Breast augmentation: choosing the right options for you

Written by: Mr Maisam Fazel
Edited by: Bronwen Griffiths

Breast augmentation is a popular cosmetic procedure which enhances and changes the size of female breasts. Not every breast augmentation is the same however, and there are numerous choices to be made when getting this procedure done. Mr Maisam Fazel, an expert aesthetic surgeon, guides us through the different options available and the important considerations to keep in mind

How do I choose my breast implant size?

Choosing your breast implant size is probably the most important decision you will make when undergoing a breast augmentation. When patients come to see me, they will often talk about breast size in terms of cup sizes. However, it is important to understand that cup sizes are not standard. For example, you can buy a bra in one shop where a C-cup fits, whereas in another shop an E-cup fits. Therefore, when deciding to undergo a breast augmentation, it is best to steer clear of relating size to cup sizes.

A better way to choose your breast implant size is to talk about shape, size, and volume. For example, you can have a 300cc implant, but a 300cc implant is not the same in all patients. A 300cc implant can either be a narrow high projecting one, which for example pushes forward more, or it can be a flat broad one which is called a low projecting implant. They can be both 300cc. 

The best way to choose implant size is by using dimensions. In my practice, I measure the patient and determine what their natural anatomy is. Then we perform a sizing exercise which allows the patients to try on different sizes to have a look to see what works for them and then based on the look, we select the appropriate implant. This way, we ensure that the implant that they select is appropriate to their frame.

What is the difference between round and teardrop breast implants?

The profile of the round implant is equal, and looks like a semi-circle, whereas the teardrop shaped implant has a slope. Many people think that with a teardrop shaped implant, you get a much more natural result, however, that is not necessarily the case. You can achieve a similar result by using an appropriately selected round implant. 

The teardrop implants are however an excellent option for breast reconstruction and I would suggest this shape for slightly older women who may need more fullness in the lower part of the breast. Round implants are great for the younger patient who is just looking for larger breasts.

One important thing to keep in mind is that with the teardrop shaped implant, although it can give a great look, there is always a small chance that it can rotate so that it sits upside down which may require surgery to fix.

What is the difference between having implants under or over the muscle?

When undergoing a breast augmentation, the implants can either be placed under the muscle or over the muscle.

During the patient consultation, I estimate the amount of breast tissue that is present. If there is not enough breast tissue, then I generally recommend that the patient has the implants placed behind the muscle. If there is enough breast tissue, then the patient can have implant placed over the muscle.

There are some important anatomical and aesthetic considerations as well. If the implant is placed behind the muscle, it generally gives a more natural look. Also, there is a slightly lower risk of developing rippling, which can be more prominent if the implant is over the muscle, especially in a slimmer patient. 

The second issue is that if the implant is placed behind the muscle, there is generally less disruption to the breast unit. 

The third point to consider is the degree of pain involved. Many people are concerned that if the implant is placed behind the muscle, it is more painful. Perhaps in some patients for the first few days, it can be a little bit more uncomfortable though with the appropriate amount of painkillers and appropriate use of local anaesthetic, the pain scores of patients undergoing breast augmentation with implants behind the muscle as opposed to over the muscle can be very similar. 

If you are interested in breast augmentation, Mr Fazel would be happy to see you in his clinic.

By Mr Maisam Fazel

Mr Maisam Fazel is a consultant aesthetic, oncoplastic and reconstructive surgeon based at several prominent clinics in London and the Home Counties. He has a unique background in plastic and breast surgery, with a clinical interest in cosmetic surgery, breast reconstruction and breast cancer.

Mr Fazel trained at several leading teaching hospitals in London, Paris, and Milan, and completed several fellowships in both the UK and US, including the prestigious Royal College of Surgeons Cosmetic Fellowship, gaining considerable experience in a variety of cosmetic procedures, and working with some of the top plastic surgeons in the UK. 

Mr Fazel is a leading expert in gynaecomastia surgery having pioneered innovative techniques in this area. He is also well known for his work in post pregnancy body reshaping (mummy makeovers), VASER liposuction, PLEXR soft surgery and variety of oncoplastic techniques used during breast cancer surgery.

Mr Fazel has published widely in his field, with publications in cosmetic and reconstructive surgery to his name, and has regularly presented his work both nationally and internationally. He is also actively involved in breast reconstruction research and has been part of the faculty of the Royal College of Surgeons. He is frequently invited to lecture internationally and is also involved in medical charities in the developing world.

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