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Breast Augmentation

Dr. Paul Critelli is board-certified in plastic surgery and specializes in breast surgery. Breast augmentation gives women the opportunity to have fuller, shapelier breasts, improve balance of the female figure, as well as enhance self-image and self-confidence. Breast augmentation, also referred to as breast enlargement surgery, is a procedure that places implants within the breasts to make them appear larger. It is often used to restore volume after weight loss or pregnancy. It can help correct asymmetries is breast size.

Ideal candidates for this procedure are those who desire a larger cup size, perky breasts and more breast cleavage. Implants come in silicone shells, which may be filled with either a saline solution or silicone gel, and can vary in shape, size and texture. There may also be cases when patients desire a more natural look with a natural filler and consider a fat transfer instead of artificial implants.

Saline, Silicone or Fat

Saline breast implants

Saline implants are an excellent choice for many women deciding what type of implant to use for breast augmentation. Because these implants are filled with a sterile salt water solution, potential leakage poses no threat as the solution is safely absorbed by the body. Saline implants also cost several hundred dollars less than silicone. One of the disadvantages of saline implants is that they are more prone to show rippling, particularly over the lateral breast. This is something to consider especially for women who are thin and have low breast volume tissue. Those who opt for this type of implant must be at least 18 years old.

Silicone Breast Implants

Silicone breast implants are very popular today and are highly recommended by surgeons for patients who are thin and desire a natural look. Since the FDA validated their safety and efficacy, safety concerns surrounding these implants are today almost no different than that of saline. The silicone shell is prefilled with silicone gel and comes in different sizes, shapes and textures. Unlike saline implants in which leakage is absorbed by the body and implant volume is visibly flat, it is difficult to tell when a silicone implant ruptures. An MRI is required to detect any rupture. Patients considering silicone implants must be at least 22 years old.

Fat Transfer

For patients who desire fuller breasts but do not want an artificial implant to achieve this, there is also an option known as a fat transfer. In this procedure, the doctor will harvest fat from the patient’s flank, abdomen and/or thighs via liposuction. The fat collected will be cleansed and strained. The purified fat tissues will then be gradually reinjected within the breasts with smaller syringes so the shape is evenly distributed.


There are only 3 approved manufacturers by FDA.

  • Natrelle by Allergen-silicone and saline-based implants
  • Mentor-silicone and saline-based implants
  • Sientra-silicone-based implants


Breast implants come in a variety of different profiles and widths. The profile determines how perky or enhanced the breasts’ projection will be. The width of the implant determines how wide the breast will be. Dr. Critelli knows choosing the right profile can sometimes be a difficult decision, and will help guide you in selecting the right implant to meet your goals. Standard profiles come in low, moderate, high and extra high projection. As you increase projection you gain medial breast cleavage and lift the nipple areolar complex. The implant profile and width give you an implant volume.


The standard shape of a breast implant can either be rounded or tear-shaped. Each shape serves a different aesthetic function as it pertains to the patient’s goals. Rounded implants produce a shapelier curve on the top portion of the breast. The teardrop implants are shaped to copy the natural appearance of the breast, so they will not appear as high.

Implant Placement

The two most common placements are on top of the pectoralis muscle or under it. When the implant is placed under the muscle, a pocket is created under pectoralis major muscle. When it is placed above, a pocket is created in front of the muscle and below the breast tissue. There are advantages and disadvantages to each.

Many surgeons prefer the sub-pectoral pocket (behind the muscle). This helps to keep the implant in place for a longer period of time and resists the forces of gravity and time, particularly with larger implants. It is also thought to decrease scar tissue formation or capsular contracture. Placing the implant behind the muscle also provides a natural, smooth, upper pole look that many women prefer.

Sub-glandular implant pocket has several advantages. This pocket is often associated with less postoperative pain and recovery time. Placement can be done under local anesthetic avoiding a general anesthetic. The sub- glandular pocket also given more medial breast cleavage and more lift to the nipple areolar complex. The down side to this pocket is that there is no muscle to support and protect the implant from gravity and forces. Therefore, results tend to last a shorter time with need for correction sooner, especially with larger implants.

Incision Type

There are several standard incision approaches for breast implants. The first is known as an inframammary incision, which is an incision near the breast fold. This is by far the most common placement for the scar. The scar can often be placed within the fold making it difficult to see from most views. Second, is an incision made under the areola, which is known as a periareolar incision. This is often used on women who do not have a well-defined fold. A third option is to place the incision within the armpit, known as a transaxillary approach. It is up to the patient’s desires and surgeon recommendation as to what approach is best to take. Scarring is also discussed at this time with each method.

During/After the Surgery

Breast augmentation is an outpatient procedure that may last from an hour to several hours. It is performed using general anesthesia at UT Health Tyler. All activities must be limited within 48 hours after surgery. There will be bruising and swelling, and a compression support bra will also be worn to help in healing. It is normal to feel tightness around the chest area as the skin adjusts to the breast’s new shape. Most patients can resume normal activities within 7 days; exercise should be avoided for 4-6 weeks. It takes approximately 6 months for the breasts to look, feel and function normally in regards to softness, sensation and final placement.


Implant vs. fat?

This depends on the patient’s breast make up. Those who opt for implants may choose between saline or silicone as each has its own advantages. Generally, patients who have low breast tissue will benefit from silicone implants; otherwise, saline implants are recommended. For fat transfer, the advantage is that it poses less risk since there is no introduction of foreign material in the body. However, the results can change with fluctuations in body weight.

Silicone risk?

Negative notions about silicone started back in the early 90s when there were cases of leakage and complications. With today’s advancements in engineering, the silicone-based shells are made durable and safe, and have been proven so by the FDA. Today, in fact, silicone is more preferred than saline since they last longer and feel more natural. The rates of reported complications have significantly decreased in the last decade.

Implant or lift?

Breast augmentation is a cosmetic procedure designed to enlarge breasts while a breast lift is designed to tighten the loose skin of a droopy breast. Both resolve different breast issues. There are cases that the procedures are simultaneously done when it is agreed that a breast lift with augmentation is necessary.

Silicone leakage?

Today’s silicone implants are strong, durable and safe. Technical advancements have come so far, that even if a silicone implant does rupture, the shell of the implant will keep the silicone gel encased and protected from entering the body. In a rare case that a silicone implant does rupture, an MRI will be needed to detect the rupture. This is the main reason why MRI checks are recommended 3 years after surgery and every 2 years succeeding the first MRI.

Implant replacement?

Implants do not last forever and Dr. Critelli advises his patients to anticipate replacement every 15 years. As long as the implant shows no signs of damage or visible defects, such as breast rippling or a deformity, replacing them is not necessary. What is necessary, however, is a periodic check of the implants to make sure that they are still intact.