About “Awake” Breast Augmentation Surgery with Saline or Silicone Implants

large breastsAt the cosmetic surgery centers of Constance Barone, M.D. in San Antonio we perform various breast augmentation procedures. Typically, breast implants are placed while the patient is under general anesthesia, but Dr. Barone utilizes awake surgery techniques whenever possible for the benefit of the patient. With local anesthetic, a patient can stay awake during the breast augmentation procedure, which allows her to avoid the nausea and disorientation associated with general anesthesia. Local surgery allows a patient to walk, eat, and perform other tasks more quickly after a procedure, and the local anesthetic serves as a pain reliever once the surgery is completed.

Breast Augmentation Procedures

There are a variety of breast augmentation procedures and ways to place breast implants. The procedure that Dr. Barone utilizes differs per case, as it is dependent on a number of factors, such as patient health, breast implant type, and patient goals and expectations. That being said, Dr. Barone is an expert in every type of breast implant placement and can perform any breast augmentation procedure. The techniques are as follows:


The inframammary procedure is the most common method of breast augmentation, in part because it provides the cosmetic surgeon with unhindered access for precise placement and incision. The surgeon places an incision below the breast in the inframammary fold (IMF), allowing him or her to place the breast implant directly under the breast through the bottom incision. However, one drawback of the inframammary technique is that it tends to result in more conspicuous scarring.


In the periareolar procedure, an incision is placed along the outer edge of the areola. This technique affords cosmetic surgeons an optimal approach when IMF or mastopexy adjustment procedures are planned and due to the location of the incision, there tends to be less visible scarring. There are drawbacks however, as the size of the incision makes the placement of silicone breast implants difficult and leads to a higher incidence of capsular contracture (a rejection of the implant by the body) over other techniques. Additionally, as the nipple is affected directly by the procedure, this technique may cause complications with breast feeding.


With the transaxillary technique, an incision is placed in the armpit and the breast implant is tunneled medially into place. One of the greatest benefits of transaxillary placement is that there is no visible scarring on the breast. Dr. Barone utilizes this technique when she places breast implants with the Keller Funnel™ and believes that the results are superb. The Keller Funnel™ allows Dr. Barone to avoid forcing pre-filled implants through small incisions (and thus risking trauma and undo distress to the patient) by using a no-touch, propelled implant technology to fill breast implants after they have been placed in the breast pocket. With this technique, Dr. Barone can place breast implants of all shapes and sizes with beautiful results.

Transumbilical (TUBA)

Similar to the transaxillary technique, the transumbilical (TUBA) procedure utilizes an incision elsewhere on the body, in this case the patient's navel, so that there is no visible scarring on the breast. Silicone breast implants cannot be placed with the TUBA technique however, as the pre-filled implants cannot safely be inserted through the small incision and tunneled superiorly under the breast. The technique can be used for saline implants though, and is a popular technique as there is no scarring.

Transabdominoplasty (TABA)

The TABA procedure is similar to TUBA, but is specifically used when a patient is simultaneously undergoing an abdominoplasty or "tummy tuck" procedure.

Breast Implants

There are two types of breast implants: saline and silicone. Both types have been approved by the United States Food and Drug Administration and each has its own unique properties. Which type is right for you will depend on various factors, which Dr. Barone can discuss with you in person during your initial consultation.


The benefit of saline breast implants over silicone breast implants is that they are placed in the body while they are empty, as opposed to silicone implants which are typically pre-filled (save for ones that are placed with the Keller Funnel™), so they require much smaller incisions that result in less conspicuous scarring. Additionally, saline implants are filled with salt water, which can be harmlessly absorbed by the body in the event of a rupture. However, saline implants have a higher tendency to ripple, wrinkle or become misshapen, so patients with little breast tissue or patients who are seeking post-mastectomy breast reconstruction may be better served by silicone implants.


Both saline and silicone breast implants share a silicone outer shell, however, silicone implants are filled with a gel rather than salt water. As a result, silicone implants typically look and feel more natural than saline implants, and are less likely to become rippled, wrinkled or misshapen. In the event of a rupture though, the silicone gel can cause complications and implant deflation will be much less noticeable, which can exacerbate health issues. Women who opt for silicone implants (approved by the FDA for patients 22 and older) may benefit from regular visits to their doctor to ensure that the breast implants are stable.

Contact Dr. Constance Barone Today

If you are interested in breast implants or would like to learn more about awake breast augmentation surgery, please contact our San Antonio center today! We would be happy to discuss your goals with you in person, and we can help figure out which breast implants and breast augmentation techniques would best suit your needs.

Dr. Constance Barone

Dr. Constance Barone

Dr. Constance Barone in San Antonio, TX, and her team pride themselves in delivering safe, compassionate care tailored to your individual needs. She has been voted one of the Top Plastic Surgeons in America and her professional affiliations include:

  • American Society of Plastic Surgeons
  • American College of Surgeons
  • American Academy of Cosmetic Surgery

To schedule a consultation and learn more about how Dr. Barone can help you achieve your aesthetic goals, contact our office online, or call (210) 614-0400.

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