Breast Augmentation: Cost, Reviews, Photos

Circumareolar is a scar that is always covered by a bathing suit. The inframammary is easier, but when a small bikini top rides up, it can be seen. Axillary – use once to put in but if you have a problem or need another surgery , usually you need another incision. In my practice, I encourage a circumareolar incision and believe it is the best. (William B. Rosenblatt, MD, New York Plastic Surgeon)

Simplifying the decision about breast augmentation incision

The reason you have heard different opinions is because there is no single best answer. With your skin type, an important consideration is pigmentation of the scar.

If it is placed at the edge of the areaola, then it would be well-disguised, but potentially more obvious at the inframammary or axillary location.

The periareolar incision does not affect nipple sensation as some believe so ignore that.

Implant type and size may influence the decision too, since a slightly longer incision is need for silicone, and longer still for large silicone.

This may not be practical for the periareolar approach. (Richard Baxter, MD, Seattle Plastic Surgeon)

Breast augmentation scar choices

If you are interested in a reasonably sized silicone implant, the peri-areolar scar would work well for you.

This approach preserves the important infra-mammary fold tissues which are sometimes disrupted from an infra-mammary approach. (Scott C. Sattler, MD, FACS, Seattle Plastic Surgeon)

Your photo shows fairly symmetric alignment of the nipples, level folds under the breasts and a right breast larger than the left. The breast tissue is fairly well centered under the nipples. You will obviously need a larger implant on the left to even you out. This could just as easily be done with an armpit or areola incision. If you go through the armpit you will need a saline under the muscle so that the left can be inflated more than the right.

If you go through the areola you could go with silicone gel but the the surgeon will need to have various sized implants available in the operating room and will also need to use temporary sizers during surgery in order to try and achieve better symmetry. In your case because the folds under the breasts are not deep I would not recommend an inframammary incision because of the risk that the incsion scar may be more visible. (Aaron Stone, MD, Los Angeles Plastic Surgeon)

I know it sounds funny but it is true. Many patients don’t know which way to go. There are pros and cons to each. Using silicone requires a slightly larger incision and that may affect the periareolar approach as a choice. If you are trying to go large then I would go inframammary.

You do have a fold although it is not well defined. I would not recommend trans axillary or umbilical with silicone but would consider those if you were using saline. Discuss your dilemma with the plastic surgeon you chose and don’t rely solely on the incision for your choice of doctors. (Steven Schuster, MD, Beverly Hills Plastic Surgeon)

Breast augmentation incision

There are advantages and disadvantages to each incisional approach. The main advantage to inframammary is that it is the simplest, most direct route to place the implant. The disadvantage is that it can move relative to your inframammary fold as you age and may be visible in patients without a good fold to begin with.

The periareolar incision heals with the least perceptible scar statistically speaking and is ideal for patients like you who have a well-defined periareolar border, is small breasted, and has no clean infra-mammary fold.

The disadvantage is that if you heal poorly, it might be the most visible. The transaxillary incision was mainly developed for women without a clear fold and with small nipple areolar complexes and is often the choice of last resorts although some surgeons prefer this. The only advantage is that is moves the scar off the breast.

It affords the least control and least accuracy in implant placement but is fine for relatively small implants. Often I ask a patient where she wouldn’t want a scar if it was “bad” because if it is “good” scar, it doesn’t matter where it is. I would say a periarolar is very appropriate for you and then a transaxillary as long as you do not go too big. (Robin T.W. Yuan, MD, Miami Plastic Surgeon)

In general, not everyone can achieve a certain look or appearance since breasts have different proportions, tissue qualities and measurements relative to a person’s chest and body.

While breast implants may give you a cup size similar to the model in the picture you submitted, the shape in not likely to be the same since loose skin may result in the implants being much lower on the chest.

If you are not willing to consider a breast lift, you need to be ready to accept an appearance that is not like the model’s or be open to having a breast lift in the future. (Karol A. Gutowski, MD, FACS, Chicago Plastic Surgeon)

What procedure is best

I believe you would have the best result with a combination augmentation and breast lift.

You can do the best breast augmentation alone and have the lift secondary if you are not pleased with the appearance. But that would require an additional surgery. (Donald Nunn, MD, Atlanta Plastic Surgeon)

It is important to take a step back from the trees (the details of the procedure), and realize that you are looking at a forrest (re-examine your ultimate goal). If we can agree that your goal is to SAFELY achieve a lovely and long lasting, beautiful appearance, then it becomes very easy to understand that your best interests would be served over the long term by Breast Lift with best breast augmentation. Trying to avoid a breast lift, or getting cute with implant positioning (in other words, trying to avoid the lift you clearly need by placing the implants above your muscles), or some other short cut to the breasts you want, will almost certainly leave you disappointed and frustrated as you prepare and save for the operation you really needed in the first place – A breast lift with implants.

But the real advice is this – don’t spend even one more minute of your time investigating the procedure or its details. None of this matters unless you are in the hands of an ethical, experienced, and artistic surgeon Certified by The American Board of Plastic Surgery. Spend your time and energy finding one, and the rest will take care if itself. (Armando Soto, MD, FACS, Orlando Plastic Surgeon)

Best breast augmentation

I do not believe augmentation alone will give you the look in the picture because your skin envelope is different than the girl in the picture. I would recommend you either having an best breast augmentation and mastopexy at the same time so that you can have just one procedure that will give you a look close to what is in the picture or just have an augmentation done and wait 6 months and see if you want a lift. Since you seem decided against a lift I would recommend the augmentation only for you at this time. (Gary Hall, MD, Kansas City Plastic Surgeon)

Without a thorough exam and measurements it is difficult to recommend tne best approach. If you are set against a lift then probably a subfascial best breast augmentation would approach the look in the photo. (Todd B. Koch, MD, Buffalo Plastic Surgeon)

To obtain/copy the photo posted for the look is very hard to achieve. But if I were to try I might go above muscle with a 450 cc HP implant. Also a possible donut lift. But remember I have not examined you in person this is just my guess. (Darryl J. Blinski, MD, Miami Plastic Surgeon)

The best way to proceed with a problem like yours is to do an best breast augmentation to try and achieve the cup size of the woman in the photo . Then wait several months and see if you need a lift to position the breast where you desire. Using the photo of another person to achieve a result is not a precise way but it is done all the time to get an approximation of what a patient wants. (Walter D. Gracia, MD, Fort Worth Plastic Surgeon)

I’m afraid you won’t be able to achieve your desired look by simply placing implants. If you were to attempt a submuscular implant without a lift you would most likely get a ‘double-bubble’ look. NOT pretty. And placing an implant above the muscle is not recommended as this will make matters worse for you in the long run. I would suggest placing a small submuscular implant, a circumareolar lift with a dual plane lift.

The dual plane lift part of the procedure involves re-positioning your breast tissue over the implant to achieve a natural/fuller look. This technique is perfect for women like you who have most of their breast tissue below the areola/nipple complex. Patients are very happy and appreciate a lift without the need for a vertical scar. (Gary M. Horndeski, MD, Texas Plastic Surgeon)

Best breast augmentation and possible post-augmentation lift

Since you do not want to change the size, shape, or position of your nipples it is possible you may “get away” with an best breast augmentation only. However, you do not have a great deal of breast tissue below your aereola and after the augmentation you may decided to undergo a breast lift to achieve the look you desire. (Rondi Kathleen Walker, MD, Washington Facial Plastic Surgeon)

Lift and augmentation

If you want to look similar to the photos you posted, then you woudl probably need a lift and an implant placement. you can probably have it done through a circumareola approach. (Steven Wallach, MD, Manhattan Plastic Surgeon)

Breast Augmentation with Ptosis

Ptosis, or breast sagging, describes a situation when the nipple is positioned below the breast fold.

Most commonly, this occurs with age, after breast feeding, or with significant weight loss.

A breast implant will increase the volume of the breast and fill out the top (uppoer pole), but does little to raise the nipple.

In fact, most of the time, a round implant alone will give the appearance of more sagging rather than less. This is why most patients with ptosis benefit from a lifting procedure.

There are two options to try and improve ptosis without a lift, but they are not nearly as effective as a breast lift.

That being said, placing the implant under the breast (subglandular) may be better than submuscular, but at a risk of increased capsular contracture (hardening of the scar around the implant) and increased visibility of the implant at the top of the breast.

The second option are shaped gel implants. Due to the relative increased fill at the bottom of the implant it may give the appearance of upward rotation of the breast and nipple.

I recommend that you discuss these options with a board certified Plastic Surgeon in your area. (Lawrence Iteld, MD, Chicago Plastic Surgeon)

A breast augmentation may be done with or without a lift. If you want the nipple a bit higher, a circumareola lift can be done. (Steven Wallach, MD, Manhattan Plastic Surgeon)

Breast lift and implants

If you are not planing to have any more children then a breast augmentation with a breast lift will give you the most desirable results. I believe you will need a full breast lift also know as a wise mastopexy. (Tal T. Roudner, MD, FACS, Coral Gables Plastic Surgeon)

Avoiding the “Snoopy-deformity”

The most important determinant for breast lift in combination with breast augmentation is the preoperative appearance. Ideal nipple position should be at least above the inframmary crease. When at or below this fold, a lift should be entertained.

Placement of a breast implant does little to actually raise the nipple position and is meant to add additional size and volume to the breast. Certainly, placement of the implant in the subglandular position and an implant with higher projection will certainly move the nipple a little, usually not enough if preoperative appearance requires a lift.

Looking at your photos, your nipples appear just at the fold. In addition, you have lost some upper pole fullness, for which the implant will ameliorate. Breast augmentation alone may leave your existing breast to still hang over the breast prosthesis, leaving you with such a “snoopy-deformity” as you state. You should consider a small lift along with your augmentation for the best aesthetic result.

A consultation with a plastic surgeon to examine and evaluate you will help in assisting you decide which procedure(s) would be the right one(s) for you. Best of luck with your decision and upcoming procedure! (Lewis Albert Andres, MD, Scottsdale Plastic Surgeon)

Your breasts are amenable for either pure breast augmentation or lift with implants. Either will achieve a good result. With a lift your breasts will be higher but will require additional incisions. I disagree with some of the other recommendations that you are at risk for a snoopy deformity. A properly performed breast augmentation with appropriate muscle release and an adequately projected implant will avoid the snoopy look. I also would not place the implants above the muscle as the capsular contracture rate is too high. Any advantage of the subglangulal position can be matched by a dual plane muscle release. In the case that you choose to undergo a lift.

The vertical mammaplasy (lollipop lift) will give you the best results. It is absolutely not necessary for you to undergo a wise pattern which requires a long horizontal incision that often is problematic. (Ary Krau, MD, FACS, Miami Plastic Surgeon)

Snoopyboob

Going subglandular does decrease the chance of this problem, however, there are tradeoffs. The overall complication rate is higher with that approach and the sensitivity of your mammogram is impaired more than submuscular. (Michael Hueneke, MD, Nashville Plastic Surgeon)

A 400cc moderate plus placed in the subfascial position should give you a good result. If you want further elevation of the nipples, a circumareolar lift may be of benefit (Hilton Becker, MD, Boca Raton Plastic Surgeon)

Breast augmentation and uplift

As you have quite mild ptosis, a subglandular (under the breast tissue but on top of the muscle) augmentation should be enough to make very decent improvement without an uplift. If you have implants under the muscle (subpectoral augmentation), the chance of a ‘snoopy boob’ or double bubble appearance is much higher. (Anindya Lahiri, FRCS (Plast), Birmingham Plastic Surgeon)

Circumareolar mastopexy and breast augmentation

You would need an areolar reduction as well as a breast augmentation to address your concerns.

Silicone gel implants are more natural feeling and the problem of rippling palpable or visible is less frequent.

A circumareolar mastopexy will reduce the diameter of the areola but will also decrease its projection. (Miguel A. Yanez, MD, Charlotte Plastic Surgeon)

Areola reduction/pexy and silicone implant would be a good option and should give the results you seek. (Donald Nunn, MD, Atlanta Plastic Surgeon)

You have “tuberous” breasts, and both areola reduction and implant placement are important components of the integrated comprehensive approach the experienced plastic surgeon will incorporate when planning and executing your reconstruction.

Although gel is preferable in my opinion (higher viscosity, more natural texture), saline implants may also be used to your advantage. (Steve Laverson, MD, San Diego Plastic Surgeon)

It appears that a periareolar lifting with an areolar reduction and implants( preferably silicone) would help perkiness perkiness to your breasts. I would caution you not to insert too large implants because those will stretch the areolas. Also you seem to have tubular -like breasts which may need special attention. You need to have a consultation with a Board Certified plastic surgeon who can help address those issues. (George Lefkovits, MD, New York Plastic Surgeon)

The only thing I would add to the comments already made is that a permanent suture placed as a pursestring stitch in the outer circle of the areolar closure can help prevent stretching and dilation of the areola down the road. I have been doing this for many years and find it works well the majority of the time. (Paul W. Loewenstein, MD, Milwaukee Plastic Surgeon)

Yes, the areola reduction will perk up your breasts with or without implants. Implants will also have a lifting effect in addition to making your breasts larger. That would give you a better result if you don’t mind being larger. I am a bigger fan of he full breast lift which would have a vertical incision from the lower edge of the areola down to the fold of your breast.

This will give you a better and more lasting lift. It’s call a vertical mastopexy. That, plus the implant, will give you the best overall result. (E. Anthony Musarra II, MD, Atlanta Plastic Surgeon)

Yes, a circumareolar lift will decrease the size of your areola and also give some lift too. The addition of an implant will increase your size and add fullness to the upper part of your breasts. To be sure and discuss the specific details, see two or more board-certified plastic surgeons in your area.  (J. Jason Wendel, MD, FACS, Nashville Plastic Surgeon)

Areolar lift augmentation

I think your plan of an areolar lift and silicome augmentation is a good one. Make sure you see a board certified surgeon who understands the technique and procedure well. (Vishnu Rumalla, MD, Dallas Plastic Surgeon)

Augmentation/mastopexy

Judging from your pictures and desires, I think you are a reasonable candidate for breast implants and areola reduction.

With the areola reduction, you will not only have a smaller areola but your breast can be lifted slightly through the same incision. This combination will give you the lifted, perky breast that you desire.

Silicone implants have less likelihood of rippling and visible contour irregularities compared to saline implants. (C. Andrew Salzberg, MD, Westchester Plastic Surgeon)

I think you have really done your homework. Good job. It’s much easier for the surgeon when you come into the consultation with specific and realistic goals. It looks to me, from your photos, that the two operations you mention, the areola reduction and silicone augment, will get you to your goal. (Ronald V. DeMars, MD, Portland Plastic Surgeon)

Breast perk-up

Your breasts appear somewhat tubular. If so, this will need to be addressed at the time of surgery, as well as reduction of the areola. You will probably do best with a gel implant above the muscle. (Michael Leff, MD, Bellevue Plastic Surgeon)

The BEST Breast Augmentation Incision (Scar)

The fact that almost everything is feasible does not mean that everything SHOULD be done. With Breast Augmentation the implants can be placed through:

– Periareolar approach – a short curved around the bottom of the nipple areola complex

– Inframammary (bottom of breast) approach – a short incision in the under the breast fold

– Transaxillary (arm pit) approach – Trans Umbilical (TUBA) approach – “Scar less” – Tummy Tuck Approach – a variant of the TUBA in which during a tummy tuck after the tummy skin is lifted, the implants are placed through the top portion of the field and the tummy tuck is then continued without leaving scars on the breasts.

When you have a Breast Augmentation you MUST realize that these implants will some day deflate and need to be replaced OR you may need other breast corrective surgery (such as a scar removal or a lift). ALL subsequent breast surgeries will need a scar close or on the breast (in other words, a periareolar or inframammary scar).

Moreover, the visibility and accuracy afforded by a periareolar incision is unmatched by the other approaches. So KNOWING that you will have other surgery on your breasts in the future, why not pick the ONLY scar that can be used over and over again? Unlike Trans axillary or TUBA scars the periareolar scar allows you to use the same scar AND get better more accurate results each time.

So – in short – you are right. A Periareolar scar is THE way to go in my opinion. To learn everything you need to know about BREAST AUGMENTATION, follow the informative link below. (Peter A. Aldea, MD, Memphis Plastic Surgeon)

The transaxillary incision is the #3 choice on my list. My order of preference is 1 or 2 circumareolar or inframammary incisions. #3 transaxillary incision. I like the 1 or 2 not 3. (Darryl J. Blinski, MD, Miami Plastic Surgeon)

Transaxillary breast augmentation is a technique that places the scar off the breast, high in the underarm area. The result is excellent and the scar is away from view. The implant can be placed just as well with this approach as with any other.

Transaxillary augmentation, or any breast augmentation for that matter takes skill and experience. There are surgeons who do not do the procedure well, or do not enjoy the procedure. Perhaps they feel it takes more time, though the benefit of the concealed scar can be a very important consideration. Patients do understand their lifestyle and clothing concerns with breast augmentation, and you should not fear one incision over another. Choose your surgeon carefully. (Peter E. Johnson, MD, Chicago Plastic Surgeon)

There are some issues with transaxillary approaches; the first of them being that you are limited in the size of silicone implant that can be placed through this approach.

Any sized saline implant can be placed through a trans-ax incision, because the saline implant is placed when it is empty, and then filled inside the breast. The real problem with trans-ax incisions is the lack of control over muscle and infra-mammary fold dissection. Some surgeons do this approach ‘blind’ without the aid of an endoscope, and this approach is not very precise. Implant malposition can be a problem. It is possible to use an endoscope to dissect the implant pocket under direct vision. I was trained in this technique, but rarely do it in practice. Why? Because peri-areolar and infra-mammary incisions are so reliable. There is zero tension on a peri-areolar incision at the time of wound closure. These incisions heal beautifully, and are almost invisible in one year.

The limitation with a peri-areolar incision is size of silicone implant; I have struggled to place a 300 cc silicone implant through a peri-areolar incision, and consider 300 cc my maximum size for the peri-areolar incision. Of course, you can place any sized saline implant through a peri-areolar incision. My advice would be to go with the peri-areolar incision. (Scott C. Sattler, MD, FACS, Seattle Plastic Surgeon)

Unfortunately, there is no natural way to make your breasts grow closer together.

The biggest determinants of the spacing of breasts and fullness of the cleavage are your underlying anatomy and the mobility of the tissues of the breasts.

The bad news here is that this is largely determined by genetics. The good news is that bras are usually very effective in bringing the breasts together and helping to optimize cleavage and fullness of the décolleté area.

During consultation, we take a 3D photo of your chest area and I am able to show how the shape of the chest and the spacing of the breasts influence the spacing and fullness of the cleavage, including how this is likely to appear after Breast Augmentation surgery.

If you have questions about how your breasts and cleavage would change with surgery, a consultation with an experienced plastic surgeon is your best bet. (Nick Slenkovich, MD, Denver Plastic Surgeon)

Unfortunately no natural remedy exists yet. A circumareolar lift can be done easily under local anesthesia. Laser skin tightening can improves stretch marks and minimize scar appearance.

These options have little downtime. Remember to preview photos of similar cases. (William C. Rigano, MD, Dayton Plastic Surgeon)

How to bring the natural breasts closer together

There is no natural or medicinal way to bring the breasts together. Lingerie remains the best way to achieve this result. Surgery would be complicated and might require several steps. (John Zavell, MD, FACS, Toledo Plastic Surgeon)

Push up bras and tight fitting tops are the only way to bring your breasts closer together if you are ruling out breast implants. (Jerome Edelstein, MD, Toronto Plastic Surgeon)

Bringing breasts close together

Breast augmentation alone will not bring breasts closer together. However, improper breast implant placement can make the breasts look even further apart. With proper placement, breasts that are far apart can look very attractive after breast uagmnetation surgery.

Ideal placemement is critical in order to ensure the breasts don’t look further apart, or too high after surgery. (Michael Law, MD, Raleigh-Durham Plastic Surgeon)

Making cleavage

Unfortunately, without surgery, there’s no way I know of to achieve what you’re asking. Victoria’s secret & Fredericks can help here. Otherwise, a breast implant, or fat grafting to the medial portion of the breast, could be used for a surgical solution. (Thomas Fiala, MD, Orlando Plastic Surgeon)

Bringing your breasts closer together

I am afraid that is is extremely difficult if not impossible to do that, would leave fairly visible scars and will likely not last.

Some surgeons attempt to do that with a breast lift but the location of the breast on your ribcage is determined by your genetics, specifically the shape of your ribs as well as the width of the breast bone, and those things cannot be modified effectively. (Julio Garcia, MD, Las Vegas Plastic Surgeon)