Breast augmentation

Dr. Sean Satey Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques.

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Approaches and Techniques

There are several different breast augmentation approaches. The approaches include:

  1. Belly Button: aka Trans-Umbilical Breast Augmentation (TUBA)
  2. Armpit: aka Trans Axillary Approach
  3. Areola: aka Peri-Areolar Approach
  4. Breast: aka Infra-Mammary Approach

There are 2 different types of breast implants:

  1. Saline
  2. Silicone*

Implants can be inserted through all of the above approaches except silicone implants. *Silicone implants cannot be inserted via TUBA approach.

Breast implants can be placed in three areas-

  1. Above the muscle
  2. Below the muscle
  3. Dual plane

I’m here to help you navigate through the many options.

Breast Implant Size Selection

Selection of the correct implant size is determined by your natural anatomy and personal preferences.

Our job is to help you pick the perfect size, and present you with all of your options. We do this by allowing you to try on different breast implants sizers that will mimic the actual breast implants.

I’m here to help you navigate through the many options and help you become the best version of you!

Fat transfer to the breasts

Breast fat transfer procedures use your own natural tissues (fat) to augment the size of the breast.

This procedure is a great alternative for patients that don’t want to have a foreign body (or implant) placed. There are certain limitations, however. Fat transfer procedures can increase the size of the breast by a maximum of one breast cup size. In addition, breast fat transfer procedures are a great supplement to add upper pole fullness to the breast.

How long do breast implants last?

Most implants will last 10-15 years without issue! Now, some patients may have implants that last even longer. The key is to make sure that you aren’t having any trouble with the implants- like capsular contracture, etc.

Should you need to have your implants out, we have three options-

  1. Remove and replace the implants
  2. Remove the implants without replacement
  3. Remove the implants and perform a breast lift (with or without augmentation)

At the time of your consultation, we can discuss what the best options are for you!

Areola reduction

Let’s start off by defining the Areola: It’s the area of pigmented skin that houses the nipple on the breast mound. Another commonly defined phrase is the Nipple-Areolar Complex (or NAC).

If you are unhappy with the size of your areolas, you can have them augmented. The procedure involves an incision around the areolar to remove the excess areolar skin. This is followed by re-approximating the tissue. The incision is strategically placed on the border of the pigmented to non-pigmented skin which helps camouflage the incision!

Options after breast implant removal

After your breast implants are removed, we have several options: Option 1- do nothing. A lot of this depends on how much natural breast tissue you have! Option 2- replace the implants. Once we remove the old implants, we can replace them with new implants- either saline or silicone. Option 3- breast lift. Once we remove the implants, there will invariably be some degree of ptosis (or droop) of the breasts. A lift will raise the breasts to the correct anatomical position with the nipple areola complex centered on the breast mound. Option 4- lift and replace the implants. This is essentially the same as option 3, but includes the placement of an implant to augment the size of the breast. Option 5- remove and transfer fat. Once the implants are removed, fat is harvested from a donor site and re-injected into the breasts. This is typically performed to provide upper pole fullness of the breasts. I’m here to help you navigate through the many options.

Breast augmentation age and timing

You should wait until your breasts have fully developed before delving into the realm of surgical augmentation.

There are some absolute numbers, however.

The youngest age to perform surgical breast augmentation for cosmetic purposes is the age of 18. As far as timing is concerned – eg having a revision breast augmentation – I recommend waiting at least 6 months.

The reason is that at the 6 month mark, significant swelling has gone down and the new baseline of the breasts are apparent. At the time of your consultation, we will discuss your candidacy for surgical breast augmentation.

Mammogram after implants

Routine breast cancer follow up is IMPERATIVE regardless of breast implants!

A common misconception is that you can’t have routine mammography after implant placement.

This is absolutely false.

Just make sure to let your radiologist and mammographer know that you have had breast implants in the past!

There are several governing bodies when it comes down to routine breast cancer surveillance guidelines. Regardless of which your primary medical doctor chooses to follow- make sure that you get it done!

I’m always here to help you along the way.


Let’s start with discussing the normal anatomy of the breast:

Place the palm of your hand flat on your chest with your index finger touching and parallel to your collar bone. Where your pinky lays is where the upper pole of the breast should begin. The nipple areolar complex (NAC) should be centered on the breast mound.

There is a grading system (see image below) based on the degree of breast ptosis or “droop” that you have which will allow us to determine which type of breast lift will best suit you. We will review this on the day of your consultation!

Augmentations, lifts, and combinations

Breast augmentation does exactly what its name implies: augment the size of the breasts.

These can be done via one of two ways- fat transfers, or implants.

Fat transfers to the breasts involve the harvesting of your own natural fat with subsequent grafting of the fat to the breasts. This allows for a natural volumization of the breasts.

Implants, on the other hand, involve the placement of either saline or silicone foreign bodies to augment the size of the breasts. These can be placed either above or below the pectoralis muscle! We have a great video on breast augmentations above, so make sure to check it out.

Breast lifts are employed in patients that have ptosis or “droopiness” of the breasts. This often times happens as a consequence of aging, significant weight loss, or breast feeding. The procedure involves a peri-areolar incision, as well as an anchor scar to help lift the breasts to their normal anatomical positions!

If you have ptotic breasts and want to increase their size, you’re a great candidate for a combination procedure – a breast lift with augmentation! This will not only lift the breasts to their correct position, but will also augment their size to your choosing.


The recovery timeline from a breast augmentation is actually really short!

You’ll be able to return to work in about 7 days post-operatively.

You will have limitations on what you can lift though!

You want to restrict strenuous activities and heavy lifting for about 6 weeks- that’s when your body has reached approximately 80% of its tensile strength!

Capsular contracture

Let’s start with the basics.

Whenever your body detects a foreign body, it decides to wall it off and create a barrier from the rest of the body- regardless of whether or not that foreign body is safe! An implant is a perfect example. Even though a breast implant is safe, your body realizes that it’s not normal anatomical tissue and can form a capsule around it.

On its own, a capsule is harmless.

You can live the entirety of your life with a capsule and have zero issues. A capsule is essentially natural, fibrous scar tissue. This becomes an issue when you start to have contractures of the capsule. What that means is that the capsule itself will tighten down and contract. This can create issues ranging from aesthetic asymmetries to pain! There is a capsular contracture grading scale that I use to help guide treatment.

The risk of forming a capsule is 1% per year, and at 10 years, it’s about 10-15%.

There are risk factors to forming a capsule. These include previous capsule formation, hematoma, and previous history of radiation to the area.

Breast feeding and breast lifting

Timing is everything when it comes to cosmetic surgery.

During the breast feeding period, the milk ducts engorge with milk. Hormonal changes take effect, and the breasts increase in size.

Once breast feeding is complete, these ducts will involute and shrink. This may cause architectural changes to the breast, including contracture of the breast tissue.

This is why it’s I advise my patients to wait 6 months after the completion of breast feeding to proceed with surgery!

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