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101 Old Short Hills Road Ste 510
West Orange, New Jersey 07052

Breast Augmentation

Breast augmentation, also known as “augmentation mammaplasty,” is a surgical procedure designed to increase the size and enhance the shape of the breasts with the use of implants. Women who have naturally small breasts or who have lost breast volume over time often benefit from this procedure. A breast augmentation does not improve excessively sagging skin or correct nipples that fall below the breast crease. Patients with these concerns might consider a breast lift to be performed instead of or in conjunction with a breast augmentation.

Best Candidates

Candidates for breast augmentation with implants can include one or more of the following:

  • A decrease in breast volume from weight loss, pregnancy, or nursing
  • Small breast size due to genetics
  • One breast larger than the other (asymmetrical breasts)
  • Need of implants for breast reconstruction after mastectomy

Options with Breast Augmentation

There are essentially six characteristics that can be modified in a breast augmentation.

1. Breast implant options include saline or silicone filled implants.

Saline Implants

Saline implants are filled with saline solution after they are inserted into the breast, which allows the surgeon to easily adjust the volume and correct asymmetry during surgery. Saline implants are approved by the FDA for use in women over 18 years of age. These implants can sometimes feel firm, but submuscular placement provides a more natural feel.

Silicone Gel Implants

Because silicone implants are associated with a lower risk of implant rippling, they are often recommended for breast reconstruction patients, women who are very thin or have thin skin, those who prefer subglandular implant placement, or those who desire a more natural softer feel to their breast. They are approved by the FDA for use in women over the age of 22 but may be used on younger women in select cases. Many patients report that silicone implants feel more like natural breasts.

Visit my blog for my recommendations for saline and silicone gel implants.

2. Implants are covered in either a smooth surface or a textured surface.

Visit my blog for more information about smooth or textured implants.

3. Implants are either round shaped or “shaped.”

Remember, however, that the shape of your breast outcome comes from a combination of the shape of your original breast, the shape of your rib cage, the shape created internally under muscle by the surgeon, and finally by the shape of the implant.

Visit my blog for more information about round and “shaped” implants.

4. Anatomical location can either be over or under muscle.

Under the pectoral muscle

Placement of implants beneath the pectoral muscles is known as submuscular placement. This technique allows for better support of the implant, which results in a lower risk of implant rippling and implant rotation. Submuscular implant placement does not cause trauma to breast tissue.

Over the pectoral muscle

When implants are placed above the pectoral muscle but below the breast tissue, this is known as subglandular placement. Many believe this placement yields a less natural-looking result than submuscular placement because the implants tend to show more rippling over the breast.

Visit my blog for more information about implant placement.

5. Incisions can be either, inframammary, transaxillary, periareolar, or umbilical.

Inframammary Incision

  • Size and location: Horizontal incision made beneath each breast along the natural crease
  • Scarring: Scars beneath the breasts are easily hidden by bras and swimwear
  • Implant Placement: Allows for either submuscular or subglandular placement
  • Implant Type: Either saline or silicone implants may be used
  • Invasiveness: Provides the surgeon with direct access to the breast pocket, allowing for more precise implant positioning

Transaxillary Incision

  • Size and location: Small incision made under the arm in the armpit area.
  • Scarring: A small scar in each armpit, but no scars on the breasts
  • Implant Placement: Either subglandular or submuscular placement may be used
  • Implant Type: Saline implants may be used or silicone gel implants (limited to certain types of silicone gel)
  • Invasiveness: A more complex procedure when done submuscularly because the implant must travel from the armpit to the breast so precision may be compromised; Surgeon’s visibility may be limited to an endoscopic camera

Periareolar Incision

  • Size and location: Curved incision is made around the areola (the darker-colored skin surrounding the nipple)
  • Scarring: Scar follows the outline of the areola and becomes minimal over time
  • Implant Placement: Allows for submuscular or subglandular placement
  • Implant Type: Either saline or silicone implants may be used; Saline implants may be recommended for those who desire large implants and have small areolas
  • Invasiveness: Potential damage to breast ducts, nerves, and glands may interfere with future breastfeeding

Transumbilical Incision

  • Size and location: A small incision is made inside the navel
  • Scarring: There will be no scars on the breasts. Scarring on the navel will be undetectable over time.
  • Implant Placement: Allows for subglandular placement
  • Implant Type: Saline only
  • Invasiveness: This procedure is more technical because the implant must travel a long distance before it reaches the breast.

Visit my blog for my recommendations for incision placement.

6. The size of final outcomes.

Final size is a combination of your own breast volume and implant volume. Breast implant size does not correlate with bra cup size. Implants are measured in cubic centimeters (cc’s). A higher number of cubic centimeters indicates greater volume, which results in a larger size implant. During our consultation, I will assess the amount of breast tissue you have as well as underlying torso shape and size along with the cup size you desire to determine the most beneficial implant size.

a href=””>Visit my blog for more information about breast implant size.

7. The shape.

Shape comes from a combination of the surgeon creating the implant space by creative internal tissue release, the implant choice, the implant size, the firmness or laxity of breast and its connections to overlying skin envelope and underlying chest wall characteristics such as the rib cage.

I will carefully evaluate you to help you determine what is ideal for you in each of these choices. We will have a second follow-up meeting prior to surgery to reconfirm these choices.



The surgery is always under general anesthesia, same day surgery, at a hospital-based outpatient center with skilled, experienced anesthesiologists. It is important to have general anesthesia because this allows me full muscle relaxation and the most precise implant placement and breast shaping.

The surgery takes a little more than an hour and most of my patients have one day of modest discomfort. There are no drains. The next day the wrapping is removed in the office and we put you into a compression bra.

You are seen weekly, the sutures dissolve on their own , and the incision is about one inch plus in length. You can wear a bathing suit in 10 days and by three weeks you’re back in the gym.


Recovery Time

Breast augmentation patients should plan to be absent from scheduled commitments and routine activities for about a week. There is modest discomfort the first twenty-four hours. This dissipates dramatically over the next 24 hours. I will prescribe medication that will help keep my patients comfortable. If you’re like most patients here, there is virtually no swelling and no bruising! Tightness of the muscle and implant space may make the implants seem like they sit higher. In actuality, the implant is in the proper location. Volume redistribution within the implant occurs as surrounding tissues “settle” and soften over the first eight weeks. Patients can resume strenuous exercise three to four weeks after surgery. I will schedule a follow-up visit to ensure the healing process is going smoothly.

I passionately believe breast augmentation is a true art form which is lost in most plastic surgery where the objective seems just to place a volume enhancer. I believe it is an opportunity to create something magical, an idealized beauty. Look at the examples of my results. I hope you agree.

If you are interested in the breast augmentation procedure in the West Orange area, schedule a consultation with board-certified plastic surgeon Dr. Scott Spiro. Please call (888) 377-9660 or fill out our online contact form today. We look forward to hearing from you!

Promises to fill the needs of our patients who are seeking non-surgical facial & body regenerative skin care.