Breast Augmentation Choices Mountain View

Options for Breast Implant Surgery

At An Enhanced You, Dr. Lowen offers breast implants San Jose patients rave about. Dr. Lowen wants to understand his patients’ goals and help them make educated choices about their care. This individualized treatment planning approach makes it possible to decide the best incision placement and breast implant combination for their specific goals. Contact our San Jose area center, serving the entire San Francisco Bay Area, to learn more.

Choices of Surgical Approach

Every woman will have her own specific goals in having augmentation mammoplasty and our goal is to work with you to meet those goals. Since there is no one breast implant or one way to place breast implants that is right for every woman, we will help you learn exactly what your options are and what we think is the best approach based on your own specific desires and particular anatomy.

Experienced in all three incisional approaches and various styles of breast implants, Dr. Lowen can offer the full range of options available today to patients.

There is not one “right way” to do augmentation mammoplasty. Should you be told that there is one best way to perform an augmentation or that there is one type of implant that is best, we would advise a second opinion. If the surgeon is experienced in the use of all incisional approaches and types of breast implants, it is far more likely that the operation will be tailored to your specific needs.

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Breast Implants – Quick Facts

The information below is an overview of the many options available to patients considering breast implants. These can be discussed more fully during your consultation at our Mountain View practice near San Jose.


If your goal is to achieve an aesthetically-pleasing breast shape with the least risk of capsular contracture, you may choose saline, Ideal structured saline or gel implants. Each has particular pros and cons that Dr. Lowen will discuss with you.


If you have a particular choice of incision location, it is usually possible to offer you that location. Since the choice of implant and incision location takes into account such factors as a tight or loose skin envelope, tissue coverage for the implant, and lower breast sagging or constriction, Dr. Lowen will advise you if the best result would be more predictably achieved with a different incision or breast implants.

Dr. Lowen can use all incisions, but prefers the inframammary incision for its predictability, and straightforward anatomical approach to the pectoralis facilitating a bloodless cautery dissection. If the goal of a natural-appearing and soft breast is obtained, the resulting scar, regardless of location, fades rapidly from attention. During your consultation, all of your options for type of breast implants, implant size, and incision location are open. Only after discussing all of the factors affecting you individually, will we jointly arrive at a final decision.

We have attempted to stress that the decision to have breast augmentation is a personal decision that any woman is entitled to make. Once that decision is made it is our goal to help you achieve the results you want: a natural appearing, soft, and esthetically pleasing breast. We want you to have a choice, and we want you to be informed.

We hope that the information we have provided will help you in your educational process of breast implants. Since there is no one best implant or incision for every woman, researching breast augmentation can be a difficult task unless you are given a chance to examine and understand your choices.

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Choices of Incision Location

All incisions are precise, surgical wounds in the skin and as such must necessarily heal as a scar. The optimal outcome is healing with a thin, inconspicuous line, one that is barely noticeable except on close inspection. While this outcome is usually achieved, there is no way at present to predict which patients may heal with a less than optimal scar, despite careful surgical technique and gentle treatment of the skin.

Healing is affected by genetic factors over which we have insufficient knowledge and control to predict final appearance in any given individual. However, we do know how to create and suture incisions to minimize scar appearance, and how to place them to make the scar as favorable as possible.

Wherever the incision is placed, favorable healing usually results in scar that is thin and barely detectable after the usual six to 12 months required for scars to mature. This means that if the ultimate goal is optimal breast shape, and if that shape may be best achieved by one or two but not all three of your incision location choices, the trade-off is usually well worth it.

The Inframammary Incisional Approach: Beneath the Breast

When there is sufficient breast tissue development, the lower border of the breast can be seen distinctly to meet the chest wall along a line of attachment that is called the inframammary fold. A larger, more developed breast may have a more defined fold than a smaller breast.

If the breast hangs down over the fold, an excellent location is provided for a well-hidden incision. The incision, properly placed, will only be visible lying down, not when looking at the breast from the front, and will be only slightly visible, if at all, when viewed from the side.

Even in a woman with little breast tissue, once some time has gone by, and the lower breast skin has stretched, the breast implants scar should be well hidden at the very lowest edge of the breast, and not visible when viewed from the front.

The scar is about 1.5-2 inches in length, is initially slightly raised, and gradually softens and flattens. Scar redness is normal for several months and gradually fades. No special treatment is needed to achieve optimal healing other than avoidance of sun exposure by use of sunscreen during the first six months.

The inframammary fold approach offers the most versatility in achieving specific improvement in breast shape. It allows direct surgical access underneath the breast and/or muscle, facilitating the correction of difficult breast problems including drooping, stretched out breasts, or breasts which are tightly constricted at their lower border.

When larger cup sizes are desired, the inframammary approach also offers more accuracy in pocket dissection to achieve optimum breast implant placement.

The Periareolar Incisional Approach: Around the Areola

The periareolar incision goes along the natural boundary between the pigmented areola and breast skin for half the circumference of the areola. In this position it usually heals as a thin, inconspicuous scar.

This incision technique requires that a tunnel be made through breast tissue to place the implant below the breast or pectoralis muscle. The width of the areola affects the length of the incision and thus the size of implant that can be placed through this approach.

The degree of injury to fine terminal branches of sensory nerves going to the nipple and lower breast skin is greater using the periareolar approach, so the risk of some degree of nipple or skin numbness is slightly increased. The sensation usually recovers as the nerves regenerate.

When the areola is large, or when there is a pre-existing periareolar scar, the periareolar incision is a suitable approach to breast augmentation and allows the precise pocket dissection and implant positioning needed to use larger breast implants.

There is some evidence that the presence of bacteria in the breast pocket may be linked to hardening of the capsule surrounding the breast, also called capsular contracture. Since the periareolar incision goes through the breast tissue, and it is known that bacteria such as staph epidermidis are present in breast ducts, it is felt that there may be is an increased risk of capsular contracture using the periareolar approach.

The Axillary Incisional Approach: Deepest Hollow of the Armpit

In the axillary approach the incision is placed high in the armpit off of the esthetic unit of the breast. There is no scar on the breast. A tunnel is made from the incision to the pectoralis muscle and a pocket is then made underneath the muscle.

Saline or gel implants may be placed through the axillary incision. Larger implants with an increase of two cup sizes may also be placed.

The axillary incision has a lower risk of sensation loss than the periareolar incision. The pocket is made entirely under breast tissue and muscle so there is no contact with breast ducts that may harbor bacteria.

Certain problems with breast shape, such as sagging of the breast and skin envelope below the inframammary fold or constriction of the lower half of the breast cannot be addressed well through the axillary incision, and are best approached by one of the other two incisions. The axillary incision has a higher incidence of implant malposition either too high or two low. Revisions require an incision on or under the breast. Having done hundreds of transaxillary augmentations Dr. Lowen prefers the inframammary incision for its predictability, the ability to do a bloodless cautery dissection under direct vision and its low rate of capsular contracture, malposition or need for revision.

The final choice of incision will depend on your personal preference and an analysis of breast anatomy and specific needs and desires for changes in shape and size. We do not prefer any particular incision, but attempt to help you understand what can and cannot be achieved most predictably in our goal of creating the most natural-looking and attractive breast.

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Implant Shape

The most commonly used are moderate profile implants, smooth round implants. The most commonly used gel implant is the Allergan Inspira Soft Touch, cohesive gel implant which has a nice combination of feel, upper pole support and minimal wrinkling compared to less cohesive implants. They are designed to fill the width of the breast while providing a natural anterior projection. Ideal structured saline implants have a profile in between gel moderate and high.

High-profile implants are used when the volume a woman desires is larger than would fit appropriately in her breast base width if moderate profile implants were used. Because high profile implants are narrower and project more for the same volume, more volume can be fitted into the same width. And some women just prefer the “perkier” shape of high profile implants. If high-profile implants are chosen that are too narrow for the breast width, they can give a “torpedo look”, particularly with larger implants.

Gel high-profile implants do not project as much for the same volume as high-profile saline implants, and high-profile saline implants are used much less often than high-profile gel implants.