by Dr Kourosh Tavakoli

The number of breast enlargement procedures is on the increase, with a trend toward natural-looking breast implants. A well-augmented breast has a natural fullness, with gentle sloping off 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:

1. Breast implant margin This should be soft and imperceptible, as obvious implant edge visibility, especially in the midline, will resemble the 'Tori Spelling' look.

2. Breast implant size An implant that is too large for a small frame is usually an obvious giveaway that a patient has had a breast augmentation. The best example of this would be 'Pamela Anderson' breasts.

3. 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 breast implants should roll to the side like natural breast tissue and not sit up like rigid peaks.

Before undergoing 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 six main clinical parameters for breast implants on initial consultation:

1. Patient's body build and height
2. Natural breast size, shape and symmetry
3. Nipple position in relation to the breast
4. The quality of breast skin
5. Chest wall shape and dimension,
   
6. Patient's desire for cup size and shape.
   

Six key considerations

I believe there are six key considerations for a surgeon when customising a breast augmentation to gain a naturallooking result. I discuss three of these key considerations below and the final three in the next issue.

1. 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 may voice some initial concerns about the location of their scars, they are ultimately far more with the final shape and size of their breasts.

Generally, a great majority of patients in my practice opt for the inframammary incision (breast fold). I also find this incision has the least amount of interference with breast feeding and nipple sensation, and it generally heals very well.

2. Breast implant shape

The choice of implant shape varies from round to teardrop. The round implant comes in both low- and high-profile varieties. The majority of patients in my practice elect to have round-shaped implants. Since I prefer placing the implant in a submuscular pocket in most patients, implant edge visibility in the upper pole of the breast can be avoided. The round implant tends to be ideal for those patients with good-shaped natural breasts 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 breast implants available to the 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 breast implants. It can be the ideal choice for women who have droopy or tuberous breasts. Mild elevation of the nipple in relation to the breast mound can be achieved without the need for extra scars on the breast (unlike a breast lift). In these cases, the implants will be inserted in a subglandular (subfascial) pocket (under the breast tissue).

Secondly, some patients specifically want less fullness in the upper quadrant. Teardrop breast implants certainly offer less fullness in these particular situations. It should be noted, however, that this request tends to be very personal, as most women are seeking breast augmentations in order to obtain upper pole fullness.

Teardrop implants do have a slight tendency to rotate. Unfortunately, this problem can only be corrected by secondary surgery.

3. Breast implant fill

I use both the cohesive silicone-gel and saline-filled breast implants. The new generation silicone-gel breast implant is very safe and generally feels and looks more like a natural breast. Most breast augmentation operations in Australia are performed with silicone-gel implants. In December 2006, the Food and drug Administration (FDA) approved the use of gel implants in the US market. The decision was based on a great amount of scientific research into siliconegel implants.

To be continued....

About the Author

Dr Kourosh Tavakoli - Sydney Cosmetic Plastic Surgeon, MBBS, BSc (med), MS (unsw), FRACS (plast.) Dr Kourosh Tavakoli is a fully qualified Australian trained Plastic Surgeon specialising in Breast Implants. http://www.drtavakoli.com.au

Natural Breast Enlargement Secrets