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Christopher Chang MD

If you are unhappy with your bust size and are considering breast augmentation surgery, you have questions that need answer. Luckily for you, Dr. Christopher Chang is one of the premier breast surgeons in Washington D.C.. Here you will find some of the most common questions for breast augmentation answered here.


What implant placement will be best for me: over or under the chest muscles?



Every person has a unique body structure and physiology. How the implants are placed in a breast augmentation surgery is customized to suit the patient’s body and needs.

Over the Muscle: Pros and Cons

Over the muscle implants are placed on top of the chest muscle, and under the breast tissue. This may be an effective method for some patients with more breast tissue. It has the advantage of allowing the breast implant to retain its shape when the chest muscles contract, rather than flattening it, as can occur when the implant is placed beneath the muscles. Modern silicone implant shapes are available, with teardrop shapes that are less likely to look like an implant, even when placed above the muscle. We will thoroughly discuss the placement options with you, so you know what to expect, and can make an educated decision.

Under the Muscle: Pros and Cons

Under the muscle implant placement can produce a look that is more natural in appearance, particularly for those patients with very little breast tissue. Placing the implant partially under a portion of the chest muscles poses less risk of “rippling,” or capsular contracture (when scar tissue forms tightly around the implant, requiring revision surgery). One surgical option is the implant placed fully beneath the chest muscle, with complete muscle coverage, which can add volume to the upper breast that appears natural. The implant is less likely to “bottom out,” which is when the breast implant drifts lower than intended.

Which type of incision will be best for me?

There are several types of incisions that can be used in breast augmentation surgery. Your custom treatment plan will include a discussion about how you can achieve the breast size and projection you want, and what type of incision will be necessary. The range of breast augmentation incisions includes the following, along with a brief description about why that incision will produce the best results:

Inframammary Incision:

This incision allows for the best access for implant placement. The incision is placed in the breast crease and is hidden beneath the hanging breast once healed. This incision has many benefits, including inconspicuous scar location, versatile enough to be appropriate for either silicone or saline implants, it allows for accurate, symmetrical placement, and has less risk of infection than the TUBA procedure. Another advantage is related to replacing implants; all implants will eventually need to be replaced, and with this incision, the same incision site can be used for no added scars.

Periareolar Incision:

This incision is placed around the areola. This allows for great accuracy in positioning implants, and the incision scar is less visible, as it is hidden in the darker pigment of the nipple structure. The incision is typically around the lower section of the areola. For those who tend to develop more obvious raised scars, this incision is likely not appropriate. It has some other drawbacks, such as a higher incidence of loss of nipple sensation or impacting the ability to breastfeed. For patients with very little existing breast tissue, this may be the preferred type of incision.

Transaxillary Incision:

This incision is hidden in the armpit, in the natural fold. To place the implant requires creating a channel from the armpit to the breast area, and the creation of a pocket within which the implant will be placed. This incision site is most often used for women who are getting saline implants, as the implant shell is filled after placement, and requires only a very short incision. For women who plan to breastfeed in the future, this is a safer incision as it is far less likely to damage the breast structure.

TUBA Incision:

A TUBA (transumbilical breast augmentation) incision is made in the belly button. This surgical procedure requires the highest level of skill, and is the most difficult to perform, but is essentially scarless. The advantages include the ability to place larger-sized implants, and that only one incision is needed for both implants. This incision can reduce recovery time and allows for implant placement either over or under the muscle. The procedure is only appropriate for patients who want saline implants as they are filled after placement. Only the most highly-skilled plastic surgeon should perform this advanced “scarless” breast implant procedure.

If I plan a pregnancy in the future, can I get breast augmentation surgery?

If you are unhappy with your breast size but plan to get pregnant in the future, you can have your breasts enhanced and retain the ability to breastfeed. The implants themselves don’t pose a risk to an unborn child. Breast will get larger during pregnancy and breastfeeding, but once completed, your breasts will return to the earlier size. The implants are not affected and remain as placed.

Countless women with breast implants have become pregnant. Getting pregnant with existing implants is considered safe. It is important to understand that the natural breast tissue goes through changes during pregnancy, and it is always important to maintain a healthy weight while pregnant to avoid the risk of excessive sagging. Whether you have implants or not, sagging can occur.

You should still be able to breastfeed your baby, and the implants should not get in the way. If you plan to have children and breastfeed, you should inform your surgeon, so the appropriate incision is used, one that poses less risk of affecting the glands that produce milk. If you are planning on getting pregnant in the very near future, it is advised that you wait until you have finished breastfeeding before undergoing the surgery.

You are a unique individual, and we are available to answer your questions and concerns about pregnancy and breast implants. You don’t need to worry about breast implants making it impossible to breastfeed – the implants are placed beneath the milk-producing section of the breasts. Women who have not had children and plan on a future pregnancy may want to avoid the periareolar incision, as access through the nipple structure is more likely to cause a problem – but this incision location is not your only option.

What are the most common complications from breast augmentation surgery?

While most women who get implants do not suffer any complications, it is important that you understand the most common types of complications, and how they are resolved. According to the FDA, these complications occur in one percent of patients: asymmetry, difficulty in breastfeeding, breast pain, sagging, calcification, capsular contracture, implant deflation, delayed incision healing, hematoma, swollen or enlarged lymph nodes, or dissatisfaction with size or shape.

Capsular contracture is a condition in which the body produces an excess of scar tissue around the implant, squeezing it into an unnatural shape. This condition is often painful, and the breasts no longer look as they should. This condition can be resolved with revision surgery. How your implants were placed can affect the likelihood of developing capsular contracture, and we can discuss your options with you personally, so you can make an educated decision about your surgery.

Implant rupture is when a hole or tear in the implant shell allows the gel (with silicone) to leak into the body. The rupture may be because an older implant degraded. Those who have silicone implants should have them checked with an MRI every few years. Leaking silicone implants often don’t present any obvious symptoms, so testing can be important in identifying a leak or rupture. Implants are considered to have about a 10-year lifespan, although many last far, far longer. With saline implants, a rupture is obvious, as the saline runs out of the implant and is absorbed by the body, leaving the breast looking deflated. In these cases, the implant must be replaced.

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