For a natural breast augmentation, what implant type, size and position? Also treatment for puffy nipples? (photos)

I'm wanting a natural enlargement (a B to C/D). I am confused with what implants would work best for me size shape and position? Round v anatomical? Over, under or dual plane I'm also concerned with my "puffy nipples" and was wondering if there is anything that can be done surgical wise to imprive them that won't impact breast feeding. If nothing is done will a breast augmentation make my nipples worse? Are they what you would call a nipple herniation? Images of both soft and hard.

Doctor Answers 7

"Puffy Nipples" and "Natural Breast Augmentation"

Hi Catie

Thanks for your question.  Generally, for any volume, a teardrop shaped (anatomical) implant will produce a more natural result than a round one.  In a moderate plus profile and in a sub muscular position, round implants can also produce natural results.  When you choose a surgeon, they should measure your breasts and select a range of implants which match your breast footprint whilst offering you the type of result you seek.  If there is enough of your own breast tissue, a teardrop implant in a pre-pectoral (Subglandular) position can produce very pleasing and natural results provided the implant size is relatively conservative as you appear to be seeking.  It is usually around 100-150cc per cup size.  You look like you are already a large A to small B so there is not much volume required to get you to the size you seek.  This means there are a lot of options including sub muscular round (Moderate plus or moderate profile) or teardrop shaped implants in any position.  Dual plane and sub muscular are essentially the same thing though there are different types of dual plane depending on the degree of sag in the breast.  You would have a dual plane 1/submuscular augmentation in my practice unless you preferred a sub glandular augmentation and had sufficient coverage.

I think it would be wise to avoid surgery to the nipples if you are keen on breast feeding at some stage.  No surgery to the nipples can guarantee not affecting the lactiferous ducts within the nipple.

I hope that helps.  You should make sure you are assessed by a Specialist Plastic Surgeon (Australian Equivalent of Board certified) for an opinion.

Kind regards and good luck.

Dr Mark Hanikeri MBBS, FRACS

Perth Specialist Plastic Surgeon

Perth Plastic Surgeon
4.9 out of 5 stars 69 reviews

Implant selection

The most natural augmentation results rely on respecting the dimensions and proportions of the chest wall.  I would not focus on trying to figure out the exact "cc's" but rather discuss your goals with your plastic surgeon.  Guide photos are helpful, and will give your surgeon the information needed to select the correct implant.

David A. Lickstein, MD
Palm Beach Gardens Plastic Surgeon
5.0 out of 5 stars 6 reviews

For a natural breast augmentation, what implant type, size and position? Also treatment for puffy nipples?

Dear catie12

In my experience, moderate plus round silicone mentor implants tend to give a great balance between size shape and softness. In your case, a submuscular implant would work well. sizing should be done in person based on breast size and body shape. I would not be surprised if a 300 to 350 cc implant would give you the result you describe. I would leave your areola alone. let it stretch out after the implants and then at 6 months, if it was too large, can have a periareolar areola reduction if needed.

Afshin Parhiscar, MD
Bay Area Plastic Surgeon
4.8 out of 5 stars 57 reviews

Breast Augmentation - Size Selection

Thank you for your question. "Tissue based planning" relies on your chest and breast measurements and is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic breast surgery. Hope this helps and good luck with your surgery.

Steven J. Rottman, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 81 reviews

Natural Breast Augmentation

From your photos, you are a good candidate for the procedure, but there is no way to tell you more about the specifics you would need. You should meet with a board certified surgeon in your area to better determine your goals. The areola can be reduced in size if you desire and this can help to limit the herniation of tissue at the sam time. 

You should see a board certified plastic surgeon in your area to get a formal opinion through an in-person consultation.

Best of luck,

Vincent Marin, MD

San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 47 reviews

Breast augmentation

Thank you for your question and photographs.

I would recommend that you schedule a consultation with a board certified plastic surgeon so they can perform a physical examination and take measurements to recommend the best implant type/sizes for your body. There are 3D simulators that can show you what you would look like with different types of implants and different sizes, this can be helpful when trying to decide what size would achieve your cosmetic goals. At my office, I use high profile Sientra implants under the muscle to create a round full result that looks natural, giving you the result that you want. In regards to your nipples, I wouldn’t suggest undergoing a nipple/areola reduction I do not believe you need it and it isn’t worth the risk of compromising your ability to breast feed in the future. Additionally, i use Crisalix which is a virtual reality device that will allow you to view different sizes of implants and pick which best suits your desires.  As the only board certified plastic surgeon in Pittsburgh offering this virtual reality imaging system, we have a 100% satisfaction rate.  Crisalix is truly a unique experience for our patients as they can view themselves using virtual reality goggles and can instantly visualize their own breasts changing in size and shape with all of the various brands, sizes and shapes of breast implants.  Thus, our patients leave the consultation feeling confident with the size of the implant they chose. 
Best of luck in your endeavors!

James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

James Fernau, MD, FACS
Pittsburgh Plastic Surgeon
4.9 out of 5 stars 77 reviews

For a natural breast augmentation, what implant type, size and position?

Thank you for the question. Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery.  In my practice, I would likely recommend a sub muscular (dual plane) positioned silicone gel breast  augmentation. Based on your photographs,  unless you told me you have significant concerns about areola "puffiness", I would recommend that you avoid areola reduction surgery (especially given your understandable concerns about potential breast-feeding),  typically done to reduce areola size and "puffiness".

Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.


Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural” or "C or D cup" etc means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.

I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 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.