Natural Looking Breast Augmentation
Can breast implants really look and feel natural?
Yes, augmented breasts can and should look natural. With the right implant in the correct position, they can also feel completely natural. Excessively large breast implants never look or feel natural, so the first important factor to consider is implant size. Not only do large implants look odd, they also stretch out breast skin and tend to become very droopy over time. Most patients with excessively large implants end up having multiple operations over time to address problems with implant position ('bottoming out', for example, where implants drop below the desired level of the inframammary fold), implant visibility, and overstretched skin. If the goal is a natural-appearing breast augmentation, then most patients will require an implant volume between 250cc and 450cc. A petite patient looking for a B-cup to C-cup transition may need a 275cc implant for example, while a tall, broad-shouldered patient looking for an A-cup to C-cup transition may require a 425cc implant.
Implants can also look unnatural if they are too small, however. A pair of 225cc implants on a patient with a broad chest will result in augmented breasts that appear too far apart, which is another odd and unnatural appearance. Too small an implant can also be a problem if the goal is to fill out an underdeveloped or 'constricted' lower pole, or to improve a 'tubular breast' appearance - in these situations the lower pole of the augmented breast will be almost all implant, so a larger volume implant is needed compared to a patient with a larger amount of natural breast tissue in the lower pole. It is important for your surgeon to measure the preoperative breast base diameter (the width of the breasts) and the intermammary distance (the space between the breasts), and to take into consideration the breast implant base diameter, in order to choose an implant size and profile that fills the appropriate amount of horizontal space on the chest wall and thus creates an aesthetically ideal, natural appearance.
A common error that leads to an unnatural appearance after breast augmentation, even with implants of an ideal size, is inadequate lower pole dissection and/or inadequate release of the pectoralis major origin just above the inframammary fold. As a result the implants sit too high and appear excessively full in the upper poles (the area above the nipple-areola complex), while the lower poles - which should be the fullest area of the breast - are underfilled. Inadequate muscle release may also result in bizarre-appearing breast implant 'animation' when the pec major muscle contracts. In some cases this may result in one or both of their implants jumping up literally to the level of a patient's collarbones. An alarmingly unnatural look, and one that is totally avoidable.
Most patients want to have the fullest breast profile that still looks natural on their body. The limiting factor for implant size is almost always the appearance of the upper pole. At some implant volume, the upper pole of the breast begins to look excessively rounded or convex, and that is a look that says "breast implants live here". There really is no way to determine preoperatively what the fullest implant volume is for each patient that does not produce that rounded upper pole look. The only way to accurately make this decision is to use breast implant sizers intra-operatively, and to evaluate them with the patient sitting fully upright in the operating room during the surgery. Surgeons who are attentive to detail use an O.R. table which allows them to sit a patient upright several times over the course of the procedure, so that an implant size and profile can be selected that is ideal for each individual patient.
The type of implant is also important, as the implant style that will work best to produce a natural feeling result depends on a patient's body style and preoperative breast size. Silicone gel implants, without question, have a much more natural feel than saline implants in slender patients, especially those with an A-cup or small B-cup preop breast profile. On the other hand, fuller-figured patients with a full B-cup breast size that are seeking a full C- or a D-cup breast enhancement will almost always get a breast augmentation result that feels completely natural if saline implants are used. The more natural tissue there is to conceal a pair of implants, the harder it is to detect saline implants by feel.
Regardless of implant type, there is really only one ideal position for breast implants with respect to the pectoralis major muscle. Subpectoral placement provides additional coverage of the implants in the cleavage area, which results in both a more natural appearance and more natural feel. This is especially true for slender, small-breasted patients, as the pec major helps to flatten the upper pole of the implant and prevents the upper edge of the implant from being visually obvious. That excessively round appearance in the upper pole is to be avoided at all costs.