There was a time when you could spot a breast augmentation from across a room because the majority of implants were very large and conspicuously coconut shaped. But these days, more and more women are requesting breast enhancement that mimics natural breasts, and are concerned not just about size, but about shape and proportion too. “The natural look has definitely been on the rise,” says Leif Rogers, MD, a board certified plastic surgeon in Beverly Hills. Fortunately, there are breast augmentation procedures and types of implants that can give you natural-looking results.
There are two ways to place a breast implant: Over the pectoral muscle or under it. “Placing an implant under the muscle provides a more natural, gradual slope at the top,” says Palm Beach-based board certified plastic surgeon Michael Frederick, MD. This technique is most often used when the patient has a thin body type and is very small chested, with little natural breast tissue to work with. “If a patient has some breast tissue, the implant will look more natural because the natural breast tissue will camouflage the edges of the implant,” says Melissa Doft, MD, a board certified plastic surgeon in New York City. So, if a patient doesn’t have much natural tissue, placing the implant under the muscle can be beneficial, as the muscle will help soften the look of the implant.
The downside to placing the implant under the muscle is the possibility of “something called animation deformity, which means the implant moves as you activate your pectoral muscles,” says Jacob Unger, MD, a board certified plastic surgeon at Maxwell Aesthetics in Nashville, TN. So if you are a dancer, swimmer, Crossfitter, or regularly engage in upper body exercise—above-the muscle-placement may be a better option for you.
Fat grafting can also help get the most natural results. It involves sucking fat out of another area of your body (like your belly or thighs) via liposuction and having the fat inserted into your breasts to add volume. This can be done in conjunction with breast augmentation surgery to help the implant sit more naturally and correct any imperfections. “In my practice, fat grafting is done on the majority of breast augmentation cases,” says Dr. Rogers. In some instances, it’s even done instead of an implant. “The benefit of using fat only is that the breasts look and feel completely natural and there is no risk of needing future surgery; future surgery is almost a guarantee with breast implants since they don’t last forever,” adds Dr. Rogers.
It might be tempting to go as large as possible – if you’re bothering to go under the knife, you might as well get the most bang for your buck, right? – but big implants can often look fake. Implant sizes come in a range of diameters, which is the width of the implant, projections, which is how far the implant projects from the chest wall, and volumes, which is the fullness and measured in cubic centimeters (cc’s). To get the most natural-looking breast implants, a surgeon will assess a patient’s height, build, skin quality, skin stretch, amount of natural breast tissue, and other qualities, and then suggest an implant shape with a diameter, projection, and volume that’s most appropriate for their body.
Choosing the right implant is highly individual, but Dr. Unger says he prefers low to moderate projection for the majority of patients, and the typical school of thought for the diameter is for the implant size to be 2 cm narrower (1cm on each side) than the breast base. When it comes to volume, “For a natural look, I always advise patients to choose the smallest sized implants that will achieve their goals,” says Dr. Doft. This often means not going up more than two cup sizes (a cup is equal to 150 to 200 cc’s).
Anatomical Shaped Implants
These implants, also referred to as gummy bear implants, are filled with silicone gel that’s thicker and firmer than the kind used inside traditional silicone implants or saline implants. And because they’re tear-dropped in shape, they are believed to look more like natural breasts. But experts say this isn’t necessarily always the case. “There was a study in which one shaped implant and one round implant were put into the patient. A photo was taken, and then the implants were replaced with the actual implants being used. A board of plastic surgeons – I was one of them – were asked to look at the pictures and determine which side was the shaped implant and which side was the round implant. None of us were reliably correct! So not even a plastic surgeon can tell the difference between a round implant and a shaped one,” says Dr. Doft.
This implant type is not commonly used right now because “they can rotate within the pocket, deforming the shape of the breast,” says Dr. Unger. To prevent this from happening, these silicone breast implants are usually textured, and textured implants are linked to a higher risk of anaplastic large cell lymphoma (ALCL), according to research that appeared in the journal Plastic and Reconstructive Surgery. “I have not used textured implants in my patients. I think we are still learning about ALCL, and it’s not worth the risk,” says Dr. Doft.
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