacts with the surrounding tissue. 88% of women choose a smooth implant surface [2]. 

  • Smooth: The outer shell is smooth, allowing the implant to move freely within the breast pocket.some text
    • Pros: Lower risk of feeling the implant edges through the skin.
    • Cons: Higher chance of visible rippling.
  • Textured: The outer shell is rough to keep the implant from moving.some text
    • Pros: Reduces the risk of implant displacement and capsular contracture.
    • Cons: more likely to have palpable folds and ripples.  In very thin people with little breast tissue, if the textured implant is placed on top of the muscle it is more likely to be felt than a smooth implant

4. Implant Profile

The implant profile determines how much the implant projects forward from the chest wall. Different profiles cater to various body types and desired outcomes.

  • Low Profile: These implants have a wider base and less projection, making them suitable for individuals with a larger frame or wider chest.some text
    • Pros: Provides a more subtle enhancement, suitable for larger frames.
    • Cons: May not achieve significant projection for those seeking a more pronounced change.
  • Moderate Profile: Strikes a balance between width and projection, offering a natural look.some text
    • Pros: Versatile option suitable for many body types; provides a balanced enhancement.
    • Cons: May not offer as much fullness or projection as higher-profile implants.
  • Moderate Plus (Mod+): Offers a bit more projection than the moderate profile, providing additional fullness.some text
    • Pros: Suitable for those seeking more projection without the extremes of higher-profile implants.
    • Cons: The additional projection may still be limited compared to high-profile options.
  • High Profile: Ideal for individuals with a smaller frame or narrow chest, these implants have a smaller base and more projection.some text
    • Pros: Provides significant projection and fullness; suitable for smaller frames.
    • Cons: May look unnatural on individuals with wider chests or larger frames.
  • Extra High Profile: Offers the maximum projection and fullness, ideal for those desiring a more pronounced and dramatic outcome.some text
    • Pros: Achieves a substantial enhancement for a striking appearance.
    • Cons: May look less natural; increased risk of rippling and palpability.

5. Incision Type

The incision type refers to the location where the surgeon will make the cut to insert the implant. 80% of women choose to get an inframammary incision [1].

  •  Inframammary: Involves making an incision on the crease of the breast fold, where the breast meets the rib cage.some text
    • Pros: Easily concealed scar; provides good access for placement.
    • Cons: Scar may be visible when lying down.
  • Periareolar: The incision is made around the outer edge of the areola (nipple).some text
    • Pros: Scar blends with the edge of the areola.
    • Cons: Potential for altered nipple sensation.
  • Transaxillary: An incision made in the armpit.some text
    • Pros: No scars on the breast.
    • Cons: May not provide the surgeon with the best visibility for implant placement.

6. Implant Pocket Placement

Implant pocket placement describes the location of the implant in relation to the breast tissue and chest muscle. 91% of women opt to place the implant submuscular [1]. 

  • Submuscular: The implant is placed under the pectoral muscle.some text
    • Pros: Provides a more natural look and lessens the chance of rippling.
    • Cons: Recovery may involve more discomfort initially.  May also cause animation deformity.
  • Subglandular: Placing the implant between the breast tissue and the chest muscle.some text
    • Pros: May result in a shorter recovery time.
    • Cons: Higher likelihood of implant visibility and rippling.
  • Dual plane: A combination of subglandular and submuscular placement, where the upper part of the implant is covered by the muscle, and the lower part is covered by breast tissue.some text
    • Pros: Offers the benefits of both subglandular and submuscular placement; can provide a more natural look and lower risk of rippling compared to subglandular placement.
    • Cons: Recovery may be more uncomfortable than subglandular placement, and the procedure is more complex.

7. Implant Size

 Implant size refers to the volume of the breast implant, which is measured in cubic centimeters (cc). While 57% of women get implant volumes in the range of 300-500cc [2], the average implant size in the US is 386cc [1].

  • Pros: Size options are highly customizable
  • Cons: it’s not easy to gauge how an implant  will look before it goes into your body. Selecting the wrong size could result in revision surgery, complications, or general dissatisfaction.  

Size is one of the most important decisions in breast augmentation, as it directly impacts the final appearance and proportions of the breasts. The right implant size for each woman depends on various factors, including their desired look, body frame, and existing breast tissue. A skilled plastic surgeon will take precise measurements of the patient's anatomy and discuss their goals to determine the appropriate range of implant sizes that will achieve the most natural-looking and aesthetically pleasing results.

For more tips on how to select an implant size, read our article, Your Guide to Choosing the Right Breast Implant Size

Breast augmentation offers various options to customize the procedure to your preferences and physical characteristics. Discussing these choices with your surgeon will help ensure that you achieve the results you desire while understanding the trade-offs involved. 


[1] Stein, M.J. et al. (2023) ‘Practice patterns in primary breast augmentation: A 16-year review of Continuous Certification Tracer data from the American Board of Plastic Surgery’, Plastic & Reconstructive Surgery, 152(6). doi:10.1097/prs.0000000000010497. 

[2] Jalalabadi, F., Doval, A. F., Neese, V., Andrews, E., & Spiegel, A. J. (2021). Breast Implant Utilization Trends in USA versus Europe and the Impact of BIA-ALCL Publications. Plastic and reconstructive surgery. Global open, 9(3), e3449.