Breast Augmentation with Minimal Natural Breast Tissue?

A lower profile and lower volume implant will look more natural if placed under the chest muscle. Silicone would also be the better choice to reduce rippling.

You are right to be concerned about achieving a
natural look in a women with little breast tissue and very tight skin. However,
it can be done. All skin stretches. We also have many more options of implant
shapes and sizes, more than ever before. A smaller, perhaps shaped, implant
should work well for her without making her look ridiculous or completely
unproportioned.

Thank you for your question. If I were the surgeon, I would recommend that your fiancee select a conservative-sized implant. In addition, she may be a good candidate for an anatomical, or shaped, implant, which is less full near the top of the implant than at the bottom. This implant produces a more natural looking contour than the more commonly used round implant. The strongest indication for these shaped implants is for a patient who doesn't want too large of an augmented breast and has little of their own natural breast tissue pre-operatively. Note however that anatomically shaped implants come with a risk of implant position changes, which can cause asymmetries.Good luck, and for more information about other choices to be made before undergoing breast augmentation, take a look at the Guide to Breast Augmentation on my website from the web reference below. I discuss common patient questions I receive, silicone versus saline implants, round versus anatomically shaped implants, smooth versus texturized implants, implant manufacturer, implant insertion incision location, implant location inside the breast, and more.

It’s not unusual for plastic surgeons to encounter patients
with minimal native breast tissue.For
these patients, breast augmentation has the potential to dramatically improve
the quality of their lives.When
this situation arises, the best results are obtained when patients undergo
breast augmentation with moderate sized, moderate profile silicone breast
implants.In addition, results appear to
be better when implants are placed in a submuscular position.This
approach minimizes the potential for an unnatural artificial look.It avoids excess upper breast fullness and
avoids rippling which is frequently seen when saline implants are placed on top
of the muscle.In
patients with minimal native breast tissue who are considering breast
augmentation, consultation with a board certified plastic surgeon is
appropriate.This surgeon should be able
to formulate a treatment plan that addresses both anatomic findings and
aesthetic goals.

If your fiancee is concerned about her appearance then she can consider breast augmentation. It is possible to achieve beautiful results even with little breast tissue. She may want to consider submuscular placement with silicone implants, but she should talk to a PS for an in-person consult.

I use a technique called dimensional breast augmentation which involves taking in a number of factors and measurements, so each patient is unique. That being said, given your height, weight, and your activity level, along with the fact you are considering a lift, I would say you are probably not that far off in choosing an implant in that range. Best thing to do is to see a qualified plastic surgeon that has good breast expertise.This technique has helped my Asian patients achieve beautiful, natural looking results. 

In most cases like this, going under the muscle will help provide more coverage.  Results can be quite good with this.  

Best,

In patients that desire natural breast tissue appearance for breast augmentation one can consider fat augmentation which can certainly be done safely if fat injections are done correctly above and around the breast tissue. One must know that this will give you one breast size augmentation only. For patients with little or no breast tissue, a breast implant is still a better option and one can consider doing fat augmentation around the breast implant as well for improved shaping and correction of asymmetry.

I know this is a crude example but it helps to make the point. If you hide a golf ball (implant) under a silk sheet (tissue), the appearance will be very ball-like. However, if you hide the baseball under a thick comforter, the thickness of the comforter will greatly influence the result. A very thick comforter may make the ball barely visible. The comforter will determine the overall appearance of the result. If you change the golf ball to a volley ball, it may appear more round.

In individuals with very little tissue ( thin athletic women with low body fat and an A cup breast), the breast implants may be more noticeable and will ultimately have a significant role in determining the appearance of the outcome.

In individuals with C or D cup breasts, the overall breast tissue and position of the gland will have a greater effect on the overall appearance of the final result
 

Breast augmentation in very thin patients with small breasts can give excellent results.  These patients often have the most dramatic improvement in self-esteem because they have always been very self-conscious about their breast size.  As long as an appropriate sized implant is chosen, the breast should look "normal".  Also, placement of the implant below the muscle will help mask the implant in someone with thin skin.  Having a detailed discussion with a board-certified plastic surgeon will help in making a decision in proceeding with surgery.