Breast Augmentation with Minimal Natural Breast Tissue?

My fiance is Asian and has little or no breast tissue. She wears a bra that is essentially all foam, as there is no need to wear one. She is very self-conscious about it and wants to have breast implants.

I am concerned that with so little natural tissue that it would not look right, and she might be even more self-conscious.

Would breast implants look natural on a woman with little or no natural tissue, and if so, how much enhancement could she expect ? She is very thin with very tight skin.

Doctor Answers 39

Natural Looking Breast Augmentation Small Breasts - With Proper technique results can look very natural

It is very common in my practice to perform a breast enhancement that changes the breast profile from an A cup to a B cup.  Take a look at my breast augmnetation gallery of more than 100 women. May of them start with very minimal breast tissue. I have an area specificallly about femail athletes. These women very often have very limited breast tissue.  They all can have a beautiful, natural looking result. 

I rarely have patients in my practice requesting large implants anymore.
Most women are opting for smaller, more realistic appearing breast augmentation. Professional women (including physicians!) want to look their best, but they don't want to look done.
Women with very small breasts and very little breast tissue can acheive a natural looking result provided a plastic surgeon with expertise in performing natural looking breast augmentation chooses uses an implant of the appropriate size in the ideal postion.

Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 98 reviews

Natural breast augmentation

Most women having breast augmentation fit the description of your fiance. There are some considerations:

1. Silicone implants in this situation will not only feel more natural they will look more natural because they have a softer consistency. The edges are less obvious than saline. Wrinkling occurs less often but it does still occur.

2. Submuscular place will increase soft tissue coverage and will give a more natural appearance as well.

3. Choose a conservative size implant. This is the most important point. This will give the most natural result. The most common mistake women make is choosing an implant that is too large. This will overstretch the skin and breast tissue. They will take longer to settle.

Ralph R. Garramone, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 45 reviews

Breast implant sizing/type

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.  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.

Under Muscle Breast Augmentation Best for Little Natural Breast Tissue

Thank you for your question.

In patients with little natural breast tissue, usually thin patients, a big concern is that the Breast Implant can be visible since there is little tissue covering the Breast Implants.

Breast Augmentation in people with little natural breast tissue is best performed by placing the Breast Implant Under the Muscle. This is called a Submuscular or Subpectoral Breast Augmentation.

This adds muscle tissue covering the implant and will make the Breast Implant less visible after Breast Augmentation.

Breast Augmentation Works Well for a Slender Small Breasted Woman

You can expect excellent results!

Your concerns are very appropriate and should be expressed just as explicitly during consultation.

Of course, many women who seek augmentation fit the very description you've given.

With any surgery, there will be tradeoffs; it's important to know what these might be, before undergoing surgery. A frank discussion with the plastic surgeon should clarify reasonable expectations, and achievable goals to obtain a gratifying cosmetic improvement.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.5 out of 5 stars 27 reviews

Dimensional selection of Implants is Critical

In any patient, it is important that the desired outcome of surgery be frankly discussed in the context of the patient's starting anatomy and examination. This becomes more important the less natural breast tissue is available, as more of the resultant breast mound will be due to the implant.

As long as your friend's goals and the dimensions of her chest wall and breast diameter are not at odds (in other words, as long as she doesn't want breasts that are larger than what would look natural for her given her current body type), and as long as she is able to find an experienced surgeon sensitive to these issues, she should be able to look forward to a very nice outcome despite her lack of natural breast tissue.

In my practice, I like to point out to patients such as your friend that her anatomy and the existing soft tissues will often dictate the implant that will give the best result.

Breast implant size in small breasted women can be challenging

Thanks for your question -

A natural appearance for breast augmentation is something that most women strive for and it is correct to be concerned with minimal breast tissue that the implant may be more obvious.

Dr. Salemy has characterized some of the techniques your fiance may employ -

Of these the most important is likely size. Choosing too large an implant will typically appear unnatural and in my practice we strive to balance the patient's desires and expectation with a shape that will complement - not look unusual.

Most breast augmentations are placed under the muscle and this can help hide the implant.

Being able to feel the implant or see rippling (especially when the breasts are hanging) is a common problem with saline implants that may be improved by using silicone implants. There is a tradeoff here though - typically silicone implant scars are wider since the implants are full as opposed to saline implants which start out empty and are filled once in position.

Scar size and position can be a critical consideration if she decides to stay on the small side as an inframmary scar may not be hidden by the size of the breast.

I hope this helps.

A natural result IS possible

My recommendation to obtain a natural result would be to have a moderate profile silicone gel implant placed under the muscle.  The implant's width should match hers behind the breast and by staying away from the higher profile implants, the upper pole won't have that tell-tale unnatural buldgy look.

Implants could look very nice


Implants in patients with little breast tissue can look very nice. My suggestion would be silicone implants placed in a submuscular pocket. This will provide muscular coverage to most of the implant. With little overlying tissue, the silicone implant will look and feel more natural. The best plan would be to talk to a plastic surgeon and have your fiance try putting a few different size implants into her bra - one without padding. She does not necessarily need very large implants, only ones that fit her body shape. All that matters is that she finds one that she is happy with.

I hope this is helpful.

David Shafer, MD

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 70 reviews

Consider silicone implants

For women who are very thin with very little breast tissue, I will usually recommend at least considering silicone implants. They will give a very natural look and feel and can produce a wonderful result.

Here are a few things to consider in order to increase the chance at a great result:

  • Silicone implants (saline implants without extra tissue to hide them run the risk of looking very obvious as they may not sit in a natural position)
  • Placing the implant underneath the muscle (the muscle will provide a bit more cover for the implant)
  • Placing the incision in the armpit (in very thin women with some pigment in their skin, this is a nice option because it can be very difficult to hide the scar in these situations)
  • Using a modest sized implant (if you go too big, it will certainly not look natural in a thin Asian woman)

Hope that helps!

Dr. S

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 134 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.