Natural Breast Augmentation
Sydney plastic surgeon Dr Kourosh Tavakoli explains the key
elements to a natural looking breast augmentation.
The number of breast enlargement procedures is increasing, and
the demand for natural-looking breasts is paramount. A
well-augmented breast has a natural fullness, with gentle
sloping of f the chest wall. There should be natural cleavage
without webbing between the breasts and only a certain amount of
perkiness.
There are three main telltale signs of unnatural breast
augmentation:
Implant margin It should be soft and imperceptible, as
obvious implant edge visibility, especially in the midline, will
resemble the 'Tori Spelling' look.
Implant size An implant that is too large for a small
frame is a dead giveaway . The best example of this would be
'Pamela Anderson' breasts.
Perkiness An augmented breast that is too perky will tend
to look fake, as a small amount of droop is natural. When the
patient lies on their back the implants should roll to the side
like natural breast tissue and not sit up like mountains. Before
having surgery, it is beneficial for the patient to review
photographic examples of the breasts they would like, and to
convey their wants to the surgeon so there is a clear, visual
understanding of the desired result.
There are five main clinical parameters on initial
consultation:
1. Patient's body build and height
2. Breast size, shape and symmetry
3. Nipple position in r elation to the breast
4. Chest wall shape and dimension
5. Patient's desire for cup size and shape.
After establishing the crucial parameters in the clinical
examination, the process of tailor-making the 'right' breast
augmentation begins. There are five considerations when
customising a breast augmentation to gain a natural-looking
result:
Incision placement
There are three choices about where to make the skin incisions
for breast enlargement. They can be in the breast fold
(inframammary), around the nipple (periareolar) or underneath
the arm (transaxillary). These incisions can all produce
scarring. Although patients voice some initial concerns about
the location of their scars, they are ultimately far more
concerned with the final shape and size of their breasts.
Implant shape
The choice of implant shape varies from round to teardrop. The
round implant comes in both low- and high-profile varieties.
About 50 per cent of patients in my practice end up with round
implants. Since I prefer placing the implant in a sub-muscular
pocket in most patients, implant edge visibility in the upper
pole of the breast is not a major issue. The round implant tends
to be ideal for those patients with nice shape who desire a
straightforward enlargement. Use of the teardrop (anatomical)
shape depends on the patient's desire as well as her body shape.
The shape variation is in the width and projection of the
implant for any given size. The spectrum of implants available
to the plastic surgeon can therefore provide great versatility
in achieving a more natural look. In general, there are two
groups of women who benefit from teardrop shaped implants.
Firstly, the teardrop variety is ideal for women who have droopy
breasts. Mild elevation of the nipple in relation to the breast
mound can be achieved without the need for extra scars on the
breast. Secondly, some patients specifically want less fullness
in the upper quadrant. Teardrop implants offer less fullness in
these particular situations. Bear in mind that this request
tends to be very personal as most women are seeking breast
augmentations in order to obtain upper pole fullness.
Implant fill
I use both the cohesive silicone-gel and saline-filled implants.
The new generation silicone-gel implant is very safe and in
general it feels and looks more like a natural breast. Most
breast augmentation operations in Australia are performed with
siliconegel implants.
Implant size
I ask patients to try different implant sample sizes at the time
of consultation. The samples are put on top of the breast and
the patient wears a larger bra to hold it in place. The patient
is encouraged to bring their partner or close family members for
the sizing procedure. Although it is impossible to have every
implant sample available for the consultation, I try to keep a
large selection of samples of varying sizes and shapes, so
patients can try as many implant sizes as required prior to
making their final decision.
Implant position
The next consideration is where to put the implant. It can be
placed either on top of or behind the muscle. In general I
prefer to put implants behind the muscle so they are partially
covered. The muscle allows a nice, smooth takeoff from the chest
wall. If put directly on top of the muscle the breasts can look
like rounded balls on the chest, which is another definite
giveaway. In women with droopy (ptotic) breasts, I use a dual
pocket technique of dissecting both on top and underneath the
pectoral muscle, but inserting the implant behind the muscle.
There are many different combinations of the above
considerations. To attain a natural-looking augmentation, the
surgeon must be skilled in deciding the best options for each
individual patient as well as carrying out the surgery.