How much variation is possible when performing breast augmentation?

I do not want the upper fullness but rather desire to have a natural fullness toward the bottom of the breast? I'm afraid of having that fake look that in some consultations I have heard is more popular. If I get results that have upper roundness rather than natural sloping I will be regretting ever getting breast implants! This is my main worry.

Doctor Answers 13

Variation in breast augmentation

I find that the natural look, with fullness toward the bottom of the breast, to be more popular than that round, obviously augmented look. You can certainly achieve your desired results — just express your goals clearly and honestly during your consultation. A reputable surgeon will help you select the right implant size/shape and apply surgical techniques that will give you the results you want.

Making sure your breast augmentation looks natural

Thank you for your question I can see that you are concerned over getting fake looking breasts, and I would like you to know that most surgeons will either prefer a natural look by choosing an implant that FITS your breast dimensions, or combine your own preferences with your breast characteristics to make sure you receive aesthetically pleasing results. Next, I would like to bring to your attention the fact that breasts must follow a set ideals to be classified as natural. Natural breasts have the following characteristics: The areola – dark pigmented region around the nipples – should not be large relative to your nipple                 The nipple should be above the breast fold – inframammary fold                 The 2 nipples should form an equilateral triangle with the notch of your breast bone                 The breasts should not be sagging                 The nipples should sit directly behind the part of the breast that projects the fullest                 The breasts should appear symmetrical A recent study by Dr. Mallucci and Dr. Branford, titled “Shapes, Proportions, and Variations in breast Aesthetic Ideals,” gives us 4 set of ideals in beautiful and natural-looking breasts. They are as follows:                 An upward pointing nipple (angled at 20 degrees)                 A slope in the upper pole of the breast                 A tight curvature (convexity) in the lower pole of the breast (i.e., below the nipple) An upper pole to lower pole ratio of 45:55 (i.e., the percent of fill below the nipple should be 55% compared to 45% above the nipple) If your breasts meet these ideals and those I mentioned above, they will look natural.  That being said, there are many factors that go into creating natural-looking breasts, and a combination of the right choices contributes to achieving the desired result. I mention some of these factors below. 1) The size of the implant – a large implant that exceeds your breast boundaries, or overly stretches your breasts, or is too round will make your breasts look unnatural. In fact, there is higher likelihood of bottoming out (i.e., an empty upper pole, nipple sitting too high on the breast), double bubble deformity, implant malposition, implant visibility, breast sagging, and breast tissue wasting. So going big is good, but going beyond limits will get you in big trouble…pun intended. A board-certified surgeon will always determine a suitable range for the implant volume after conducting some breast measurements. Measurements such as breast base width, the amount of breast skin stretch, nipple to breast fold distance under maximal stretch, skin quality, chest wall asymmetries, etc. will be looked into. For example, if your breast base is very wide, we will require a higher implant volume to avoid the “rock in a sock” appearance. 2) The profile of the implant – How much the implant protrudes or sticks out in the forward direction influences how much stretch is put on the overlying breast skin, and excessively stretching the skin results in negative consequences. 3) The shape of the implant – majority of surgeons prefer round and smooth implants, but if your breasts do not have a natural shape to begin with as we see in patients who have tuberous breasts, then you may require the use of anatomic implants (tear-drop shaped implants) whose lower half is more loaded in volume than the upper half corresponding with the desired natural look. 4) Incision placement – incision location not only determines the degree of trauma to breast’s soft tissues, exposure of the implant to breast’s endogenous bacteria, pocket visibility and control, but also the implant’s position vertically and horizontally relative to the chest wall. For example, compared to the tranaxillary (armpit) or the areola (around the nipple) incision, the inframammary (IMF) incision better allows your surgeon to lower the inframammary fold to increase its distance from the nipple. In many 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, and in order to prevent the appearance of excessive upper pole fullness. I need you to realize that an overly full upper pole will make it obvious that you got implants to enhance your breasts. 5) Pocket – Now to answer your original question, the decision to go behind the muscle or above the muscle has to do with the amount of soft tissue coverage – “padding” under the skin. Choosing a pocket that is tight with sufficient soft tissue coverage not only prevents implant visibility, palpability, and risks of excessive stretching on the breast, but also excessive implant movement into the outer or inner sides of the breasts. A hand-in-glove fit for the implant allows for a natural and long-lasting result. Your surgeon will do a pinch test in the upper pole of the breast to see how much “padding” you have. If you have less than 2 cm, then you do not have much padding and it would be best to go under the muscle. Generally speaking, if your ribs are visible under the muscle, then you do not have much “padding.” If however, you have more than 2 cm, then you have the option to go over the muscle or under the muscle. So which pocket allows a more natural look? There is a difference in opinion, but if we are trying to meet those ideals I described in the beginning, then under the muscle (partially submuscular) is the best option because the muscle helps to maintain a slope for the upper pole while allowing for a curvature in the lower pole, while over the muscle will just make your breasts appear round and augmented. Once again, these decisions need to be tailored to your breast characteristics. If you are hoping to fully preserve the functionality of the pectoralis major muscle due to athletics or body building, or if you have a shapeless, constricted, tuberous, sagging breasts, and do not have a proper cleavage, then over the muscle may be a better option. Over the muscle (subglandular) implant placement may cause tissue wasting, interference with mammography, hold higher risk for capsular contracture and synmastia (disappearance of the cleavage gap). An excellent alternative to subglandular approach is the Dual Plane approach. Please see a board-certified plastic surgeon and share your concerns with them and look at their work (i.e., before & after photos for Breast augmentation with natural results). If you are not satisfied, and you find your surgeon rushing you, or if you don't trust their decisions, then keep looking.  Hope this helps!

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 414 reviews

Many Options/Variations Available

Dear kalia07dee,

It is important you have a heart to heart with your operating plastic surgeon to be sure he or she knows exactly what kind of look you are looking for. Yes, there are variations that can be employed in a breast augmentation. The options are: incision site, muscle position, saline, silicone or the new Ideal Implant, volume of implant, profile of implant, position of the implant on the torso, teardrop shaped implant. Most often the desired position of the implant should be centered under the nipple areola. That is to say the nipple and areola should be on the equator of the breast globe so to speak. If, however, you want more fullness in the lower pole of the breast, the implant can be dropped a bit lower on the torso to achieve that look.

I hope this has been helpful.

Robert D. Wilcox, MD

Robert D. Wilcox, MD
Dallas Plastic Surgeon
4.1 out of 5 stars 13 reviews

Your own desires for a specific size

will determine what kind of result you get when considering your anatomy and native breast tissue.  Your goals should be clearly stated to your surgeon and my patients have a very active role during their recovery in determining what kind of result they achieve.  Implant style should be chosen by your surgeon after you have decided on what volume you want... and I always use the widest implants that the chest will tolerate.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Can you have breast augmentation without upper fullness?

Yes! You can achieve the shape you are wanting without a lot of upper fullness. While any breast augmentation with increase upper fullness some, selecting shaped implants and/or the right profile implant can minimize upper fullness while still increasing breast size. An experienced board certified plastic surgeon should be able to show photos of their work on women who present physically similar to you. Being vocal and letting your surgeon know what you are looking for, both in description and possibly with photos of what you like and dislike will help them deliver what you are looking for.

Robert N. Young, MD, FACS
San Antonio Plastic Surgeon
4.6 out of 5 stars 65 reviews

Natural look versus the Augmented look during breast augmentation

Hi Kalia,

Thanks for your question. This concern of your is easily corrected with shaped implants. These typically give great natural shape appearance. I recommend getting a consultation with a board certified plastic surgeon that performs this type of operation with these types of implants. Good Luck!

All the best,
Carlos Mata MD, MBA, FACS
@breastlift @breastaugmentation @docmata #drcarlosmata
Board Certified Plastic Surgeon

Breast augmentation: It's possible to achieve your goals

In general, breast augmentation just takes your breasts and makes them fuller. Their shape remains the same. Looking at your plastic surgeon's pictures, especially women with a similar shape to yours, should give you more clarity on what that means and what you might expect. For more information on this and similar topics, recommend a plastic surgery Q&A book like "The Scoop On Breasts: A Plastic Surgeon Busts the Myths." Good luck to you.

Ted Eisenberg, DO, FACOS
Philadelphia Plastic Surgeon
5.0 out of 5 stars 59 reviews

About the Types of Breast Implants and their Placement

Each implant have their benefits. #SalineImplants is made with a #silicone outer shell that is filled with saline water during the surgery. It is filled with sterile saline (salt-water). Since saline is like normal body fluid, it is safe and easily absorbed if the implants were to leakThe #implant shell is ordered in a specified size which can be filled to a minimum or maximum fill amount. This allows the plastic surgeon some flexibility with sizing during surgery. Often times a woman has breasts which vary slightly in size. If one breast is slightly smaller than the other, each implant can be filled to a different amount to create better symmetry. Saline tends to be a little less natural feeling than silicone, but it can also create a more dramatic upper breast appearance, which some women prefer. A new saline breast implants option called Ideal Implant™ was recently FDA approved and was created for women who are not comfortable having silicone implants in their body, but desire a more natural feeling implant than traditional saline implants on the market. The unique structure of the Ideal Implant allows for a similar look and feel as silicone with the safety of saline.
#SiliconeImplants are made with a silicone outer shell and are filled with a gummy-bear consistency silicone on the inside. More women tend to choose silicone breast implants due to the natural feel and appearance. Silicone implants are now made of a cohesive gel which are anti-leak even when cut. Look and feel like natural breasts due to the cohesive silicone gel material. New generation silicone gel implants are far superior than those used in the past and have a proven track record of safety. Silicone implants have gone through more testing than any other medical device and are the preferred choice for over the muscle implant placement.
To further ensure the safety, the FDA recommends women have periodic MRI testing to ensure their silicone implants are free from any defects. With both implant types there are choices

#Subpectoral or #submuscular implants refer to placement under the muscle which still remains the most common placement in the United States. #Submammary or #subglandular implants are the placement under the breast tissue in front of the muscle. This tends to more common in Europe and South America. General guidelines suggest that women with larger drooping (ptosis) breasts that do not want a breast lift often have the implant placed above the muscle, although another option, #DualPlane, has become more popular. In the Dual Plane method, the implant is placed under the pectoralis muscle but the breast tissue is also release, in part, from the muscle. Those patients with minimal breast tissue should usually have the implant placed beneath the pectoralis muscle for more soft tissue padding.
Your Plastic Surgeon will measure you to determine the best shape, size and placement of the #implants to be used. Lastly, another important element to a satisfying result of your #augmentation is realistic #expectations.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

Natural Fullness without Too Much Upper Pole Fullness

Hi KaliaDee.

What you describe, lower pole fullness and less upper pole fullness without roundness, with a more natural slope is achievable with an anatomically-shaped implant, appropriately sized to your breast dimensions and tissue characteristics.  In my opinion, the saline anatomically-shaped (or "tear drop") implants have a strange triangular shape, and I do not like them.  Much development and design has gone into the new silicone gel anatomically-shaped implants.

In my area, my patients want the opposite, and they are generally looking for more significant upper pole fullness and roundness.  So the tear drop implants are not part of my practice.

Since sizing/implant selection and the surgical technique is different with he anatomically-shaped implants, and there are some unique complications associated with these implants, I would recommend going to a surgeon who has a lot of experience using them.  

Best of luck to you!

Giovanna Ghafoori, MD
Harlingen Plastic Surgeon
4.6 out of 5 stars 20 reviews

Natural look


Thank you for your question. The shape, projection, firmness and placement of your implants can all be expected to affect the eventual "look". If you wish to have very little upper pole fullness, I would suggest sharing that and photo examples if you wish, with your chosen Plastic Surgeon. They will examine and measure you, then make recommendations for implant sizes and shapes. My patients find it helpful to try on the implant sizers with a form-fitting T-Shirt in the office in order to get a feel for how they will look.

All the best

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.