Breast augmentation with minimal natural breast tissue?

In any patient, it is important that the desired outcome of surgery be frankly discussed in the context of the patient's starting anatomy and examination. This becomes more important the less natural breast tissue is available, as more of the resultant breast mound will be due to the implant.

As long as your friend's goals and the dimensions of her chest wall and breast diameter are not at odds (in other words, as long as she doesn't want breasts that are larger than what would look natural for her given her current body type), and as long as she is able to find an experienced surgeon sensitive to these issues, she should be able to look forward to a very nice outcome despite her lack of natural breast tissue.

In my practice, I like to point out to patients such as your friend that her anatomy and the existing soft tissues will often dictate the implant that will give the best result.

It is very common in my practice to perform a breast enhancement that changes the breast profile from an A cup to a B cup. I rarely have patients in my practice requesting large implants anymore.

Most women are opting for smaller, more realistic appearing breast augmentation. Professional women (including physicians!) want to look their best, but they don't want to look done.

Women with very small breasts and very little breast tissue can acheive a natural looking result provided a plastic surgeon with expertise in performing natural looking breast augmentation chooses  uses an implant of the appropriate size in the ideal postion.

Thanks for your question -

A natural appearance for breast augmentation is something that most women strive for and it is correct to be concerned with minimal breast tissue that the implant may be more obvious.

Dr. Salemy has characterized some of the techniques your fiance may employ -

Of these the most important is likely size.  Choosing too large an implant will typically appear unnatural and in my practice we strive to balance the patient's desires and expectation with a shape that will complement - not look unusual.

Most breast augmentations are placed under the muscle and this can help hide the implant.

Being able to feel the implant or see rippling (especially when the breasts are hanging) is a common problem with saline implants that may be improved by using silicone implants.  There is a tradeoff here though - typically silicone implant scars are wider since the implants are full as opposed to saline implants which start out empty and are filled once in position.

Scar size and position can be a critical consideration if she decides to stay on the small side as an inframmary scar may not be hidden by the size of the breast.

I hope this helps.

To Jon P,

It is possible , with the anatomy that you describe, to get a nice result and have your fiancee feel more feminine.

I recommend using relatively small, round, smooth walled high profile implants placed under the muscle.  Saline implants are fine in this setting, and can be put in through a very small incision.  Silicone implants are also fine, but with a slightly longer scar.  I would aim for a large A cup.

We use temporary implant sizers DURING SURGERY  to determine the best implant size.  We try different volumes in the sizers  with the patient (under anesthesia, of course) sitting up on the operating table.  Then the sizers are discarded at the end of the operation.

Thin tight skin with little breast tissue is a situation in which it is more difficult to look natural, if you mean that the implant is not detectable.  However, patients such as this can be some of the happiest patients, because modest improvement is so significant for them.

My brief advice would be to consider relatively small volume implants, placed subpectoral.  The implants should be as wide as her natural breast area, which usually equates to a low or moderate profile style.  I would encourage her not to try to achieve a full C-cup or larger postop size.  Small B-cup may be natural appearing for her and minimize stretching her thin tissue.

Without seeing and talking with a patient, it is difficult to answer these questions well.  I wish her the best.

My recommendation to obtain a natural result would be to have a moderate profile silicone gel implant placed under the muscle.  The implant's width should match hers behind the breast and by staying away from the higher profile implants, the upper pole won't have that tell-tale unnatural buldgy look.

When a patient comes in saying they want breast augmentation but want to look matural, I oftne tell them they look natural already, but they just don't like it. What they usually mean is that they don't want to look obviously unnatural. The general philosophy and approach to naturalness (or minimal unnaturalness) is to try and hide the implant as much as possible behind the nautral breast tissue, and to keep the proportion of implant to natural breast  tissue as low as possible.The key, of course, is to do all this and still produce the enlargement that makes the operation worth it to the patient.

If you think about putting in a golfball size implant in the breast, the breast will look and feel pretty much like a natural breast, but it would produce much enlargement. If you put a softball size implant in the breast, the breast will be noticeably enlarged but will act and feel more like the implant.

Most patients with even  the smallest amount of breast tissue can accept some implant that will satisfy the above approach. However, it might mean choosing a very small implant that gives only a modest amount of augmentation. For example, if your fiance has only abouot 100-150cc of breast tissue with a diameter of 10 cm., she might only be able to be matched with a 150cc. implant. If she wants something larger, she will have to accept becoming more and more unnatural with more and more of the characteristics of the implant chosen. Since there are more complications and side effects with relatively larger implants, silicone implants under the muscle becomes more and more reasonable. Carefully discuss all factors with her surgeon.

Jon,

Implants in patients with little breast tissue can look very nice. My suggestion would be silicone implants placed in a submuscular pocket. This will provide muscular coverage to most of the implant. With little overlying tissue, the silicone implant will look and feel more natural. The best plan would be to talk to a plastic surgeon and have your fiance try putting a few different size implants into her bra - one without padding. She does not necessarily need very large implants, only ones that fit her body shape. All that matters is that she finds one that she is happy with.

I hope this is helpful.

David Shafer, MD

The most natural results are when moderate size implants are placed.  In very thin patients, it is probably best to place them in a submuscular pocket to give more soft tissue coverage, but you can obtain very natural results.  The larger the implant, the more likely to see less than natural results.