Shape versus Size: Which Matters?
Actually, when considering breast enhancement, both are important. But most women report that they are more concerned with shape than with size. In our practice, a natural look is what women seek; unfortunately too many women who undergo breast enhancement surgery look as though they have had surgery, with either a high round artificial appearance or a disproportionately large breast size, neither of which is desirable if the goal is to be discreet. Ideally, only the patient (and whomever she chooses to tell) and her surgeon should know that she had surgery. This is as true for breast enhancement as it is for any other plastic surgery, be it on the face, breast or body.
Specifically, regarding breast augmentation, achieving a natural slope to the upper pole of the breast rather than an exaggerated round appearance depends on at least three things: the implant shape; the implant size; and the proper placement or positioning of the implant within the breast. Placing the implant underneath the pectoralis muscle is most commonly recommended and this maneuver alone can increase the upper pole fullness which many women desire. But too large an implant or an implant resting too high on the chest can result in an artificial appearance.
Today there are more breast implant options than ever before for women considering breast enhancement surgery. In 2006, the FDA concluded that silicone-gel-filled breast implants were entirely safe even for cosmetic breast augmentation, giving women the choice of saline-filled versus silicone-gel-filled implants. With proper and careful selection, both types of implants can result in a very pretty and natural appearance. Most patients and surgeons alike agree that the silicone-gel-filled implant feels a bit more natural than the saline-filled implant, which has a bit more of a “water bag” feel.
Just this year, the FDA approved the release by the three main breast implant manufacturers of anatomically shaped “Gummy Bear” or “form stable” implants that can be used to give a more natural and less artificially round appearance to the breast (see accompanying photo).
From left to right: Round silicone gel-filled, Round saline-filled, and anatomically shaped “Gummy Bear” silicone breast implants
If the skin envelope is very loose or if the nipple/areola is positioned low on the breast, which might be the case after one or more pregnancies, a breast lift or “mastopexy” may be necessary, either alone or in conjunction with a breast augmentation. An augmentation by itself can never be a substitute for a true breast lift if the breast has too much sag or droop.
Although most women can expect a beautiful result with a round silicone-gel-filled implant, the newer anatomically shaped implants may provide a more natural-appearing enhancement. The optimal implant shape and size for any given patient and whether or not a breast lift might also be required needs to be determined on an individual basis after careful evaluation and discussion with the patient about her own expectations. Such a consultation should always occur with a board-certified plastic surgeon with extensive experience with breast surgery.
For more information please visit www.PlasticSurgeryCarolina.com or schedule your consultation with Dr. Ram Kalus at Plastic Surgery of the Carolinas in Charleston/Mount Pleasant by calling us at 843-881-3881.
