What are the Main Breast Augmentation Techniques?

What are the Main Breast Augmentation Techniques?

What are the Main Breast Augmentation Techniques?

Breast augmentation is by far the first plastic surgery procedure representing more than a million and a half procedure last year, about one plastic and cosmetic surgery out of six.

What is the History of Breast Augmentation?

  • Both saline-filled and silicone-filled implants have been used since the 1960s to enhance and enlarge women's breasts. Initial silicone implants in the early 1960s had a thick elastomer shell and were filled with a relatively firm silicone gel.
  • In the mid 1970s, silicone implants tended to have a thin elastomeric shell and a less viscous gel, though gel cohesiveness was varied. Over the years, modifications have been made to implant shape, shell texture and properties, and the substance with which the implant is filled.
  • Currently, they are the preferred method for augmentation mammoplasty.

Why having a Breast Augmentation Performed?

  • Restoring breast fullness lost after pregnancy & breastfeeding
  • Feeling more confident in a swimsuit
  • Adding balance to better complement curvy hips
  • Enhancing self-image

What are the Breast Augmentation Choices?

  • Filling type: Saline, Silicone Gel, or Highly Cohesive Silicone “Gummy Bear” Implants.  Silicone implants require a larger incision for placement than do saline implants. Silicone implants are prefilled and are, therefore, available in fixed volumes, in contrast to saline implants, which are filled after they are placed in the patient and may be adjusted to compensate for any difference in volume between the patient's two breasts.
  • Shape: Saline & Silicone Gel implants are typically round, while gummy bear implants come in shaped and round options. Round implants will typically achieve a fuller upper pole (the top portion of  breast), while shaped implants lend a gently sloping look to breast profile. Both can look very natural with a skilled cosmetic surgeon’s help.
  • Profile: The cosmetic surgeon will help in this based on patient’s existing proportions and goals. Generally, patients with a more petite frame will require a higher profile implant to achieve the desired size increase while ensuring the implants are not too wide at the base.
  • Size: Breast implants range in size from about 150cc to 800cc or larger. Many patients require a different sized breast implant for each breast; this helps to achieve the best possible symmetry. The size depends on patient’s existing breast size, personal goals, and cosmetic surgeon’s recommendations.

What are the Breast Augmentation Surgical Techniques?

The Inframammary Breast Augmentation

  • An inframammary incision is the most common approach for placement of a breast implant. This approach, which entails a 3- to 4-cm incision, attempts to place the incision in or adjacent to the inframammary crease. The inframammary approach provides the most direct route and generally requires the least operative time for placement of the implant.

Advantages of this Breast Augmentation Technique

  • a wider access point, allowing a cosmetic surgeon to place larger silicone implants or gummy bear implants with precision.
  • less impact to milk production with this technique as neither the glandular tissue nor innervation is affected.  However, if the implant is placed on top of the pectoral muscle, it can exert pressure on the ducts and glands, which may reduce milk production functionality.


  • a visible scar on the anterior surface of the breast.
  • additional problems center on the difficulty in placing the incision in the inframammary crease; this difficulty is potentially exacerbated with low-profile implants.

TheTransaxillary Breast Augmentation Technique

Involves a small incision made within the armpit, through which cosmetic surgeon will place the breast implant using a specialized camera and instruments to ensure optimal placement. 

Implants are usually placed below the muscle.  As with the other incision techniques, placement of the implant above the muscle will result in greater impairment than placement underneath according to Doctor Inaze from the Cornell University.

Advantage :

  • leaves a small scar within the armpit but no scar on the breast itself.
  • The impact to milk production is usually minimal because the glandular tissue and nerves are largely undisturbed. 

Disadvantage :

  • provides the worst exposure for placement of the implant.
  • increased incidence of paresthesia
  • obtaining symmetric pockets is more difficult with this approach, and damage to the intercostal brachial nerve and subclavian venous thrombosis has been reported.
  • if infection results, removal of the implant may require conversion of the transaxillary incision to one of the other incisions described. 
  • hypertrophic scar formation also can occur in the axilla, and the incision may be visible when the patient elevates her arms while wearing a sleeveless shirt.
  • because silicone implants are prefilled and, therefore, require a larger incision for placement, only smaller silicone implants are typically placed via this route.

Since 2020 and 2021 no new techniques are to be added.

The Trans-umbilical or Periumbilical Technique

It is s performed by inserting the implant through an incision in the umbilicus (navel) and moving it into place in the breast.

In this technique, no incisions are made on the breast or into the breast tissue, although the breast tissue is disrupted and sometimes damaged as the implant is brought into position. Insertion through the umbilicus makes it difficult to position the implant accurately, requiring the use of a camera scope.  It also permits placement only above the muscle. 

Advantage of this Breast Augmentation Technique

A single scar with no scarring on the breast itself.

It preserves glandular function and nerve response so that the impact to milk production is usually minimal. 


Placement of the implant is restricted to a prepectoral plane, and this approach provides the worst control for dissection of the pockets. Superior dissection and symmetry of placement are difficult, even in the most experienced hands.

Complications of hematoma or infection require conversion to one of the other incisions for implant removal.

Additionally, placement of saline-filled implants through a periumbilical approach requires a special type of valvular mechanism, and the long-term reliability of the valvular mechanism in these implants has not been fully clarified.

Breast augmentation with fat injections

Breast augmentation using the patient’s own fat (autologous fat transfer or fat micrografting) is a procedure that involves removing fat from one or several areas of the body by liposuction and then injecting that fat into the breast tissue to achieve a cosmetic augmentation.

Modest augmentations are possible with current fat grafting techniques.

Limitations :

Results from injection of autogenous tissue have lacked predictability.

In addition to the risks of scarring and uneven texture that may be visible in patients who have undergone tissue injection into the breasts, microcalcifications may develop. This makes performing follow-up mammography on these women for early diagnosis of breast cancer difficult.

Despite the extensive list of potential complications, breast augmentation remains one of the safest and most predictable procedures performed.

The surgery provides a balance between the size and shape of the patient's breasts and the rest of her body.

The low incidence of complications and the predictability of surgical outcome have prompted an increasing number of individuals to undergo the procedure.

Details of each procedure, complication, recommendations, read more and download our Ultimate Breast Augmentation Techniques Guide.

Doctor Nountras

Last update January 2021

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