What's The Best Way For Me To Get Natural Looking Breasts With An Augmentation?

I am 36 years old 5'3, 56kg. cup size full B. I am looking at getting 350cc subglandular silicone implants. Do you think this will give me a full D cup? also, will overs make them look "fake" or could i get natural looking breasts? I have a fair amount of tissue Thanks

Doctor Answers 13

Natural look after a breast augmentation

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what looks fake depends on the person evaluating them and that is quite variable. I think that as long as there is no capsular contracture, you will have a fairly natural looking breast with what you are planning. In time they wil sag  like unaugmented breasts too, but there is no way to predict a cup size because the makers of the bras make them all different shapes and it also depends on how wide your ribcage is and what the angles of the ribs are.

Breast implant sizing and naturalness

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Nearly all the issues for breast augmentation are in this question. Like fitting your foot to a shoe or your body in a dress, the implant must fit properly in relation to your breast to look "natural". The surgeon's job is to determine the correct dimensions of the implant to fit your breast, get it positioned properly at surgery, fill it properly (if it's saline-filled), and then get it healed there. The rest is experience of what gets the best results both short term and long term. For overall consistency this has been round, smooth-surface, saline-filled or gel-filled implants under the pectoralis muscle for the part of the implant the muscle covers behind the breast. 

In my opinion and experience, there should be no difference in looks between saline-filled and gel-filled breast implants in most cases like yours. The difference is in feel on the side and underneath the breast where the muscle does not cover. In most normal breast width-to-chest ratios, the low profile implant that is fitted to the width will make the breast look about a cup size bigger, the medium profile will make it look 1 1/2 cups larger, and the high profile will look 2 cup sizes larger (they are not called this in gels). By definition a D cup size is out of proportion and can be argued that it doesn't look "natural". Of course big can be "natural" too. The trick to natural is that the breast doesn't look like it has an implant behind it. Thus it must be sized and positioned and healed correctly regardless of the forward volume from the projection or the endpoint in size.


Scott L. Replogle, MD
Boulder Plastic Surgeon

How to get natural looking breasts with augmentation

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If you have thick enough tissue, AT LEAST 2 cm. of pinch thickness in the upper pole of your breast, then you might get by with a gel implant over the muscle, but ideally you should have more thickness than that to be sure of not seeing a more prominent upper edge of the implant.  Going under the muscle will camouflage the implant better, but there will be some movement of the implant with pectoralis muscle contractions, though probably only seen with actively contracting the muscle when your clothes are off.  There are pros and cons of going over vs. under the muscle which your surgeon should discuss with you.  And if you want a natural result, a 350cc implant may be ok depending on your tissue tightness, but it may or may not give you a full D cup.  If you want natural, I would suggest not focusing on a cup size...choose an implant size based on trying on sizers in a bra and choose the size that gives you the total volume of breast mound that you desire...and then give the surgeon permission to decrease the size if at the time of surgery the placement of a sterile sizer indicates that your tissues will not tolerate this size in a natural contour.

Best Augmentation For Naturally Appearing Breasts

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I feel that the best chance for you and any woman to achieve  naturally appearing breasts with an augmentation is to have smooth silicone implants placed under your muscle. The other factor which is extremely important if you want to avoid the "fake look" is to select an implant which is not larger in diameter than your breast.  I cannot be certain, but I think 350cc implants will likely not give you a full D cup.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Natural looking

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The best way to achieve a natural looking result in breast augmentation is to decide what shape you feel is acceptably natural. Your surgeon can then use your measurements and desired shape to decide which implants would fit. I recommend deciding about shape first and size second as any implant will make you larger and the right implant choice will make the shape. Most likely a dual plane sub muscular augmentation would result in natural results. Remember there is no way to guarantee a post op breast cup size.

Breast implant sizing

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 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" 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.

Natural Look after Breast Augmentation. Implant size

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Bra sizes are confusing. More often than not, a woman is not wearing a correctly fitted bra, doesn't know her bra size, or doesn't know how a bra is fitted.

Cup size is dependent on the "number" part of the bra size... a D cup in a 34 bra is a different size from a 42 bra.

That being said, bra manufacturers are not held to any uniform standards when it comes to cup size and shape... that is why one brand of bra might fit you very well for a given size, but not another brand. Or, you wear a 34D in a Victoria's Secret bra, and a 34C in another brand, for example.

When discussing breast size after augmentation, outward projection can be further determined by the "profile" of the implant. High school geometry: Height (projection) times Width (base width). A Higher Profile implant will give you a larger cup size for less volume than a Moderate Profile implant.

Furthermore, a saline implant looks bigger than a silicone implant of the same volume. That is because a saline implant is more oval (round on both top and base), while a silicone implant is flat on the base.

Some plastic surgery books have proposed the following parameters for breast augmentation:

  • 32 bra: 100-200 ml per cup size
  • 34 bra: 150-250 ml per cup size
  • 36 bra: 200-300 ml per cup size
  • 38 bra: 250-350 ml per cup size 

Natural looking breasts following breast augmentation

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I tell my patients that, once everything has settled following surgery, your breasts should look exactly like they did pre-operatively, only fuller.  That is what an implant is supposed to do - add volume to your breasts.  If you are happy with the shape of your breasts and just want them a little bit fuller then a breast augmentation is a good operation for you. 

Best way to achieve natural looking breast augmentation

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Breast augmentation should blend in with a woman's anatomy to look natural.  Disproportionate implants often look obvious when the implant is somehow visible in the contours of a woman's breast.  This occurs more often with implants that are too large, too round and are above the muscle.  The measurement process of choosing an implant is vital in finding the size that blends best with a woman's body.

Elizabeth S. Harris, MD
San Antonio Plastic Surgeon

Natural Appearing Breast Augmentation

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I think that there are 3 keys to a natural looking breast augmentation:

    * Type of implant
    * Size selection
    * Technique of surgeon

Regarding type of breast implant, most plastic surgeons would agree that silicone gel implants feel and look more natural than saline. An exception to this is a woman with a substantial amount of her own breast tissue with a good shape.

The size that you select should be proportional to your body (height, weight, shoulder width etc). I have found that a sizing session in which you try different size implants in a bra with and without snug fitting clothes and look in a mirror is very helpful.

As for a surgeon's technique, it is critical to create a pocket or space for the implant in the correct position with the proper dimensions. The best way to see if your plastic surgeon is doing this is to look at several before and after pictures. If most of the "Afters" have a bubble-like appearance along the outer boarder of the breast beware. Sometimes it is unavoidable but in most instances you shouldn't see what looks like an implant.

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.