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How To Achieve A Natural Looking Breast Augmentation

As a surgeon who’s performed thousands of breast augmentations, lifts, reductions and more over my three decades in cosmetic surgery, I’ve noticed how trends change over time.

In the nineties and noughties, bigger and rounder implants were in-trend. But now, we seem to have moved passed that point. The majority of women who come to my practice for breast surgery today ask for more natural-looking results.

But how is a natural-looking breast augmentation achieved?

In this post, we discuss the many factors that must be considered.

First, what do we mean by “natural-looking” results?

With rare exceptions, my breast augmentation patients arrive with the request that they want to look, “Not too big, not too small, and as natural as possible”.

So we can take this to mean that “natural-looking” results are achieved through balance. The shape, position and size of the implants should be balanced with the rest of the body. 

I’m completely on board with this approach. I like my patients to look lovely and believable. I always recommend implants that can be dressed up or down, as the occasion warrants.

But the task is not as easy as one might think. Every patient is different and unique, and many factors will go into achieving a great natural-looking breast augmentation.

Age, skin quality, breastfeeding, and weight loss, all are common factors.

For example, a 25-year-old who has never breastfed and wants a full “C” cup is a very different type of case to a 40-year-old woman with three children, who also wants a full “C” cup result.

The 40-year-old woman may need a breast lift and augmentation, whereas the 25-year-old may only need an augmentation. 

How To Achieve A Natural-Looking Breast Enhancement

Step 1: Choose A Suitable Implant Type 

When a new patient comes in for a breast augmentation consultation there are many factors to consider, but the first is whether to go with silicone or saline implants.

This is a personal choice, and it will vary depending on each patient as to which type of implant will look more natural and suitable. 

Silicone gel breast implants often tend to look and feel more natural. However, saline breast implants offer some flexibility because I can change the volume of the implant.

I will often adjust the size of saline implants intraoperatively to find the best overall balance of shape versus volume. When you change the volume of saline, you also change its shape.

In some situations, I will use a larger breast implant on one side. If one breast is higher than the other, I may have to drop the fold of the higher breast down so that the upper portion of the implants will be symmetric. This is a balance and trade-off as well.

Implants can be round or teardrop-shaped. I prefer round over teardrop-shaped implants because if a teardrop implant rotates it will look abnormal. If a round implant rotates it will make no difference. Round silicone gel implants take on a teardrop- shape under the muscle. To me, they are the preferred implant for very slender patients with little breast tissue to cover over the implant itself. 

I prefer implants placed beneath the pectoral muscles. Below the muscle provides a more natural result. The muscle drapes over and softens the upper border of the breast. Above the muscle, the implant can look more “stuck on” particularly if the patient has little natural breast tissue over the implant.  

Finding the right size

The next step is choosing the correct size. The width of the implant to me is the most important starting point.  Too wide and a person will look top-heavy, too narrow and the result will look like two torpedoes.  I like to see the width of the implant fill the chest nicely and have an implant whose diameter balances the outer curve of the breast with the curve of the hip. 

Some women have this curve naturally, in others the diameter of the implant will create this balance. During my breast implant sizing sessions, we first find the breast implant diameter that fills the chest appropriately and has enough diameter to balance with the curve of the hips. Once we like the width I can then change the size of the breast by looking at a high, moderate, or low-profile breast implant in that same diameter. 

The “Bigger Disease”

What I call the “bigger disease” is highly contagious and usually occurs about six months after breast enhancement surgery. For most patients, when breast implants are first put in, they look too big, tight, and high before the skin and muscles relax to a more natural-looking size. I prepare my patients extensively for this time, so they don’t panic or think it is uncommon and dangerous. It is neither. Next comes what I call the “honeymoon period”. As about three weeks roll around, the implants start to settle but still have that push-up bra look without the push-up bra. For most, after six months the implants have settled into their most natural position. Some may miss that “push-up bra” look and wish they had gone larger, but even a large implant would go through the same settling process.

The best way to treat the “bigger disease” is through knowledge and prevention, and a clear sense of what you want from your surgery early on. I try to help my patients navigate these challenging waters and I will always give my heartfelt opinion if I think an implant is wrong for you. If the patient is agonizing between two implant sizes I will generally err on the side of slightly fuller because implants tend to look smaller inside the body than they do in the sizing bras we use to show patients their options.

Lastly, I encourage my patients to come in as many times as they like before surgery to try on our sizers. The last thing I want to do is make a last-minute decision on the day of surgery. Photos and examples can be helpful as a reality check to see that we are on the same page, but I find nothing more valuable than having patients try on implant sizers in their own garments in front of a full-length mirror.

Balance is Natural

I think there are a lot of subtleties about breast augmentation that the public is not aware of. The operation is not just about increasing the size or scale of the breasts. It’s also about balancing each breast to maximise symmetry. Breasts, by their very nature, are never exactly the same before or after breast implant surgery. They will be sisters, but not twins, although we strive to make them as even as possible.

While the breasts certainly play an important part, to me, the key is a sense of balance when I look at the person’s bodily makeup – especially the hips. If you look at the breast augmentation photographs on my web page I always try to include the hips so patients can see the overall balance. Breast implant photos that only show a “box of breasts” are just a small part of the story and I don’t think are helpful.

Prospective breast implant patients are first taken to an implant sizing room in my office where we keep implants to try on in all sizes and shapes. Before I even walk into the consultation, the patient has often already chosen and is trying on the smallest breast implant in our sample drawer. I think the conventional wisdom is that “smaller” will always be more natural. I try to instill in my breast implant patients that balance is more natural, whether it means larger or smaller.

Small breast implants tend to be narrow which may be just fine for a very narrow chested breast implant patient. But in the average breast augmentation patient, a breast implant that is too narrow for the breast will tend to look like a torpedo and give a very unnatural look once the patient has healed and the skin has settled. A breast implant that is too wide will make the patient look “top-heavy” and can often feel wrong. 

Breast augmentation patients’ height makes a huge difference as well. Tall people will look very different from shorter people even with the same implant. All these factors play an important role in ensuring the patient chooses the right option.

Breast Augmentation Consultation

Any breast surgery is an important and long-term decision. My goal in a consultation is to make you feel comfortable and provide you with the right information and options to ensure your breast augmentation procedure fits your exact needs. 

Our consultation will go over your desired results, medical history, etc. During this time, breast implant options will be discussed, as well as techniques. Based on your desires, health, and body frame one implant type may be better than another, as well as one technique may be more appropriate than another.

For your consultation, it is good to bring a friend, relative, or significant other to your sizing session along with a work blouse, casual blouse or sweater, and even exercise clothes. It’s good to have a second opinion from a friend or loved one who may be able to provide valuable insight. Making sure that you are comfortable in both work and play clothing is important as well.

Considering Breast Augmentation And Want A More Natural Look?

I have helped many patients get the breast size they have always desired by aligning their goals with my professional advice and analysis of their breasts. Together we can determine the best implant size and type that will meet your needs.

We serve patients in three locations across Maryland, Virginia and Washington D.C. If you have any questions or would like to schedule a consultation, please contact us online.

March 14, 2022 10:03 am
Categories: Blog

Written by Dr. Adam Tattelbaum

Dr. Adam Tattelbaum is a highly skilled and compassionate plastic surgeon with over two decades of experience.

Double-certified by the American Board of Plastic Surgery and the American Board of Surgery, Dr. Tattelbaum believes in providing personalized patient care and customizes his treatment plans to suit the individual.

Dr. Tattelbaum's candid and realistic approach has earned him recognition, not only with his patients but in the Top Doctor lists of the Washingtonian and Bethesda magazines. He is also a member of the American Society for Aesthetic Plastic Surgery, a mark of distinction in the field of cosmetic surgery.

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