Choosing breast implants involves more than picking a size. This episode organizes the discussion around implant fill, incision location, placement relative to the chest muscle, and volume. Each decision needs to fit your anatomy, goals and understanding of the risks.
In this June 23, 2020 episode of Plastic Surgery: Before and After, board-certified New York City plastic surgeon Darren M. Smith, MD explains the choices he discussed with patients at that time, including how 3D simulation could help them compare sizes.
Key takeaways
🔎 Fill affects the conversation.
Dr. Smith compares saline and silicone gel implants, including feel and how a rupture may become apparent.
🔎 Incision location affects the surgical route.
The discussion covers the breast fold, the areolar border and the armpit.
🔎 Placement has tradeoffs.
He discusses tissue coverage and changes that may occur when the chest muscle contracts over an implant.
🔎 Size is personal and anatomical.
Body proportions, aesthetic goals and 3D simulation all feature in his explanation.
⚠️ Complications belong in the decision.
The episode explains capsular contracture, when scar tissue around an implant tightens and can cause pain or a change in shape.
💬 Questions answered
Why does silicone implant rupture require follow-up imaging?
The episode explains that rupture can be silent, without an obvious change in appearance. A normal-looking breast does not confirm that a silicone implant is intact.
Does everyone need the same implant position?
No. Dr. Smith explains his 2020 preference for placement beneath the muscle and discusses muscle-related movement as a tradeoff. That preference should not be read as the only appropriate plan for every patient.
Can 3D imaging guarantee my result?
The recording describes simulation as a way to compare possible sizes and clarify preferences. It is a planning discussion, not a guarantee of the eventual appearance.
ℹ️ Current safety context
This recording predates the FDA's 2021 labeling changes. Breast implants are not lifetime devices, additional surgery may be needed, and silicone rupture screening can involve MRI or ultrasound. Review the device-specific patient decision checklist and the FDA's current patient information with your surgeon.
🎧 Episode chapters
00:36 — Silicone, saline and the historical implant comparison
02:51 — Incision choices and the surgical route
04:45 — Placement above or below the chest muscle
06:25 — Implant size and 3D simulation
07:07 — Understanding capsular contracture
🔗 Related information
Explore breast implant options, breast augmentation, or request a consultation with Dr. Smith in New York City.
About the host — current biography
Darren M. Smith, MD, FACS specializes in mommy makeover surgery, breast surgery, and body contouring in Manhattan. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.
Originally released June 23, 2020. Show notes updated September 30, 2026. This is general education. Current recommendations, suitability, risks and expected results require an individual assessment.
Full transcript and related resources
