Which Breast Implants Result in Natural Slope and Cleavage?

My wife is going to get Breast Augmentation in 3 months. She's 130 lbs, 5'4", 34A (breast fed 2 children), breast width was narrow, long torso and curvy hips, measured 1" on the upper pec/armpit area. We have decided on Silicone Breast Implants and under the muscle. She wants to be a small/medium C. One doctor said 350cc smooth high profile round implants. Our fear is we don't like the grapefruit look under the skin. We want a natural slope and decent cleavage. What are your thoughts? Which implant (high profile, mod+, mod) and what size would you recommend? Attached picture with measurements.

Doctor Answers 15

Natural looking breast augmentation

A natural-appearing breast is noticeably fuller in the lower pole (below the nipple) than the upper pole. In profile (viewing from the side), the upper pole slopes gradually from where the breast begins in the upper chest down to the nipple, and the lower pole is full and rounded. For any patient considering breast augmentation, there is an implant size above which the upper pole begins to look rounded, convex, and unnaturally full. Mild to moderate upper pole fullness can look beautiful and youthful, but excessive upper pole fullness due to overly-large implants looks decidedly fake, and like what most people think of as a 'boob job'.
The actual size of a breast implant, measured in cc's, is really not very descriptive of what a breast augmentation will look like, or what the cup size will be. It is all relative to the size of the breast and the size of the patient preoperatively. A tall, broad-shouldered patient with small A-cup breasts may require 450cc implants to achieve a C-cup breast volume postoperatively, while a shorter patient with medium B-cup breasts may only need a 250cc implant to achieve a C-cup breast volume.

Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 70 reviews

Implant choices

Thanks for all the info.  I prefer High profile implants for most patients that want to be a little bigger but are fairly narrow. Moderate plus are all right as well, they can give a bit more cleavage with less projection at the same volume of the HP's.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 22 reviews

Best breast implants for natural shape

There are several factors to consider. In general, silicone will feel and behave more like a natural breast. Then next step is to select the size, and the most common way to do this is trying on samples in a bra with the desired cup. Once the implant size is decided, then the implant with the best match of diameter to the base diameter of the breast is determined. That is how the cleavage will be optimized. In general, a high profile implant is to maximize volume on a narrow base, low profile to minimize size on a wide base. High profile implants have a steeper angle from the upper chest into the breast so they tend to have less of a slope.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 36 reviews

Natural breast implants

In my experience, under the muscle silicone breast implants give the most natural result. The extra tissue coverage from the muscle helps camouflage the implant look. Additionally, there is no question that the silicone implants feel much more natural than saline implants. Good luck with your surgery.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 66 reviews


Simply put: Pick the best plastic surgeon that you trust, be clear about your desired outcome and let him/her select the best implant. It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 76 reviews

Volume, dimensions, projection, and width

Once you have selected a volume based on the visual you get from trying on sizers, the surgeon can use the measurements to determine which implant will give you the look that you desire.  If for instance you are using saline high profile round implants, you can achieve natural if you are at the low end of the volume range of a larger implant, if you choose a smaller implant and fill it to the middle of the range to get to the same volume you will get more cleavage and an intermediate look, if you choose the smallest implant that can be used to get to the same volume, and fill it all the way up, it will be the most projected of the three looks.  For silicone, you just need to look at the dimensions of the implants and decide with the surgeon which will give you the projection you are looking for.

Choosing Breast Implants

It’s important to understand that breast implants come in all shapes and sizes. Choosing the right implant depends on several variables including the patients underlying anatomy and personal preferences.


         Two of the more popular implants are the round moderate plus and high profile varieties. These breast implants have important differences and specific indications.


         The majority of patients require a round moderate plus implant. This implant gives a more natural appearance. It has a broader base width and less anterior projection. This results in a more natural slope and more cleavage.


         In contrast, the high profile breast implant has a narrow base with more anterior projection. This implant is indicated when women desire more projection, and upper breast fullness. It tends to give a more artificial appearance.


         Although, it’s impossible to know what implant is right for any individual without performing a physical exam, the majority of patients require a moderate plus implant.


         If you’re considering breast augmentation, the style of implant chosen is one of the more important considerations. Make sure, you discuss this issue with your plastic surgeon so you can obtain the best possible result.

Choosing the right implant look

Based on your wife's photo, bra size, weight and height a 350-400cc moderate plus silicone implant would be my highest suggestion. Reason is, a high profile implant is selected more for petite women with a 30-32 bra size. High profile implants have a small base & project forward, giving the more "done" vs "real" look. Moderate profile implants have a wider base and much lees of a projection meant for a 34+ bra size. Moderate plus is basically in the middle, for a 32-34 bra size, projection is more realistic but still with some perk.

Breast implants for natural results

The more breast surgery I do the more I realize that there is no correlation between the size or model (profile) of implant used and resulting cup size or breast "look".  

This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saline/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size. 
Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.

2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.

I hope this helps.

The natural looking breast implant.

I offer patient's a simple analogy to illustrate what we mean:

Q: If you take a baseball and you cover it with a silksheet, what will it look like?

A: Like a baseball, you will even see the stitching.

Q: Now if you take that same baseball and cover it with a comforter what will you see?

A: It depends on how thick the comforter is but generally you will see a softly shaped lump.

So now the question is what do you have on your chest, silk sheets or comforters?

The way we determine this is by looking at your chest, if I can see your ribs (under the muscle) then you anatomy will have a hard time disguising the implant whether it is placed under or over the muscle and you are more likely better off with a silicone implant. Another way of measuring this is to pinch your upper chest skin (similar to pinch and inch of your waist on the Special K commercial). If you have less than an 2 cm (under 4/5 of an inch) than you have "silk sheets"

If you have a thicker skin/fat/breast layer that pinches over an inch than you have the option of going under or over.

Now the exception to the rule:

Q: What happens if you change the baseball to a volleyball?

A: All bets are off, whether you put it under or over the muscle it will not look natural.

The last issue is the implant shape. A moderate or moderate plus implant that has minimal projection is more likely to be more natural appearing (less baseball like). However many paitents seek upper pole fullness and larger volumes with a small BWD and the only way to achieve this is with a high profile implant.  There are some anatomic shaped implants but I have generally found them to produce no significant difference in outcome with the exception of breast cancer reconstruction. However, this is my personal opinion

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 60 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.