To obtain a natural and pleasing look after breast augmentation, choosing the proper implant is critical. I cringe when I hear that “the surgeon gave me a bucket of implants and let me choose the size I wanted”. Pamela Anderson is one well-known example of having an implant that is too wide for her tissues. Not only does it not look natural, but can actually overly stretch the tissues and make problems that are difficult to fix. Breast augmentation consultation is a process of understanding the tradeoffs that come with having any implant. I tell patients that I want to educate them so that they can make the decisions that they would make if they had my 23 years of experience in practice.

When implants are selected that are too large for a given patient, not only does it not appear natural, but it can cause real problems with over stretching and thinning of the tissues that can be difficult if not impossible to correct. In New England I find that most of my patients are quite conservative and “don’t want anyone to notice” after surgery. So they might try to initially select an implant that seems comfortable at first, but once they get used to it might seem too small. So typically we will try and select “the largest implant” but one “that still looks natural” and won’t be heavier that the tissues can support over time.

Natural would be without too much or any upper breast fullness (the “Victoria Secret look” and without any visible or unnatural appearing roundness. I review photos of these differences in the office so that patients can understand this better. Our general goal is for the breasts to look natural out of clothing. But this might mean selecting a smaller implant that a woman would want to give a certain look in clothing. Many women are willing or desire to have some slight upper breast fullness and slight roundness to achieve the look that they want in clothing, as long as the look doesn’t scream “implant!!!” It is typical in my practice to be traveling to the operating room with a hockey bag full of a few different sizes. The “wish implant” that we wish to have, and a smaller size that we will drop down to based on the patients predetermined wishes if the larger implant is unnatural in appearance.

A useful method of finding the proper implant size uses 5 critical measurements to help determine the breast size.1

We typically will check the width of the breast base, the distance of the nipple-to-inframammary fold distance under stretch, the thickness of a given

1Five Critical Decisions in Breast Augmentation Using Five Measurements in 5 Minutes:
The High Five Decision Support Process
Plastic & Reconstructive Surgery: December 2005 – Volume 116 – Issue 7 – pp 2005-2016 Tebbetts, John B. M.D. ; Adams, William P., M.D.