Are Those Things Real? Breast Implant Sizing 101

You have a size for almost everything. A shoe size, a pant size, and yes—a breast size. While you can probably sneak your way into something a little off-size if you really want to (like those purple suede boots that you just can’t live without), things will always look a little wrong if the fit doesn’t match. Same with ill-fitting breast augmentation; a little too far in one direction, and you won’t get the natural look you want. From sizing, to materials, to things you should ask your doctor, this is the guide to natural-looking breast augmentation.

Choosing The Right Size

The biggest mistake people make with breast augmentation is being off-size, which usually means going too big. The second mistake is failing to tailor the implant, meaning not getting the implant pocket to sit just right. If either of these things happen, you get what you would expect: an obvious “boob job” effect. Anyone can put an implant in the breast, but it takes an experienced surgeon with a true understanding of the augmentation procedure to know how to hit a home run.

Yes, It’s Your Body—But Trust Your Doctor

The first potential misstep is having the patient choose their own implant size, rather than be guided by a professional. Just like most women are wearing the wrong size bra, most women would choose the wrong size implant. Take-home implant kits are wonderful for practicing with your new size, but it should not be a free-for-all. If you take a random implant off the shelf, the chance that it’s the right one for you is very slim. Your breast augmentation consultation should be a fitting, where the surgeon assesses your breast width, tissue quality, elasticity, and amount of breast tissue, to figure out what size and shape would work best. By the end of your consultation, you should understand why you have a specific size, and what that size is. Depending on your height and frame, this may be very different than you originally thought.

Bigger Isn’t Always Better

Many surgeons worry that they’re choosing an implant that’s too small. They don’t want to spend the first postoperative visit with their patient staring in the mirror saying, “I should have gone bigger.” The problem with an oversized implant is that it needs somewhere to go. It will either spill into middle, creating a uni-boob effect, or pour into the armpit area. This is what happens when the width of the implant is too big for the breast. In cases where the width is right but the patient demands more volume than she can handle, the only other option is to make the implant more projecting, or taller. This is how you get the torpedo effect, which is definitely not the natural look. Your size is your size, and the right surgeon will know how to determine that within a small range of options.

The Ideal Implant Pocket

The second potential pitfall is failing to create the right implant pocket, the space that the implant will sit in. Breast implants are designed to sit on their flat surface and spread out just the right way. Bunching or crimping will prevent a smooth shape, which can happen if the pocket is too small. On the other hand, a big pocket will allow the implant to float around, which usually means drifting up to the collarbones, and riding too high for its own good.

The perfect implant pocket is the tailoring part of the process, and this is largely surgeon dependent. Some surgeons believe that the only way to get a natural look is to place the implant below the muscle. This provides “upper pole” coverage to the implant and a draped look to the breast. For women who have a very small amount of their own breast tissue, this can be helpful in creating a more natural slope, but in most cases it exposes the patient to the risk of double bubble deformity. The double bubble occurs when the breast hangs lower but the implant stays up under the muscle and there is a step-off in between. This can be a particular problem for very active patients who do a lot of upper body exercise. A long-term breast augmentation result involves understanding how the patient’s tissues will change over time. In most instances, allowing the implant and the breast to migrate together is the best bet, and this means keeping them in the same space as a unit.

The Material—Silicone vs. Saline

When it comes to materials, the two main categories of implants are silicone and saline. Silicone implants have gone through many generations of upgrades, and at this point we have a few different kinds to work with. The first option is the regular standard gel, which is very mushy and moveable, and feels just like breast tissue. The other option is the cohesive gel, which is more like a gummy bear. These implants are still soft and compressible, but they don’t really flow like gel. They can look good, but they are firmer than gel, so they feel a bit different. Because cohesive gel implants hold their shape, they can be made into “anatomic” implants, meaning that they have a teardrop shape rather than being a round disk. The shaped implants can give you a nice look, but they can also flip over time, and they don’t shift like natural tissue. The end result is that they look quite natural when you are standing up still, but they won’t fit the bill during movement or by feel.

In A Perfect World, Both The Look & Feel Will Be Natural

So that brings us to our final point: look vs. feel. What looks natural and what feels natural are two different things. Ideally, you want a little of both. The best bet for a natural feel is standard silicone gel. The best bet for a natural look is also standard silicone gel. For patients with a good amount of their own breast tissue, they can sometimes pull off the natural look with a saline implant, but these are more prone to rippling, which is a total giveaway.

Beware Contracture: Discuss Complication Rates With Your Doctor

The final word of caution for a telltale augmentation is contracture. Some breast implants start out perfect and then take a turn for the worst. Any implant in the body will form a capsule, or a scar that walls it off. This is not a problem in and of itself, but some capsules can tighten and eventually deform, leading to huge changes in shape, placement, and overall drape. This explains how a perfectly good augmentation can turn into one implant dragging down and the other high enough to rest your chin on it. While plastic surgeons today still have not completely conquered the capsular contracture issue, we have gotten better at limiting this awful complication. Any thorough discussion about breast augmentation should include a talk about contracture—this is the time to ask your surgeon about her complication rates and what she does to prevent it.

Trending Natural

In the last 20 years, breast implant surgery has seen a shift in trends. It used to be all about bigger is better, and patients wanted to look like they had surgery. Plastic surgery was a coveted luxury item, and the more ostentatious the better. Today, most patients appreciate feeling fuller, more balanced, but essentially just a more blossomed version of themselves. The natural look is all the rage, as well it should be. I have always believed that cosmetic surgery should be like makeup: it should go largely unnoticed. But this involves experience, patience, and a true aesthetic eye. It’s not that mystifying, but it’s more complicated than it seems. A good gel in the right place and of the right size will almost always give you a fabulous result, and will definitely keep them guessing.

Originally published June 20, 2015

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