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At its best breast augmentation surgery enhances the appearance of the breast without sacrificing how the breast looks, feels, and moves.  Any woman considering breast enhancement surgery should know that a natural result comes from choices made by her surgeon in the operating room.  It is a very good idea to discuss these choices with your surgeon as you plan your operation in order to avoid having breasts that look “done.”

The first choice is to respect the natural base of the breast.  You can see the base of the breast when you compress it against the chest wall.   You will be able to see a clear limit to the breast tissue.  Occasionally it is necessary for the surgeon to change the base of the breast, but for the vast majority of patients it should be respected.

A second choice is to position the implant under the pectoral muscle.  This has three very desirable consequences.  The upper pole of the breast will have a natural slope, rather than a sharp transition at the upper edge of the implant.  Also, it is easier to get good quality mammograms with the implant under the muscle.  There is good evidence that the breast is softer with the implant in this location.  There is the occasional patient where I will place the implants above the muscle for very specific technical reasons, but submuscular is best for most patients.

Many patients do not know that implants come in a variety of profiles.   Not all 300 cc implants are created equal.  A high profile implant has a relatively small base for its given volume, so it will push the breast forward to a much greater degree than a low profile implant, which has a wider base.  The intermediate profile implants are somewhere in between these two extremes.  If you are considering saline implants, there is a range of volumes to which a saline implant can be filled, and this will affect the appearance of the breast.  These issues are important to discuss with your surgeon if you desire a natural result.

In general, silicone gel implants have a more natural behavior than saline filled breast implants.  Their feel is much more like that of natural breast tissue and they are less likely to show irregularities on the surface of the breast.

A common misconception is that for a breast to look natural, the surgeon must use a relatively small implant.  In fact, a wide range of possible volumes exist for most patients as long as the natural breast architecture is respected.

One final gentle word of warning.  Beware of the surgeon who says he can correct a droopy breast by placing a large volume implant underneath the breast and above the muscle.  Over time most of these patients become “breast implant cripples” and require complex revisional surgery.  The best choice for this situation is either a breast lift alone or a breast lift combined with an implant.