"High Five" Considerations Before Breast Augmentation Surgery

1. Soft-Tissue Coverage

This term refers to the amount and quality of natural breast tissue covering and supporting the breast implant. Sufficient soft-tissue coverage conceals the implant and minimizes its visibility under the skin. It prevents complications such as rippling, or when an implant's edges, folds, and wrinkles are visible through the skin.

Achieving optimal soft-tissue coverage has several considerations. First, it depends on the initial breast anatomy and amount of existing breast tissue. Surgeons evaluate these factors during preoperative consultations to determine if additional procedures, such as fat grafting or using different implant types, are necessary to enhance coverage.

In addition, techniques during surgery can influence soft-tissue coverage. For example, placing an implant under the pectoral muscle (submuscular placement) offers more natural coverage compared to positioning them above the muscle (subglandular placement). Although implants have some degree of rippling in general, submuscular placement reduces the risk of visible implant edges for a more natural breast contour.

Further reading: Should Your Breast Implants Be Under or Over the Muscle?

2. Implant Size (Volume/Weight)

Breast implant size, typically measured in volume or weight, influences the final appearance and proportions of the breasts. Choosing the right implant size involves a thorough assessment of the patient's anatomy, aesthetic goals, and overall build. Surgeons guide patients through this process by considering factors such as existing breast tissue, chest dimensions, and ideal cup size.

Breast implants are available in almost every size imaginable, enabling customization to deliver patients' desired results. Larger implants provide more significant breast projection and fullness, while smaller implants offer a more subtle enhancement.

In hindsight, future patients must keep in mind that choosing a breast implant size not only aims for aesthetic harmony but also considers the long-term impact on physical comfort. A reputable breast augmentation specialist educates patients about the potential drawbacks of large breast implants, such as increased strain on the back and shoulders, to help them make well-informed decisions aligned with their lifestyle and body goals.

The following articles can help patients determine the right breast implant type and size for their specific lifestyle and preferences:

• Breast Augmentation Size Guide


• Biggest Breast Implant – Does Size Really Matter?


• Saline vs. Silicone: Breast Implants for Active Lifestyles


• How to Benefit From Plastic Surgery Before-and-After Photos

3. Implant Dimensions

Dimensions typically include the width, projection, and profile of a breast implant.

An implant's width refers to its diameter, which can determine how well it fits within the natural contours of a patient's chest. A properly sized breast implant achieves excellent surgical results that look proportionate and exceptional.

Implant projection is a straightforward numerical assessment. It measures how far the implant extends outward from the chest wall in a straight line.

On the other hand, "profile" describes the three-dimensional aspect of the implant's projection, including its volume, relative to its base diameter. It considers not only how far an implant sticks out, but also its shape and how it fills out the breast area in terms of forward projection and side dimensions.

4. Location of the Inframammary Fold

The inframammary fold (IMF) is the natural crease beneath each breast. Its position can impact the overall look of augmented breasts.

Surgeons examine each patient's anatomy to determine the ideal position for the IMF relative to the new breast implants. This assessment considers the existing IMF, the size and shape of the implants, and the sought-after final appearance of the breasts.

In some cases, surgeons may need to modify the IMF by releasing or repositioning the fold to accommodate larger implants or to correct pre-existing asymmetry. This adjustment helps achieve a harmonious result—one that meets the patient's aesthetic goals and complements their body proportions. Moreover, if the IMF is too high or too low, it can leave an unnatural appearance or cause issues such as implant bottoming or visible implant edges. A patient may require breast implant revision surgery if these complications occur.

5. Incision Location

The incision site affects scar visibility, the ease of implant placement, and the overall aesthetic outcome. Most board-certified plastic surgeons choose from three main incision locations: inframammary, periareolar, and transaxillary.

The inframammary incision, made in the crease under each breast, is the most common choice. It offers excellent access for precise breast implant placement and a perfectly concealed scar within the natural breast fold. This incision also accommodates various implant sizes and types.

The periareolar incision, made along the areola's edges, reduces visible scarring due to the color and texture transition between the darker areola and lighter breast skin. However, this approach may not be suitable for patients with smaller areolas, especially if they want pre-filled implants.

The transaxillary incision, made in the armpit, leaves no scar on the breast itself. This approach can be appealing for patients concerned about visible scarring, as it eliminates cutting through the breast or muscle to access the implant location.

A breast augmentation specialist will recommend the best incision location based on a patient's unique anatomy, aesthetic goals, and implant preference.

The Bottom Line

According to recent findings, revision rates following primary breast augmentation are as high as 36 percent. Common causes include capsular contracture and implant malposition.

The "High Five" Decision Support Process focuses on precision, patient-centered outcomes, and fewer reoperations. It emphasizes key factors such as soft-tissue coverage, exact implant sizing and dimensions, careful consideration of the IMF, and informed incision choices. These considerations help plastic surgeons deliver beautiful results, which, in turn, minimizes the risk of complications and any need for revision surgery.

Discuss these "High Five" critical decisions with a board-certified plastic surgeon for safer, more satisfying, and long-lasting results. A qualified and experienced practitioner, such as Dr. Aldo Guerra and Dr. Scott Ogley, will walk you through the decision-making process by explaining how each factor contributes to your desired results. Schedule a consultation now to personalize your breast augmentation experience and shape your ideal silhouette.