Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
When a patient sits down in consultation and says “I just want to look natural”, that one sentence can mean six different decisions about what implant goes in, where it sits, and how we get it there. Size. Shape. Surface texture. Projection. Placement behind or in front of the muscle. Incision location. Every one of those choices has consequences that last years, and they all interact. Get the size right and the projection wrong, and the result looks off. Get both right but choose the wrong placement for the patient’s tissue thickness, and you may see implant edges within a year.
This guide walks through the six decisions I work through with every breast augmentation patient, and what actually drives each call. I’m Dr Scott J Turner, a Specialist Plastic Surgeon (FRACS), and I consult at our Bondi Junction and Manly clinics.
1. Implant Size
Patients often arrive asking for a cup size. Cup sizes are useless for surgical planning. Two different bra brands will size the same breast differently, and cup measurements don’t tell me anything about whether a given implant will fit your chest wall.
Implants are measured in cubic centimetres (cc). Sizes in Australia typically run from around 150cc up to 700cc and beyond, though the sweet spot for most patients sits somewhere between 250cc and 400cc. The right volume for you isn’t a number, it’s a range, and that range is determined by three measurements I take at consultation.
Chest wall width. The base diameter of the implant has to fit within the soft tissue envelope of your breast. An implant too wide for your chest wall pushes into the armpit or crosses the midline. An implant too narrow leaves visible edges at the sides.
Tissue thickness. The amount of soft tissue cover you have over the implant determines how much of the implant shape will show through. Thinner tissue means visible implant edges and rippling with larger volumes. This is measured by pinch-test at key points around the breast.
Skin elasticity. Your skin has to stretch to accommodate the implant. Patients with tight skin have a smaller working range. Patients with stretched skin (post-pregnancy, post-weight-loss) have more room but may need a lift as well.
Once I have those measurements, I use a combination of external sizers (try-on implants in a sports bra) and Vectra 3D imaging to help patients visualise what different volumes will actually look like on their body. It’s a more reliable way to make the decision than trying to imagine it from a number.
2. Implant Shape
Two options: round or anatomical (also called teardrop or shaped).
Round implants are the most commonly used worldwide, and for most patients they’re my recommendation. They’re symmetrical, which means rotation within the pocket isn’t a concern. They produce good upper-pole fullness when that’s wanted, or a more subtle look when combined with dual-plane placement. The old criticism that round implants always look fake doesn’t hold up in modern practice, where sizing and placement matter more than shape.
Anatomical implants have more volume at the bottom and taper toward the top, mimicking the natural slope of breast tissue. There are specific situations where I recommend them: patients with very little existing breast tissue, mild ptosis where a lift isn’t warranted, or tuberous breast deformity where a shaped implant helps reconstruct the breast form. They require more precise positioning because rotation produces a visible deformity. They’re also made from a firmer, more cohesive gel to maintain their shape, which some patients find less natural in feel.
The choice isn’t about which is better, it’s about which suits your anatomy and goals. Learn more about breast implant shapes here.
3. Implant Surface Texture
This is the decision where the industry has changed significantly over the last decade, and where I now spend less time on choice than I used to.
Smooth implants have a slippery outer shell. They don’t adhere to tissue, they move within the pocket, and they feel softer. Most of my breast augmentation patients now receive smooth or nano-textured implants.
Textured implants have a rough surface designed to encourage tissue to grip the shell. They were originally developed to reduce capsular contracture and to stop shaped implants from rotating.
The reason texture matters: Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare cancer linked specifically to certain macrotextured implants. It’s genuinely rare, but the association was strong enough that macrotextured implants have been largely withdrawn from the Australian market. The Therapeutic Goods Administration (TGA) now cancels registration of specific products where risk is identified.
Current practice at our clinics is smooth or nano-textured silicone gel implants for the vast majority of patients. Specific clinical situations may warrant microtextured implants, and we discuss the risk profile honestly with every patient at consultation.
4. Implant Projection
Projection is how far the implant sits forward from the chest wall. Same volume, different projection, completely different look.
Think of it this way: a 350cc implant can be wide and flat, or narrower and more forward-projecting. The same 350cc of silicone, but visually distinct results. Projection categories in most manufacturers’ ranges include:
- Low profile: flatter, wider, more subtle
- Moderate profile: balanced projection with a gentle forward curve
- High profile: more forward projection, more upper-pole volume for a given width
- Ultra-high profile: maximum forward projection for the narrowest base width
Which projection works for you depends on your chest wall width (already measured), the look you’re after, and whether you want upper-pole fullness or a more tapered slope. Narrow chest walls usually benefit from higher projections. Broader chest walls often look best with moderate projection.
5. Implant Placement
Where the implant sits relative to the pectoralis major muscle. Four options in modern practice, though the two I use most often are dual-plane and submuscular.
Subglandular placement sits the implant behind the breast tissue but in front of the muscle. Quicker recovery, less pain, and no animation deformity during chest exercise. The tradeoff: the implant is only covered by breast tissue and skin, so thinner patients often see visible edges or rippling over time. Suits patients with good tissue thickness who prioritise a faster recovery.
Submuscular placement positions the implant entirely beneath the pectoralis major muscle. More muscle and soft tissue cover means less visible rippling, better mammography access, and slightly lower capsular contracture rates in some studies. The tradeoffs: slower recovery, more chest-tightness in the first weeks, and animation deformity during heavy chest exercise (the implant moves visibly when you contract the pec).
Dual-plane placement is the one I use most commonly. The upper portion of the implant sits beneath the muscle; the lower portion sits beneath the breast tissue only. This gives upper-pole muscle cover where it matters for appearance while letting the lower pole fill out naturally. For most patients with average tissue thickness seeking a balanced look, dual-plane is the approach that typically delivers the most versatile result.
Subfascial placement is a variant of subglandular where the implant sits below the thin layer of fascia covering the pectoral muscle. It offers slightly more tissue cover than pure subglandular without the submuscular tradeoffs. Useful in specific cases, but not a default choice.
I assess tissue thickness, existing breast shape, activity level (a powerlifter has different considerations to a runner), and aesthetic preferences when recommending placement. More detail on placement options here.
6. Incision Location
Where the surgeon accesses the chest to create the pocket. Three options in most cases.
Inframammary fold (IMF) is an incision in the crease beneath the breast, typically 4-5cm long. It’s my default approach for most patients. Advantages: direct visualisation of the surgical field, precise pocket creation, the lowest published complication rates, and a scar that sits in the natural fold where it’s typically not visible when standing or lying down. Most patients find the scar fades to a fine line over 12 to 18 months.
Periareolar is an incision around the lower half of the areola. Advantages: the scar often heals well because it sits at the natural colour transition between areola and surrounding skin. Disadvantages: narrower access to the pocket, a slightly higher risk of disrupting milk ducts (relevant if you plan to breastfeed), and more bacterial exposure during surgery because the incision cuts through breast tissue. Not my first choice in most cases.
Transaxillary is an incision within the armpit, with the implant tunnelled up to the breast pocket. Advantages: no scar on the breast itself. Disadvantages: indirect visualisation makes precise pocket creation harder, higher published rates of implant malposition, and limited revision options if complications occur (most revisions require an IMF incision anyway, which defeats the purpose). Occasionally requested, rarely recommended.
The incision decision often drives the scar conversation. Patients who absolutely cannot have a visible breast scar sometimes choose transaxillary knowing the tradeoffs. Patients who prioritise precision and low complication rates almost always end up with an IMF approach.
How the Six Decisions Interact
None of these choices happen in isolation. A 450cc high-profile round implant with dual-plane placement through an IMF incision is a different surgical plan to a 320cc anatomical implant with submuscular placement through a periareolar incision. Each combination has different expected outcomes, recovery profiles, and long-term considerations.
What this means in practice: the decision tree happens across at least two consultations, with physical measurement, sizing, imaging, and discussion. Patients who arrive having already chosen a specific implant from social media are often surprised that their anatomy suggests something different. Good surgical planning starts with the body you have, not with the implant you’ve seen on someone else.
Frequently Asked Questions
What’s the most popular implant size in Australia? The most commonly used range at our clinics sits between 280cc and 380cc, though individual selection depends entirely on anatomy and goals. Patients with broader chest walls often suit larger volumes without looking out of proportion. Patients with narrower chest walls typically look balanced with smaller volumes. The number on the implant is less meaningful than whether it fits the patient.
Are silicone implants safer than saline? Both are TGA-approved in Australia and both are considered safe. Modern silicone gel implants are highly cohesive (the gel doesn’t run if the shell is compromised) and typically feel closer to natural breast tissue than saline. Saline implants are filled during surgery through a smaller valve, which some patients prefer. The vast majority of breast augmentations in Australia use silicone gel.
Do I have to choose submuscular placement to avoid rippling? No. Tissue thickness matters more than placement for rippling prevention. A patient with good tissue cover and subglandular placement may have no rippling. A patient with thin tissue and submuscular placement can still develop rippling at the lateral or lower edge where muscle doesn’t cover the implant. We assess your specific tissue characteristics at consultation before recommending placement.
Will my implant choice affect mammogram screening? All implants affect mammogram interpretation to some degree because they block X-rays from passing through. Radiographers experienced with augmented patients use Eklund displacement views to compress breast tissue forward of the implant for better visualisation. Submuscular placement may allow slightly more complete imaging because the implant sits behind the muscle. MRI and ultrasound are also available as supplementary imaging where mammography is limited.
How do I know if my existing breast tissue is enough for subglandular placement? Pinch-test measurement at consultation is the most reliable guide. If the tissue cover at the upper pole measures less than 2cm, subglandular placement typically isn’t suitable because implant edges will show. Submuscular or dual-plane placement is usually recommended in thinner tissue. The measurement is individual and doesn’t correlate directly to BMI or breast size.
Book a Consultation
If you’re considering breast augmentation and want to work through the implant options against your own anatomy, you can book a consultation with Dr Scott J Turner. Our primary clinics are at Bondi Junction and Manly in Sydney, with additional consulting at Brisbane, Canberra, and Newcastle.
A reminder on the process: since July 2023, breast augmentation in Australia requires a GP referral before your first surgical consultation. You’ll have a minimum of two consultations with Dr Turner, a psychological evaluation, and a cooling-off period before surgery is scheduled. These requirements are built into how every patient is managed, and they exist so decisions get made with time and information.
To book, contact our clinic or call 1300 437 758.
