Most of my patients (but not all) say they want a natural-appearing result from their breast augmentation. Although people may have different ideas about what a “natural” result is, words often used to describe it are “believable” and “proportionate”. In other words, they want their breasts to look “real” and like they could be the product of fortunate genetics instead of surgery.

A primary consideration is of course size, but there is really a lot more to it if you think about the characteristics of an un-augmented breast. In fact, truly proportionate breasts, that match the owner’s frame in an aesthetically ideal way, are probably not especially common anyway. The size issue is so subjective that it really can’t be relied upon much except perhaps to say that, if one is the object of a “fake or real?” judgment, it would be hard to tell. That being said, a general guideline is that a moderate profile implant that matches the base diameter of the breast is usually a good starting point for choosing an implant size.

So let’s move beyond the size question and consider how a breast feels and how it behaves. This sort of information is impossible to get from the galleries of “before and after” photos, which show breasts only on an upright torso, unmoving, as though they are static sculptural objects. But bodies, and the breasts to which they are attached, are not statues. As the body changes position, and moves with activity, the breasts go along for the ride. They naturally flatten and “round out” a little in the lying down position, and they move with their own rhythm (at least a little bit) when the body is in motion. But one thing they shouldn’t do is change shape when the pectoral muscle is used; that definitely isn’t natural, but altogether too common with submuscular implants.

A comprehensive approach to breast augmentation, with a natural result in mind, needs to consider all these various factors. To indulge another generalization, round implants feel and behave more like real breasts, and silicone gel implants feel more natural than saline. These differences will be more important in thinner women and those with less breast tissue. These are also the same women who benefit from having the implant under the muscle, for better coverage and a more natural slope of the upper breast. However, because the standard “dual-plane” technique for submuscular augmentation requires cutting a portion of the muscle where it attaches to the ribs, it can result in the “dynamic breast” deformity, which is a distortion of the breast when the pectoral muscle is flexed. A solution to this is the split muscle technique, which avoids cutting the muscle while still using the upper part of it to cover the implant. This has become my standard method and I have used it on several hundred patients.

Is there a perfect solution for every woman who wants “natural” breasts? Probably not. The “gummy bear” implants are appealing, but they are firmer than natural breasts and shaped (as opposed to round) so they will not be the solution for many. Sometimes advanced techniques need to be used for better coverage and concealment of the implant, regardless of which type it is. Round implants that are too large will create an obvious contour where the upper chest meets the upper breast. There are trade-offs with every option. It is all too easy to oversimplify the decision, by focusing too much on one or two things, but just as easy to make it too complicated. In the end, you should listen to your body and do what feels right (literally, and figuratively).