The selection of a particular shape of implant is based on the look that the client is seeking to achieve. Feedback from patient tends to indicate that gel breast implants offer the most realistic feel. Silicone implants are filled prior to surgery, therefore require a slightly larger incision for insertion than saline. Smooth and textured shells of saline implants provide a beautiful shape to the breast.

The technical goal of saline-implant technology was a physically less invasive surgical technique for emplacing an empty breast implant device through a smaller surgical incision.[89] In surgical praxis, after having emplaced the empty breast implants to the implant pockets, the plastic surgeon then filled each device with saline solution, and, because the required insertion-incisions are short and small, the resultant incision-scars will be smaller and shorter than the surgical scars usual to the long incisions required for inserting pre-filled, silicone-gel implants.
From the first half of the twentieth century, physicians used other substances as breast implant fillers—ivory, glass balls, ground rubber, ox cartilage, Terylene wool, gutta-percha, Dicora, polyethylene chips, Ivalon (polyvinyl alcohol—formaldehyde polymer sponge), a polyethylene sac with Ivalon, polyether foam sponge (Etheron), polyethylene tape (Polystan) strips wound into a ball, polyester (polyurethane foam sponge) Silastic rubber, and teflon-silicone prostheses.[111]
There are a few alternatives to breast augmentation with implants. Fat grafting breast augmentation involves harvesting fat via liposuction from another area of your body and injecting it into your breasts. Fat grafting is typically used to improve the appearance of your breasts after surgery to treat breast cancer, to correct a congenital breast deformity or to even out any imperfections occurring after breast augmentation with implants, such as wrinkles or ripples. The long-term effects of fat grafting to a normal breast are not fully understood, and the degree of augmentation possible via grafting is only modest at best. For these reasons, fat grafting for cosmetic breast augmentation is still considered experimental by many plastic surgeons.
It is also possible for implants to rupture and leak. If saline implants rupture, the saline will be safely absorbed by the body. A silicone leak may stay inside the implant shell or leak outside of the shell. When a saline implant ruptures, it will deflate. But silicone breast implants may cause no obvious symptoms when they rupture. This is called silent rupture.
One advantage of liposuction is that it won’t give you scars or loss of nipple sensation. Women who are in their menopausal years are the best candidates for liposuction because the fat content of the breasts increases during these years. Your skin has to have excellent elasticity for liposuction to work well. You also have to have a normally positioned nipple.

The preferred incision site is around the areola. You have your nipple, and then you have a circular dark skin around it which is called the areola. Usually the incision that is made is about 3 to 4 centimeters long which is about an inch and a half to two inches. The reason this is the preferred location for the incision is that number one it heals very well after about a week or two weeks, and it’s very difficult to see this incision even if you’re looking for it because it’s camouflaged by the dark skin and the light skin. The incision is right on the border between those two so it’s easily hidden. Another advantage of this incision is that it allows direct access to the implant pocket. The surgeon is able to use fiber optic lighting to look and examine the pocket very carefully to make sure that it’s clean, that there’s no bleeding, and allows for the best control of the implant placement.
Procedures that advertise using fat from liposuction and re-injecting it into the breast, also called fat grafts, are still considered surgical procedures, explains Dr. Doft. While it might be tempting to consider because it seems less invasive than a traditional boob job, the results are also harder to predict. Dr. Doft says: “Thirty to 50 percent of the fat will not survive. It is also not possible to know which fat will and will not survive, which may alter your results.”
Drink only liquids for the first few hours after surgery. Advance slowly to small, light meals. If you experience  nausea or vomiting more than two times, please call me so I can prescribe something to reduce this.  Excessive vomiting and retching can result in bleeding beneath the breast and/or around the implant (if  breast enlargement was done) that will require more surgery.
These placements vary from shallow (subglandular) to deep (complete submuscular). The right placement for your breast implants is based on your anatomy as well as your goals and expectations. You should express your desires to your surgeon, but make sure to take his or her expert opinion into account. Improper implant placement can create complications such as breast augmentation double bubble, wrinkles and rippling.
The best candidates for breast enlargement are women who have a thorough understanding of the procedure, including its risks, benefits and costs. Realistic expectations about the outcome are also important. Breast augmentation can improve your figure, but it can't change any other aspect of your life or make a bad relationship better. Women should only consider undergoing breast augmentation for themselves and not at someone else's urging.

Since experienced surgeons are aware of these issues with saline breast implants and their need for eventual replacement, they opt to place them under the chest muscle. The chest muscle works as an extra layer of tissue over the implant, which makes for a smoother transition from the chest wall to the implant. The finished product is a more seamless transition versus a more visible and abrupt change when the implant is not placed below the pectoral muscle. As for gel breast implants, they can also be safely placed below the pretorial muscle if that is a viable option for the patient since replacement and wrinkling is less common with this type of implant.
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