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Breast augmentation is one of the most frequently performed cosmetic surgery procedures in the U.S. and one of our most popular services at The Woodlands, and in Houston, Texas. Breast augmentation can give women with small or unevenly sized breasts a fuller, firmer, better-proportioned look through the placement of saline or silicone implants in the breast.

Our patients elect to undergo breast augmentation for many different medical and aesthetic reasons, including balancing breast size, compensating for reduced breast mass after pregnancy or surgery, and correcting a congenital breast defect. Under our doctors’ expert care, patients enjoy great-looking, natural-feeling breasts that are one or more cup sizes larger after the operation.

Dual-Plane Technique for Breast Augmentation


  • The breast implant is partially covered by the chest wall muscle.

  • It allows for a more natural appearance while keeping the benefits of having the muscle cover the implant.

  • The implant is less palpable and less rippling are observed.

  • Pectoral muscle contraction may still occur with the dual-plane placement of the implant.

  • There’s also a reduced tendency for the breast implant to ride high, as well as reduced tendency for the implant to lateralize.

  • This technique has the benefits of both the subglandular and partial submuscular breast implant placement.

  • The risk of capsular contracture is similar to the sub muscular placement of a breast implant (~13 percent.)

Figure1:  Before & After Photos of Dual-plane breast augmentation performed by Dr. De La Cruz

Complimentary Procedures


Breast augmentation can achieve dramatic and beautiful results on its own as well as in conjunction with other cosmetic surgery or non-invasive procedures. We sometimes recommend combining breast augmentation with other procedures such as a breast lift for more satisfying results.

Saline and Silicone Gel Breast Implants


Breast implants are silicone shells filled with either saline (salt water) or silicone gel. Both implant types are very safe, and each offers its own advantages. We will help you decide which kind is right for you. During surgery, we will place the implants behind each breast, underneath either breast tissue or the chest wall muscle.

After many years, the U.S. Food and Drug Administration (FDA) has approved silicone breast implants for breast augmentation surgery. We are proud to offer patients the option of silicone gel-filled breast implants, since they are much softer and feel more natural than saline-filled breast implants

Breast Augmentation Surgery Incision Techniques


The breast augmentation procedure lasts one to two hours and is typically performed with general anesthesia. Incisions are made in inconspicuous places on the breast to minimize scar visibility. These may be located:

  • In the armpit (transaxillary),

  • In the crease on the underside of the breast (inframammary), or

  • Around the areola, the dark skin around the nipple (periareolar).

The breast is then lifted, creating a pocket into which the implant is inserted.

Saline implants may also be placed endoscopically through an incision in the navel. This minimally invasive breast enhancement technique is known as a transumbilical breast augmentation or TUBA approach.

With regards to the incision, Dr. De La Cruz typically makes the smallest incision one can achieve (~2.5 cm to 3.5 cm incision) along the underside of the breast (inframammary incision).  He also performs incisions through the armpit (transaxillary) or around the areola (periareolar incision) as well.

Figure 2:  Before & After Photos of Dual-plane breast augmentation performed by Dr. De La Cruz

Breast Augmentation Surgery Placement Options


One of the most important decisions prior to a breast augmentation is the selection of the breast implant pocket.  The clinical manifestations of this may not be apparent for several years.  Sagging of the breast may inexorably worsen, especially after giving birth or with aging.  There are several breast implant placement options:  subglandular (above the muscle), partial subpectoral (below the muscle), and dual-plane technique (partially subpectoral and partially subglandular.)

Implant placement beneath the muscle of the chest offers a few advantages over placement beneath the breast tissue only. These include reduced risk of capsular contracture (post-operative tightening around the implant) and less interference with mammogram examinations. Possible disadvantages include need for drainage tubes and elevated pain in the first few days following surgery. We will discuss which option may be best for you.

Dr. De La Cruz’ preference for the breast implant placement is the dual-plane technique.  Although the surgical technique may be more complicated and may potentially take longer, the dual-plane technique has the advantages of both the subglandular (more natural result) and submuscular approaches (less capsular contracture.)  Dr. De La Cruz performs all the different implant placement options and he will decide with you your best option to achieve a natural and longer-lasting result without compromising the excellent outcome that one would want to achieve.


After the implants have been inserted and positioned beneath the nipples, the incisions are stitched closed, then taped and bandaged. A surgical bra will then be subsequently placed in the operating room.



Most patients feel tired and sore after breast augmentation surgery, but this usually passes in a day or two. Many patients return to work within the week.

The stitches that are placed during your breast augmentation will dissolve.  Typically, there will be no stitches that will need to be removed after your surgery. Any post-operative pain, swelling and sensitivity will diminish over the first few weeks.

Scars from breast augmentation incisions will begin to fade in a few months and will continue to fade for months or years.



Complications following breast augmentation surgery are uncommon and usually minimal. They may include capsular contracture, swelling and pain, infection around the implant, a change in nipple sensation, milk production if you nursed a baby within a year before the procedure, and breakage or leakage of the implant (implant rupture) as a result of injury or the normal compression and movement of your breast.

If a saline implant ruptures, the implant will simply deflate in a few hours and your body will absorb the salt water. If a silicone implant leaks, you will need to see your plastic surgeon immediately. Regular monitoring of breast implants after breast augmentation is recommended to ensure continuing breast and implant health.

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