Breast augmentation is technically known as “augmentation mammaplasty” and it allows a woman to enhance the size and shape of her breasts. Common reasons women choose to undergo breast augmentation are:

  1. To improve her body profile and proportion, especially in certain clothes.
  2. To improve her body contour if she feels her breasts are too small.
  3. To improve the volume and appearance often lost, due to pregnancy and breastfeeding.
  4. To improve symmetry in two breasts which have a moderate or significant size difference.
  5. To improve the appearance and feel with an otherwise sagging or aging breast. This may be done with a mastopexy, or breast lift.
  6. To repair a congenital or traumatic defect or a defect due to a breast lost to cancer or other reasons.

Breast augmentation is for women who are seeking to improve their appearance and self- confidence and contour and shape of their body. It is not for women who are seeking to please another individual or to save a failing relationship. Breast implants can make you look and feel better but won’t necessarily change your overall appearance to match an idea or cause other people to treat you differently.

The best candidates for breast augmentation are women who are seeking improvement but not necessarily perfection in their appearance. Advantages of breast enlargements are:

  1. 1.A woman is able to wear the clothing she desires
  2. A breast that has lost volume with pregnancy can be made larger again
  3. A breast that is small or never developed sufficiently can be made larger and more full
  4. A breast may be moderately lifted
  5. Improvement in appearance and self-confidence

Placement of implants

Implants may be placed in front of or behind the pectoralis, or chest wall muscle. Placement of the implant in front of the muscle is called a subglandular placement, while placement behind the muscle is called a submuscular or subpectoral placement. Technically, implants placed behind the muscle are placed partly or mostly behind the muscle in almost all cases. However, what is important is that the muscle implants placed partially or mostly behind the muscle allow the muscle to provide a better shape and contour in the “cleavage” portion of the breasts. This is especially important with women who are thinner or women who are requesting larger implants.

Implants placed behind the muscle allow for easier breast cancer detection and mammograms after their placement. Implants placed in front of the muscle may, in certain cases, better round out a sagging breast, although this comes at the expense of a rounder and less natural looking shape.

Types of Incisions

Implants will be placed through one of four incisions:

  1. Underneath the breast in the breast fold
  2. Around the nipple and areola
  3. In the axilla (armpit)
  4. Through the bellybutton

Types of Implants

Implants come in multiple different sizes, shapes and styles. Most implants placed in the United States are smooth round implants. While some surgeons believe that specially shaped or textured implants are required in all cases, experience has shown that an appropriately placed implant behind the breast will tend to conform to the shape and the teardrop appearance of the breast.

What about silicone vs. saline?

Article in peer-reviewed medical journals overall indicate that silicone and saline-filled implants are equally safe. Both implants are surrounded by a solid silicone rubber shell. This shell is the portion of the implant which comes in direct contact with the woman’s body. The filling, whether silicone gel or saline solution, is what makes them different.

A saline breast implant is the same saline that is used in intravenous fluid. It has the same liquid consistency as water and, in the case of an implant leak, will drain from the implant, causing the implant to deflate similar to a “flat tire.”

The silicone gel inside modern implants is a semisolid material similar to that which would be found in a very soft “gummy bear” or “gummy snake.” The modern silicone gel implant which is currently available will therefore largely retain its shape even if the implant were, for example, “cut in half,” and is much more solid in consistency than older implants filled with material more like maple syrup. In the case of an implant leak or rupture, this material can get out of the implant but tends to remain within the shell or capsule which is formed by the body in response to any implant which is placed, whether silicone or saline. There is a small chance that this material can make it out into the remaining tissues of the body, although this chance is quite low.

In order to gain approval for the studies, the FDA mandated that patients receiving silicone cosmetic implants be enrolled in a standard study and are recommended to undergo subsequent MRI scanning to determine if an implant is ruptured.

Overall, the rate of a leak or rupture of any implant is quite low, on the order of several percent in recent studies.

Silicone implants are FDA approved for women age 22 and older for primary cosmetic augmentation and saline implants are approved for primary cosmetic augmentation in women 18 years and older.

All surgery carries some uncertainty and risk

Breast augmentation surgery is a low-risk surgery. However, problems can and do occur. The most common problem, capsular contracture, occurs if the scar or capsule, which is the body’s shell formed around every breast implant, begins to tighten excessively. This can cause a harder or firmer feeling in the implant and a displacement of the implant out of the optimal pocket. The risk of capsular contracture occurring is low. Other surgical risks include bleeding, infection and some swelling and pain. Sensation may change in the nipple or the breast tissue itself as well. The chances of these complications occurring are also low.

Most women’s breasts are uneven before a breast implant procedure and will remain uneven after a breast implant procedure. However, Dr. Granzow will take steps necessary to try to even out the unevenness and match the breasts as closely as possible during the surgery.

Breast implants may break or leak, although this is unlikely. A saline implant which leaks would tend to flatten, like a “flat tire.” A silicone gel implant which leaks will tend to remain within the implant shell or capsule. This may not be noticeable other than with an MRI or with an additional surgery. The FDA recommends MRI screening for women undergoing cosmetic silicone implant placement.

Mammograms may be more difficult to obtain after having breast implants placed. Implants placed behind the muscle are typically easier to image than implants placed on top of the muscle.

Your consultation

During your consultation, Dr. Granzow will specifically go over the details of your surgery with you. He will go over what may or may not be reasonably expected from your surgery and he will answer your questions in detail. Feel free to ask whatever questions you desire and bring a list of written questions so no questions are forgotten. Also, be sure to let him know about any medications, vitamins or drugs that you are taking.

After your surgery, most patients will be up and about the night of or the day after their surgery. Many patients have little discomfort following their surgery, although some patients may be sore for 2-3 days after the procedure. Dr. Granzow and his office staff will go over detailed instructions about what to do after your surgery and about your follow-up visits.

There will be some swelling after surgery. The sutures are self-dissolving.

Most women will be able to return to work a few days after the implant surgery, although this depends significantly upon a woman’s occupation and fitness level. Dr. Granzow’s procedure generally requires no limitation on the movement of the arms, although heavy lifting, sports such as golf or tennis, or workout activities such as yoga will need to be postponed for several weeks after a breast augmentation.

The healing of the incisions tends to occur quite rapidly and most incisions and scars become relatively unnoticeable quickly.


Dr. Granzow and his office staff are happy to answer any questions which you may have regarding rhinoplasty or any other procedure. The answers to many questions may also be found in our frequently asked questions. Please feel free to call our office or contact Dr. Granzow at any time.