Breast Augmentation

Dr. Samir Shah offers access to a variety of FDA-approved implants from U.S. manufacturers. Saline implants, silicone breast implants, and gummy bear devices are available and come in a variety of sizes to suit your needs.

Saline implants are filled with a sterile saline solution during surgery, allowing for intraoperative size adjustments. If a saline implant ruptures, the body safely absorbs the saline solution, and the rupture is immediately noticeable due to deflation. This provides a safety benefit, as prompt medical attention can be sought. In contrast, silicone breast implants are pre-filled with a cohesive gel and arrive from the manufacturer with a fixed volume, which cannot be adjusted during surgery. Silicone implant ruptures may be more subtle and harder to detect without imaging.

Silicone implants can be considered “gummy” because of the gel. The term “gummy bear” generally refers to highly cohesive, form-stable devices. Firm does not necessarily mean hard, and a degree of “firmness” is often desired to recreate youthful breasts. For women with thin breast skin, a highly cohesive implant is desirable due to a lower chance of rippling. Generally, patients with more breast tissue have greater flexibility in choosing implants. For patients who desire the “public” part of their breast to be more prominent, high-profile round implants create a fuller upper pole. If a natural, subtle upper pole is desired, moderate to moderate plus implants will suffice. Because of the wide range of options available with smooth, round gel implants, these are the most common implants used by Dr. Shah.

In 2017, the 5th-generation smooth round implants were released. Now, Dr. Shah offers 5th generation Allergan’s Inspira line and Mentor’s Memory Gel Xtra, which are highly cohesive (gummy bear), smooth, round implants. In addition to gel styles, implants are available in smooth or textured versions. Currently, all of the shaped implants are textured. If indicated, Dr. Shah may use textured round implants for malposition, augmentation/mastopexy, or when a stable implant position is required. Most importantly, Dr. Shah does NOT use Allergan’s Biocell line of textured implants. As of July 2019, the FDA has requested Allergan to recall all textured implants. Refer to this link to read more information. Currently, Mentor’s textured implants have not been recalled by the FDA.

Just recently, in 2024, the FDA approved a new next-generation implant called Motiva. Motiva breast implants are FDA-approved and recognized for their next-generation design, offering patients new safety features while providing natural-looking aesthetic outcomes. Developed by Establishment Labs, these silicone implants incorporate several key advancements to address the most common concerns related to breast augmentation and implant replacement surgery.
With so many options, the process can be overwhelming. Please call and make an appointment with Dr. Samir Shah to discuss your breast augmentation goals. He will explain all the implant options, and together you will arrive at a decision.

While implant size is a highly personal decision, there are some factors to consider when making your choice. Dr. Shah will carefully evaluate your lifestyle, chest width, height, weight, and aesthetic preferences to help you select the best implants for your unique body type. For instance, our highly active and athletic patients often do best with smaller devices that allow them to work out more comfortably. As another example, women with narrower chests tend to look best with smaller implants that don’t overpower their physique. Dr. Shah understands the need for balance and natural beauty in breast augmentation, and he will carefully tailor your results to achieve your individual body contouring goals. All implants offered by A New You Plastic Surgery are round in shape.

Regarding the placement of the implant, there is a choice between subfascial and submuscular (Dual plane). For the subfascial placement, the implants are positioned above the chest muscle and directly over the chest wall. The position of the implant relative to the chest wall can influence both the appearance of the breasts and future mammograms. Though this placement typically involves shorter surgery and recovery times, less pain, and easier accessibility in case of reoperation, it may also involve an increased risk of implant palpability, capsular contracture, and mammography interference.  Therefore, the patient must be evaluated for appropriate soft-tissue coverage.  

On the other hand, submuscular placement (beneath the chest muscle and closer to the chest wall) remains a viable option for many patients.  The most common technique used is the dual-plane method. It combines the benefits of both submuscular and subglandular. The lower portion of the implant is in the subglandular plane and helps to define the fold. At the same time, the upper half of the implant is submuscular, which is beneficial for coverage.  Dr. Shah performs a modified dual-plane technique, which helps stabilize the implant and reduces its migration into the axilla.  

One downside of muscle implants is the potential for animation.  This can be lessened by the sound technique of not overleasing the muscle.

Common incision sites for breast augmentation include the breast fold (inframammary), around the areola (periareolar), and under the armpit (axillary).

Regarding incision sites, the axillary and inframammary approaches are typically associated with fewer breastfeeding complications. The inframammary incision is made in the breast fold, which is a precise site that helps minimize visible scarring. Both of these incision locations produce a visible, though small, scar. The periareolar incision location involves making an incision around the areola, which can result in less visible scarring but is associated with an increased risk of affecting the milk ducts and potentially impacting breastfeeding. Proper incision placement and diligent post-operative care are important to minimize visible scarring and reduce the appearance of breast augmentation scars.