I see many small breasted women looking for a natural looking result from breast augmentation. Many plastic surgeons have before and after breast augmentation gallery exclusively of women with limited breast tissue, like athletes and fitness models, that includes many petite women with natural looking results from breast augmentation.
Obviously, a given implant volume and diameter that works well for a small-framed patient that is 5'3" will be inadequate for a large-framed patient that is 5'10". Careful evaluation of all of these issues is necessary if the ultimate goal of the surgery is a natural-appearing breast augmentation.
Having practiced plastic surgery in the 'breast augmentation capital of the world' (Los Angeles), I have developed some fairly strong opinions about this operation. In thinking about breast augmentation surgery, I believe that the most important question for a prospective patient to ask themselves is this: Am I seeking a natural-appearing result? When the goal of this operation is a natural breast enhancement, the results can be absolutely beautiful.
However, if the goal is to create a breast profile which is out of proportion to a woman's body, the results (by definition) never appear natural, and these patients not infrequently end up having a series of operations to address problems with their abnormal appearance. For that reason, I encourage women who are investigating breast augmentation to consider a breast implant size that will help them 'fill out clothes better' and improve the overall proportions of their body, not one that makes them look like "the gal with the boob job".
Quite a number of my breast augmentation patients are moms. After one or more pregnancies, most women experience a loss of breast volume combined with some 'stretching out' of the breast skin. In many of these patients, a breast implant of moderate size will restore a very pleasing breast contour. These patients are NOT looking to raise eyebrows at work or around the neighborhood - they just want to throw their padded bras away, and to feel better about their appearance in private.
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. 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.
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. Inadequate lateral dissection, on the other hand, will result in an augmentation with an abnormal 'side by side' appearance. As it is lateral projection of the breasts beyond the lateral limit 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', careful attention must be paid to ensure that lateral breast projection is not inadequate.
Another consideration is that the breast implant base diameter must match the existing anatomic limits of the breast preoperatively and the breadth of the anterior chest in general.
Michael Law, MD
Board Certified Plastic Surgeon
Raleigh ,North Carolina