Breast augmentation explained: implants, placement and what to expect

Breast augmentation is one of the most recognised plastic surgery procedures, and also one of the procedures surrounded by the most misconceptions.

One of the first things I often hear is: "I want 350 cc." Or: "My friend has 400 cc and I want the same."

But breast augmentation does not work like choosing a clothing size. The same implant can look completely different on two different women. Your chest width, breast tissue, skin quality, existing breast shape, nipple position and overall body proportions all influence the final result.

This is why a good breast augmentation begins with your anatomy, not a number.

What actually happens during breast augmentation?

During breast augmentation, an implant is surgically placed to increase breast volume and alter the shape and proportions of the breast. The surgeon creates an incision, develops a carefully planned pocket for the implant and positions the selected implant within that pocket. The incision is then closed in layers.

The operation sounds relatively straightforward when described in a few sentences, but the important decisions happen in the planning: which implant, what width, what profile, what volume, and where should it be positioned?

Those decisions determine far more about your result than simply choosing a certain number of cubic centimetres.

Implant size: why cc does not tell the whole story

Breast implant volume is measured in cubic centimetres, or cc. But 350 cc is not a breast size.

Two 350 cc implants can have different widths, projections and profiles. And the same 350 cc implant placed in two women with different chest dimensions can produce completely different results.

This is why I would never recommend choosing your implant purely because you liked the number used by somebody on Instagram. Instead, the surgeon needs to consider how the implant dimensions relate to your breast base and chest wall.

What does implant profile mean?

Profile describes how far an implant projects forward relative to its width. Depending on the manufacturer, implants may be available in profiles described as low, moderate, high, extra-high or using similar terminology.

A lower-profile implant tends to distribute its volume across a wider base with less forward projection. A higher-profile implant generally has a narrower base relative to its projection and creates more forward fullness.

But again: higher profile does not automatically mean better cleavage or a better result. The appropriate profile depends on your anatomy and the aesthetic result you and your surgeon are trying to achieve.

Round or anatomical implants?

Implants can also differ in shape. Round implants are commonly used in breast augmentation and distribute their volume symmetrically around the implant. Anatomical or teardrop-shaped implants are designed with more volume towards the lower portion to mimic a sloping breast contour.

Neither shape is universally "more natural". The final appearance depends on much more than implant shape, including your existing breast tissue, implant dimensions, placement and surgical technique.

This is another reason why looking at the implant alone does not tell you what the final breast will look like.

Where can the implant be placed?

This is one of the most important parts of breast augmentation planning. You may hear terms such as over the muscle, under the muscle and dual plane. They describe the relationship between the implant and the pectoralis major muscle.

Over the muscle: subglandular placement

With subglandular placement, the implant sits above the pectoral muscle and behind the breast tissue. This may be appropriate for selected patients who have sufficient natural tissue to cover the implant.

Because the implant is not placed underneath the pectoral muscle, the muscle itself is less involved in creating the pocket. However, in someone with very little breast tissue, implant edges or rippling may potentially be more visible or palpable.

Under the muscle: submuscular placement

With submuscular placement, the implant is positioned at least partly beneath the pectoralis major muscle. The additional tissue coverage can be beneficial in selected patients, particularly those with less natural breast tissue.

But "under the muscle" is sometimes used quite loosely in everyday conversation, which brings us to another very common technique.

What is dual plane?

Dual-plane breast augmentation combines two tissue relationships. The upper part of the implant is covered by the pectoral muscle, while the lower portion sits beneath the breast tissue rather than being completely covered by muscle.

This allows the surgeon to use muscle coverage in the upper breast while also shaping the lower portion of the breast. There are different variations of the dual-plane technique, and the exact approach depends on the patient's anatomy and what the surgeon is trying to achieve.

It is therefore not accurate to say that dual plane is automatically the "best" placement for everybody. There is no single placement that is correct for every patient.

What about implants placed under the fascia?

Another option you may hear about is subfascial placement. In this technique, the implant is positioned above the pectoral muscle but beneath the fascia, the thin connective tissue covering the muscle. It is another surgical option available for selected patients.

Again, the important point is not to arrive at your consultation having already decided that you "need" a particular pocket because you saw it online. Your anatomy should drive that decision.

Where is the incision?

Several incision approaches exist, but one of the most commonly used is the inframammary incision, positioned within or close to the natural fold underneath the breast. Other approaches can include an incision around part of the areola or, in selected circumstances, through the armpit.

The incision selected depends on factors including implant type, surgical technique, anatomy and surgeon preference.

Every breast augmentation leaves a scar. The aim is to place it as strategically as possible and allow it to mature over time.

Will implants give me cleavage?

This is another expectation worth discussing before surgery. Implants can increase breast volume and fullness, but your natural chest anatomy strongly influences the space between your breasts.

If your breasts naturally sit further apart on the chest wall, an implant cannot simply move their anatomical origin towards the centre. Trying to use an implant that is inappropriate for your anatomy purely to create very close cleavage can create other problems.

This is why your natural breast footprint matters. A surgeon works with your anatomy rather than replacing it.

Can implants correct sagging breasts?

Sometimes increasing breast volume can improve the appearance of mild skin laxity. But an implant does not automatically correct significant breast ptosis, or sagging.

If the nipple position is low or there is substantial excess skin, a breast uplift (mastopexy) may also be required. In some patients, augmentation and uplift are combined.

This deserves its own article, because breast augmentation and breast uplift solve different problems.

Do bigger implants mean a better result?

No. An implant needs to fit the patient's tissues.

Choosing an implant that is disproportionately large for the available breast tissue and skin envelope can increase mechanical stress on those tissues. Long-term breast augmentation planning therefore should not focus exclusively on achieving the largest possible breast immediately after surgery. The surgeon also has to consider how the implant will interact with your tissues over time.

This is why I prefer the question "What implant will give me the proportions I want while working with my anatomy?" rather than "What is the biggest implant I can have?"

What will my breasts look like immediately after surgery?

Your immediate post-operative appearance is not your final result.

The breasts may initially appear swollen, firm, high or different from one another as the tissues respond to surgery. Over time, swelling reduces and the tissues adapt around the implants.

You may hear patients refer to this process as the implants "dropping and fluffing". It is an informal expression rather than a medical term, but it describes the gradual change patients often notice as the implants settle and the surrounding tissues relax during healing.

The final result therefore should not be judged in the first days or weeks.

Breast implants are not lifetime devices

This is something every patient considering breast augmentation should understand. Breast implants should not be regarded as devices that are guaranteed to remain unchanged for the rest of your life.

Future surgery may become necessary because of implant-related complications, changes in the breast over time, pregnancy, weight changes, ageing or simply because the patient wants a different result. Having implants does not automatically mean that they must be replaced after one specific number of years either. Follow-up and appropriate assessment matter.

Your surgeon should explain the risks relevant to the implant and surgical technique being proposed before you consent to surgery.

Understanding possible complications is part of making an informed decision, not something that should be hidden because it makes surgery sound less attractive.

Why consultation matters

Breast augmentation should not begin with "Which cc do you want?" It should begin with understanding:

• Your current breast anatomy
• Your chest dimensions
• Your existing breast tissue
• Your skin quality
• Your desired proportions
• What type of result you actually want

Photos showing results you like can be very useful during consultation because they help communicate your aesthetic preference. But they are references, not templates.

My role is to guide you through the consultation process, help you understand the terminology and your proposed treatment plan, and make sure you know what questions to ask before making your decision.

Your surgeon ultimately determines implant selection, placement and surgical suitability based on your anatomy and clinical assessment.