Breast Implants or Breast Lift?


Hi! I am Dr Michael Szalay and today I am going to talk about breast lift.

Often I will see patients who wish to have breast implants, but would get a better result with a breast lift.

When considering which procedure is more appropriate for someone, important factors are how loose the breasts are, where the nipples are located and the final size and position the patient wishes to achieve.

Some causes of loose breast tissue can include breast feeding, weight loss and developmental differences.

Many women are fine with the idea of a breast lift in order to achieve a better position and shape of their breasts. Some however are not keen for a breast lift because it entails extra costs and incision lines.


Some women may be suitable for either implants or a lift, depending on the final outcome they are seeking.

These women often have loose breast tissue but a good nipple position. The aim in these cases is to pick an implant which is large enough to fill out the loose breast tissue. If this doesn’t occur, then loose tissue can drape off the implant ( “snoopy” or “waterfall effect”).

Polyurethane implants can be helpful in this situation as they hold their position better than other implants and are less likely to stretch the already loose breast tissue.

Sometimes, the breast tissue might be so loose that a very large implant is required to fill it out. If the size of this implant is larger than the patient is willing to have, then she would be better suited by a breast lift.


There are 3 main types of incisions for breast lifts:

  • Peri-areolar (“doughnut”) mastopexy

This type of breast lift is primarily aimed at lifting the nipple and is mainly used when the nipple is low but the breast is not excessively loose.

An incision is made around the areola and the nipple can be lifted up to 2 to 3cm. A periareolar mastopexy is usually used in combination with an implant.

  • Vertical ( “lollipop”) mastopexy

This type of breast lift is the most common type and is used when there is loose breast tissue as well as a low position of the nipples.

An incision is made around the areola as well as down the middle of the front of the breast. Both the nipple and the breast can be lifted significantly with this technique.

  • Anchor Lift

This is a more extensive version of the vertical lift. This technique is used when the breast tissue is very loose as might occur after massive weight loss.

An incision is made around the areola, down the front of the middle of the breast and also in the crease below the breast.


It is possible to have a breast lift without implants if you are just seeking firmer breasts in a higher position with a better nipple position. All of these things can be achieved with just a breast lift.

Following a lift alone however, the breast will be lacking upper fullness. Many women choose to have implants as well as a lift in order to achieve upper fullness.


Breast Implants : Revision Surgery


Hi! I am Dr Michael Szalay and today I am going to talk about revision surgery after breast implants.

Sometimes it is necessary to perform revision surgery after breast implants. Helpful information about complications after breast implants has been gathered by Allergan and Mentor, the 2 largest breast implant manufacturers in the world. They have conducted  10 year studies on patients who have had breast implants. Here are the 4 most common reasons why revision surgery may be necessary:

1. Capsular hardening

This refers to hardening and contracture of the capsule around the breast implant. It can result in pain, abnormal shape and abnormal position of the implant. Capsular hardening rates have been listed by Allergan as 19% at 10 years for their standard smooth and textured implants.

The use of polyurethane implants dramatically reduces the capsular hardening rate to 1%.

2. Rupture

Rupture refers to a tear or hole in the outer shell of the breast implant. Various studies estimate the risk at about 1% per implant per year. So, because each patient has 2 implants, the risk after 10 years may be about 20%. There is no evidence that this rate is different for different types of implants.

3. Implant Malposition

This can refer to :

  • the implant moving out of place eg dropping too far (“bottoming out”)
  • the implant rotating if it is a teardrop shape  eg it might turn on its side and look abnormal
  • the implant flipping over on itself if it is round, which also looks abnormal

The Allergan study indicates an implant malposition rate of 7% for their standard smooth and textured implants.

In my experience, polyurethane implants have a much lower malposition rate of about 2%.

4. Breast Sagginess

This can occur for various reasons including ageing, breast feeding and weight fluctuation. It can also occur due to the weight of the implant stretching the breast tissue which occurs more commonly in the following patients:

1/ Those who have loose breasts to begin with.

2/ Those who fail to properly support their breasts after implants.

3/ Those who have large implants.

In my experience, breast stretching is less likely with polyurethane implants as they hold their position better than standard smooth or textured implants.


Whilst revision surgery may be necessary with any breast implant, the use of polyurethane coated implants significantly reduces  re-operation rates.

Teardrop Implants: Is it The Right Breast Augmentation Choice?


Hi! I am Dr Michael Szalay and today I am going to talk about teardrop implants.

Women today are conscious about their breast appearance. Many are not happy with their natural breast shape or appearance, which has made breast augmentation a common cosmetic procedure for women wishing to improve the shape, size and contours of their breasts.
Teardrop implants, also known as anatomical breast implants, are designed to create gentle contours and the fullness of a natural breast and are therefore an ideal choice for women seeking a smooth and natural-looking breast enhancement.

Here are some common benefits of Anatomical Implants;

  • Provides a natural shape and look to the breast
  • Creates a subtle-looking breast enhancement with less volume at the top and more at the base.
  • Because of their customised shape, they are more suited to women who have breasts that are wider or narrower than average.
  • They are useful when women have breasts which are droopy because they are fuller at the bottom, which helps fill out the loose breast tissue at the lower part of the breast.

What are Anatomical Implants?

Teardrop implants have elastomer shells that are filled with cohesive silicone gel and have an asymmetrical shape with a well-projected, full lower pole and a tapered upper pole.
The covering of the teardrop implant can be either polyurethane or textured. The advantages of a polyurethane surface instead of a textured surface is that the implant is much less likely to move out of place, rotate or develop capsular contracture.

Anatomical Vs. Round

Round implants are also filled with cohesive silicon gel and as their name suggests, are round in shape. Round implants are usually chosen by women who are seeking more upper fullness.
Round implants are available with a smooth, polyurethane or textured surface. The polyurethane surface offers the same advantages for round implants as it does for anatomical implants.
The choice between round implants and teardrop implants is often a difficult decision for many women. The best way to make your choice is to try on both round and teardrop implants in a firm singlet or t-shirt in front of a full length mirror.
As part of your decision making process, it is important to choose a doctor who has significant experience in performing both anatomical and round implants. An experienced surgeon can help advise you as to whether you would be a good candidate for your preferred choice.

Here is an example of a teardrop implant which I performed.


What are 3 Common Breast Implant Questions?


Hi! I am Dr M Szalay.

I have performed about 1500 pairs of breast implants and I want to run through the 3 most common questions I am asked when I see a patient for the very first time.


Patients like to know what possible shapes there are and there are lots to choose from. In order to head in the right direction of what you are looking for, one of the first things I will ask you is:

Are you hoping to achieve a full look or more of a natural look?

If you say you are wanting a more natural look then what springs to my mind is teardrop implants, or alternatively, medium profile round implants. Both can give a natural look even though they have different shapes.

Teardrop implants are, as you might think, shaped like a teardrop so they are tapered at the top, and gradually rising to give more fullness down the bottom. Here are some images of teardrop implants as well as a patient I used a teardrop implant on.

teardrop implants

Teardrop Implant

470cc Brazilian Natural Teardrop Extra High Profile Below Muscle

470cc Brazilian Natural Teardrop Extra High Profile Below Muscle

Medium profile round implants provide more upper fullness than teardrops, but still look natural. Here is an image of a medium profile round implant and a patient I used this implant on.

medium profile round implant

Medium Profile Round Implant

330cc Round Medium Profile Below Muscle-2

330cc Round Medium Profile Below Muscle

If you compare the images, you can see that the breasts are slightly different in shape, but both still look very natural.

On the other hand, If you say you are wanting a full look then what I would be thinking about is a high profile round implant. Here is an image of a high profile round implant and 2 patients I used this type of implant on.

high profile round implant

High Profile Round Implant

380cc Round High Profile Below Musclle

380cc Round High Profile Below Musclle

505cc Round High Profile Below Muscle

505cc Round High Profile Below Muscle

This brings me to the next most common question:


Some people are a little confused by what the profile of an implant is and think it means where the implant will sit on your chest eg a high profile would sit up closer to the collar bone and a low profile down closer to the belly button. This is not the case.

Profile refers to how far forward the implant will project on your chest. Here is an image of medium, high and extra-high profile round implants next to each other and one of medium, high and extra-high profile teardrop implants.

medium, high and extra-high profile round implants

Medium, high and extra-high profile round implants

medium, high and extra-high profile teardrop implants

Medium, high and extra-high profile teardrop implants

As the profile gets higher, the breast will project further forward, in the direction of the arrow shown in this next diagram.

breast with arrow


A lot of patients are unsure what size to choose. It is a big decision so understandably you want to spend some time thinking about it.

When you come in for your consultation, I will spend some time doing some careful measurements and this lets me know the range of sizes that you are able to go. Then you can try on various sizes in front of a full length mirror and decide what you like. Some visual clues that can help you make your decision are your height, shoulder width, chest width and the width of your hips.

Some patients get confused when they look at images from the internet of sizes that other woman have chosen. It is important to understand that implants can look very different on different women depending on the factors mentioned above as well as the size of their breasts before they had implants. Here are 2 images of 2 patients that I used different sizes on (230cc and 320 cc) and yet, in proportion to the rest of the body, the patient with 230cc implants appears to have larger breasts.

230cc Round Low Profile Below Muscle

230cc Round Low Profile Below Muscle

320cc Round Medium Profile Below Muscle

The reason for this is that the women with 230cc implants is smaller and had relatively larger breasts prior to implants.

So, the best guide on size is really how the implant appears on you when you are trying it on in front of the the mirror. If, after making your choice you leave my office and see a woman on the internet who chose the same size and looks totally different, please don’t panic! Try and remember how you looked in front of the mirror during the consultation, You are more than welcome, of course, to come back to see me before your operation just to make sure.

Results can vary among individuals. Any procedure has risks and it is wise to seek a second opinion. For more information