Achieving a natural look in breast augmentation


The goal for the majority of women interested in breast augmentation is to have a natural and proportional look - big enough to feel more confident and comfotable but not too large to be obvious, excessively round or fake looking. It may just be about restoring lost volume and improving shape after life events (pregnancy, weight loss) or enlarging breasts that are naturally small volume to boost self-confidence confidence. There are many considerations in achieving a natural look that will be covered during your consultation. Here are a few:

Implant size

A well chosen implant is one that fits comfortably within your natural breast footplate - i.e. is 1cm or so smaller than the breast base width. The implant embellishes the natural anatomy rather than distorts it. Moderate projecting implants (how far they stick out) are more likely to achieve a natural result than higher projecting ones. These two parameters (width and projection) give an indication of an appropriate size (implant volume).

250cc Moderate profile round implants placed in a dual plane

250cc Moderate profile round implants placed in a dual plane

Implant shape

Implants can either be round or anatomical (tear drop). In truth, few patients or even surgeons can tell the difference between breasts . The exception is that anatomical implants may be more favourable in thin patients where a sub glandular pocket has been selected (i.e. above the muscle). However, a moderately projecting round implant can deliver a very natural look and additionally avoids the risk of implant rotation, which can be an issue with anatomical implants.

270cc Anatomical implants placed in a subfascial plane

270cc Anatomical implants placed in a subfascial plane

Implant pocket

The implant pocket is the space created for the implant. Broadly speaking, it can either be above the chest wall muscle (sub glandular or subfascial) or partly covered by the chest wall muscle (dual plane). There are many advantages and disadvantages of both pocket choices. In patients with minimal natural breast tissue, a dual plane pocket is favourable as the muscle will partly cover and therefore conceal the implant. However, placing the implant on top of the muscle may allow it to move more naturally with the breast and is an option in patients with a reasonable volume of natural breast tissue. 

250cc Round implants placed in a dual plane. 

250cc Round implants placed in a dual plane. 



The process of 'drop and fluff' - how implants settle following breast augmentation

breast augmentation implants

The breasts undergo significant changes during the first few months after breast implant surgery commonly referred to as a period of ‘settling’. Early on, the breasts often look and feel unnatural – the implants sit high on the chest, especially when placed partly under the muscle (submuscular or dual plane), and feel hard. Although it can be disconcerting, this is normal. 

As the swelling resolves and the tissues loosen, the implants ‘drop’ into a lower position on the chest filling out the lower pole of the breast. This has two effects on breast appearance, which breasts begin to look and feel more natural with a full lower pole (‘fluff’) and smooth take off from the upper chest. Secondly, the nipples begin to project forwards or even upwards as more volume fills out the lower pole of the breast. 

The length of time it takes for the implants to settle varies from patient to patient from a matter of a few weeks to several months and is often different in each breast. The process tends to take longer with larger implants, patients with minimal loose skin and implants placed beneath the pectoral muscle (submusclular or dual plane). During this early period, I often see my patients regularly to ensure everything is progressing normally and to reassure them.

Preparing for a Breast Augmentation Consultation

It is important to get the most out of your breast augmentation consultation by preparing beforehand. It is a chance to meet with your plastic surgeon and decide whether he or she is the right person to help you achieve your goals and someone you can trust and be confident in.

breast augmentation

The consultation typically lasts 45 minutes if done properly. Here are a few things to think about:

•    Learn about the procedure - implant insertion/placement techniques and breast implant types. This information will help you get the most out of your consultation and help you make informed choices. It is always best if the patient is involved in the decision making process!  
•    Check the credentials of your surgeon . In the UK, it is best to see a fully accredited Plastic Surgeon who is a member of either BAAPS (British Association of Aesthetic Surgeons) or BAPRAS (British Assoication of Plastic Reconstructive and Aesthetic Surgeons). Be aware that some ‘cosmetic’ surgeons may offer this procedure but are not trained in Plastic Surgery! 

What to bring to the consultation
•    A list of questions
•    Goal photos – this is important to guide expectations - as what one patient thinks of as a ‘natural’ look may in fact be overinflated and fake-looking to another! My special interest is in delivering natural, proportional and beautiful breasts but some surgeons specialise in very large implants!
•    A spouse, family member or friend for support – someone to help remember what has been said (there is often a lot of detail to digest) and to help advise.

What to expect during the consultation
•    Questions about any medical illnesses and medication you take.
•    An examination of the breasts with a chaperone breast (always) – the measurements help determine what the best range of implant shapes/ sizes are for your particular frame and goals.
•    A trial of implant sizers – trying on different sized implants in your ‘goal bra’ (provided by the surgeon). This helps refine decisions about implant selection. It is helpful to bring eg a top to get a feel for how the chosen implant size looks in your natural clothing. 
•    A detailed discussion about the best surgical plan in your situation including risks and complications.
•    A chance to review the surgeon’s portfolio of before and after photos. Ask about patients with a similar frame/ stature to yourself.

Finally, if you are keen to proceed, ask to meet up again before surgery to go through the details of the procedure and sizing again.