In many breast augmentation patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola. Ideally the implant should be centered directly behind the nipple-areola complex (NAC). In profile, the natural-appearing breast is not convex in the upper pole, and an excessively convex and overly full upper pole is a dead giveaway that a breast implant sits below the skin. In addition, inadequate release of the inferior origin of the pectoralis major will allow the muscle to hold the implant in too high a position, and may even cause the implant to displace upwards (as high as the collar bone in some patients) when the muscle contracts. Patients with this problem require reoperation to release the inferior origin of the pec major and/or the inframammary fold.
Likewise, if the inframammary fold is lowered too far, the augmented breast will appear 'bottomed out', with an excessively full lower pole, an empty upper pole, and a nipple/areola that appears to sit too high on the breast - another situation with a distinctly unnatural appearance, and one that requires surgical correction: repair of the inframammary fold(s).
The horizontal position of breast implants also requires a great deal of attention, both in pre-operative planning and in the operating room. Excessive lateral dissection of the implant pockets will result in augmented breasts with an excessively wide space between them in the cleavage area, and the appearance that the breasts are abnormally far apart. The result may (or may not) be tolerable in the upright standing or sitting position, but when the patient lays down in supine position (on one's back) the implants may fall far to the side and produce little to no anterior breast projection in this position. Patients with the problem almost always want it corrected, and the treatment once again is surgical: a lateral repair of the implant space, to restrain the implants from falling off to the side.
Inadequate lateral dissection, on the other hand, will result in an augmentation with an abnormal 'side by side' appearance. It is lateral projection of the breasts beyond the lateral border of the chest wall (in frontal view) that, along with the concavity of the waist profile and the convexity of the hip profile, produces the appearance of an 'hourglass figure'. While one does not want to over dissect the lateral extent of an implant pocket, careful attention must also be paid to ensure that lateral breast projection is not inadequate.
Breast implant base diameter is also of crucial importance. The base diameter (the side-to-side dimension of the implant) must be ideal for the existing horizontal dimension of the breasts preoperatively, as well as the breadth of the anterior chest in general. Obviously, a given implant volume and base diameter that works well for a small-framed patient that is 5'3" will be completely inadequate for a broad-chested patient who is 5'10". One wants to increase cleavage area fullness and lateral breast projection in most cases, and an implant of inadequate base diameter may accomplish only one of those goals, while too wide an implant will be overprojecting in both directions. Careful evaluation of all of these breast and implant dimension issues is necessary if the ultimate goal of the surgery is a natural-appearing breast augmentation.
Avoiding the "Porn Star" Look - Go Smaller
Without photographs, I can only make a few general comments...
- Go smaller: The mid-range projection will probably look less like a melon than the high-profile implant.
- Go silicone: Silicone ripples less than saline.
- Go under the muscle: Better camouflage for the implant to minimize rippling. Also, the muscle will mute the upper pole projection of the implant so that the overall result is more "tear drop" shaped.
Avoiding overly fake looking breast implants
It is possible to avoid overly fake looking implants. Some things to keep in mind.
The profile of an implant equates to the projection of that implant. For a given volume, the higher the profile, the fatter and narrower an implant is. As a result, higher profile implants tend to provide more fullness and a rounder appearance to the upper portions of the breast - i.e., a more fake look. Higher profile implants tend to be really useful in women with relatively narrow breasts who want significant enlargement of the breasts; in these women, if a low or moderate profile implant were selected, to achieve the desired volume may entail the implant riding into the underarm region. In contrast, a patient with a wider build or wider breasts may find that high profile implants may fail to adequately fill their entire breast; they often times benefit from implants with lesser projection.
Implant size plays a big role in how natural the final result will be. Implants, after all, are fake manmade devices. If a patient chooses an implant that is too large for their body or breast skin envelope, the resulting augmented breast will be more implant, less native breast tissue. Those breasts will invariably look less natural.
Saline implants that are overfilled tend to look rounder and provide more projection of the upper pole of the breasts; saline implants which are underfilled tend to have more visible rippling. Silicone gel implants, although not perfect, tend to look and feel more natural than saline implants.
Hope this helps. Best of luck.
To choose the right implant for you requires a good consultation. I usually go over things in great length and work out a surgical plan with the patient. You have to talk with your doctor and tell him/her what size cup approximately you want . I usually show and demonstrate implants for patients and have them go home to evaluate the volume that I suggested. A natural result is usually achieved when the proper implant is chosen. Going to large will give the "fake" look.
Natural appearance of breast with implants
I believe that implants can look natural in many women. However, this depends upon several factors. One of the most important factors is the amount and shape of your existing breast tissue. If you have very little breast tissue (small A cup or less) the breast will always look more round, a shape many feel is not natural. In these cases, silicone implants are more helpful.
If you have more breast tissue, the chances of having a more natural, conical shape to the breast is better. Again, I tend to favor silicone implants a natural feel and shape. But a natural shape can be obtained with saline implants as well.
Another consideration is the size of the implant. Many surgeons feel that the more modest the size of the implant, the more natural the look. And this is probably so. Overly large implants for your chest will look unnatural. There can be too much fullness in the upper pole of the breast, or the breast will appear too wide. So, go big enough, but not too big.
In terms of the profile of implants, I prefer to use moderate profile or moderate profile plus with saline implants. High profile implants can give too much visibility of the implant in the upper pole of the breast. When choosing the profile of the implant to be used, I first determine the size of the implant, and then choose the profile in which the base width of the implant is closest to the width of the breast without exceeding it. So most of the time I am choosing the lowest profile that will fit the breast to give the most natural look.
These are important considerations and ones that you should take some time talking over with you surgeon. Good luck.
"Natural" means "what can occur in nature"
As Dr. Aldea nicely stated, so many patients come in wanting a "natural" result but what they really want is something quite full, just a bit less than Pamela Anderson. What "natural" means is "what can occur in nature" and this includes, at it's best, a straight line from the upper pole to the areola with no excess fullness or bulge.
I prefer that patients pick the "look" they want out of numerous pictures of mine that I show them and forget this overused and misused word "natural." The look you want determines the profile of the implant and its base dimension should match yours.
Natural looking Breast Implants
It is not so much the positioning of the implants that are important, as is the type (silicone vs. saline), the shape (round vs. anatomic), and the volume of the implant. Generally, moderate profile implants have a more natural look than high profile implants that may project too much.
Natural appearing implants: There is an answer!
Unfortunately the most commonly used type of implants (high profile) and the most common type of placement ( submuscular/dual plane) cannot deliver the natural 'tear drop' effect that you desire. There are also big problems associated with anatomic implants placed in conventional planes( they work well in subfascial carefully designed pockets). This is why I use a very unique methof of breast augmentation that I call 'cold-subfascial augmantation.' the placement of the implants is not 'above the muscle' or subglandular, nor is it submuscular or dual plane. A very strong layer of connective tissue is meticulously and atraumatically dissected from the pectoralis major muscle and this tissue is used to shape and support a lower profile implant into a gentle tear drop shape. It is the surgical dissection and not the implant itself that gives shape to the breasts. The results sit like natural breasts and do not move like submuscular implants do with arm motion. The fascia also supports the implant giving it relative protection from gravity and aging.
All the best,
Rian A. Maercks M.D.
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" 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.
Here are a few tips to get a natural look:
1) don't go too big. Big implants tend to look more "fake".
2) put the implant behind the muscle. This helps to give a smoother transition from chest wall onto the breast, and less of an obvious ridge at the top of the implant.
3) you may want to avoid the high-profile shape, which accentuates upper pole roundness.
If you follow these steps, your surgeon should be able to help you get a "natural look".
All the best,