What do people mean by “natural”?!

In each breast enlargement consultation, I ask every patient whether they are aiming for a “natural” result, or one that looks more augmented. Inevitably the majority ask for a natural look. But what does that really mean? After years of listening to the answers and then digging a little deeper, I can assure you that not everyone sees natural the same way!

To many, the concept of natural means that if they are undressed and their breasts are exposed, they don’t want to look like they have implants in. To a significant number of others, what natural means is that they don’t want to appear as if they are carrying bowling balls under their clothes, or they don’t want an obvious take off from upper chest to breast when in a bra…no matter what their breasts look like without a bra on.

You can therefore understand there is a challenge as a plastic surgeon, ensuring I am on the same wavelength as my patients when discussing implant choice and desired outcome!

I think that the best thing is to study before and after pictures together to see which breast augmentation results they like. This is only done after a careful clinical examination to ensure that the pre-operative breasts we are looking at in the gallery are similar to theirs. Only that way can patients tell me what they like and what they don’t like, which enables me to guide them towards the best implant size and shape for them. However, all my before and after photographs are very standardised clinical views, and none are in a bra or with clothes on. So this too is perhaps somewhat unrepresentative of exactly how the patients in the photographs breasts might look on a day to day basis.

There may also be a subjective disagreement between my patient and me regarding “naturalness”. I have had patients comment on how natural some breasts look in the photographs, whilst I feel they look clearly augmented, and on the other hand, some say that they think certain results look unnatural, which I feel look natural! Unless I understand what an individual desires, I will not be able to give them the result they want.

Breast implant sizing also has an important role to play. From my perspective, the bigger the implant, the less natural the result will be – this is especially true in those with little soft tissue cover (breast volume), as most of the breast volume after surgery will be composed of implant, rather than breast. So the more breast tissue there is before surgery, the more natural the result is likely to be.

The other aspect that has to be taken into account is breast implant profile or projection – this describes how far the implant sticks out of the chest. The higher the profile for a given implant width, the less natural it risks looking. So, a “moderate profile” implant has a higher chance of looking natural than a “high profile” implant; however in order to achieve this the desired volume or size increase may not be achievable.

In other words, the less projected an implant is (the lower the profile), the smaller that implant will be. Therefore a compromise needs to be settled on. For example, the choice may be between a moderate profile implant of 275cc volume or a high profile implant of 350cc. The patient may want to look natural, but they may also want the higher volume. This therefore has to be a choice by the individual as to what they consider the biggest priority – volume or “naturalness”. There is no right or wrong about this – it is very personal. I can guide them, but do not make the final choice – I leave that to my patients. If they ask me, I would usually go for a more natural, lower profile option.

Using the patient’s own fat – known as fat grafting or lipofilling – is perhaps the most natural way of enlarging a breast. As long as there is enough fat to find elsewhere (such as from the tummy, flanks or thighs) the fat can be removed using a liposuction type technique, processed in the operating theatre and carefully injected into the breasts. The great advantage with this is that there is no implant that will need replacing in the future. However, unlike an implant, there is no support provided, so if the breast skin is thin and has a degree of droop to it, whilst the breast will be enlarged, it won’t necessarily be more pert. However, it can be an excellent alternative. That said, fat grafting may require 2 or 3 operations to achieve the desired result, compared with one operation using an implant.

I wrote this piece more as food for thought, rather than for anything else. I hope it has been thought provoking, and useful in considering some of the reasons for making certain choices prior to a breast augmentation.

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