Breast aesthetics can vary widely among women, as individual preferences are influenced by factors such as personal taste, body proportions, lifestyle, and cultural perceptions of beauty. I consult thousands of women each year who desire breast enhancement with either breast implants or via fat transfer, and here are some common aesthetic goals that we will continue to see in the New Year and beyond, as women continue to place a priority on natural-looking plastic surgery outcomes.

Natural-Looking Results

Many women seek breast augmentation to achieve a natural-looking enhancement that complements their overall body proportions. They may desire fuller breasts while maintaining a balanced and harmonious appearance.

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A natural breast is shaped somewhat like a “teardrop” with less upper pole fill and more volume in the lower pole. While teardrop or anatomic-shaped implants were created to mimic a teardrop shape, their popularity has waned due to the concern about their textured surfaces. Textured implants have come under scrutiny in recent years due to an association with a rare condition called ALCL. As a result, most plastic surgeons only offer smooth implants. Selecting a smooth, round implant with a lower profile gives the result of less upper pole fill, and the effects of gravity under the pec muscles will cause it to rest in a teardrop position, creating a natural aesthetic.

Read Three Things Your Plastic Surgeon May Not Tell You About Breast Augmentation

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Women who desire to avoid breast implants frequently opt for a natural breast augmentation using their fat. Fat transfer uses liposuction to harvest fat that is processed, purified, and then injected back into the breast for volume enhancement. My fat grafting techniques allow me to sculpt the breast tissue, fanning fat to contour both the upper and lower poles while creating side boob and cleavage. The results are both natural and permanent. Women love it because it adds about a cup size (on average) in breast volume. Even thinner women can see positive changes with a harvesting technique called skimming where I'll go in and take fat from multiple body areas to give a cup size increase.

More Cleavage and Overall Fullness with An Implant

Some women desire increased cleavage and fullness in the top part of their breasts. This may involve selecting implants that provide more volume in the upper pole, creating a rounded and lifted appearance.

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If upper pole fill and more pronounced cleavage are desired, using a full or extra-full profile implant typically provides a beautiful result and in turn a happy patient. 

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The other factor is the cohesiveness or viscosity of the implant. Natrelle by Allergan refers to this as the "gumminess" of the gummy bear implants.

Implants come in 3 different cohesive gels:

  • Responsive
  • Soft Touch
  • Cohesive

The Responsive implants have the least cohesivity and thus have less upper pole fill as the thinner gel tends to settle lower in the implant. Cohesive implants are firmer to the touch and have a thicker gel that holds its shape in the upper pole. Soft Touch implants are in the middle. If maximum upper pole fill is desired, then the Soft Touch or Cohesive implants would be the best choice in combination with full or extra-full profile.

Research Breast Augmentation
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Breasts That Fit Your Body Frame

The desire for natural breast augmentation comes with achieving a proportional balance between the breasts and the rest of the body. Your board-certified plastic surgeon should work with you to choose the implant size and shape that aligns with your physique and preferences. The patient's breast anatomy should be measured to choose implants that are in line with their breast dimensions. The most utilized measurement is called the Base Diameter measurement which captures the distance across the base of the breast. Implants fit best with a corresponding base diameter measurement and the profile can determine more or less volume. Staying in proportion creates a symmetric and harmonious breast and limits complications associated with going too big or small.

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A very popular tool for implant sizing is 3D breast implant imaging. I used a web-based application called Crisalix. This amazing computer-simulating program allows patients to view their results in 3D with any implant shape, size, and profile. Patients can choose implants that most closely match their goals which takes all the guesswork out of choosing the perfect implant and eliminates anxiety that some women can have by leaving the choice up to their surgeon.

Read Dr. Burns' blog Picking The Perfect Pair of Implants From Home

Natural Feel & Movement

Beyond appearance, women may prioritize achieving breasts that feel and move naturally. Implant choices, such as silicone gel implants, are designed to mimic the natural feel of breast tissue.

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The implant pocket should be designed to fit the implant like a glove while keeping the implant centered under the breast tissue. If the implant pocket is too big it causes the implant to slide around the chest and create an unnatural look and feel. If the pocket is too small it can be forced downward by gravity, causing the breast crease to lower and lead to an increase in nipple-to-breast fold distance known as "bottoming out."

It's important to note that opinions on the natural look and feel of breast implants can vary, and individual experiences may differ. However, some people perceive differences between saline and silicone breast implants in terms of natural look and feel. Here are two reasons why saline implants may be considered by some to be less natural than silicone implants:

  • Saline implants are filled with sterile saltwater, giving them a different texture and consistency compared to natural breast tissue. Some individuals feel that saline implants can be firmer and less natural to the touch, especially when compared to the softer and more gel-like consistency of silicone implants.
  • Saline implants are more prone to visible rippling and wrinkling, especially in individuals with thin breast tissue or those with little natural breast volume. This can cause the implant edges to be more noticeable under the skin, even showing visible rippling of the implant itself.

Subtle Enhancement

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Some women may prefer a more subtle breast enhancement, aiming for a result that enhances their natural breast shape without drawing excessive attention to their chest. This might involve choosing a modest implant size or opting for a fat transfer procedure. Natural results are generally achieved by using a moderate, low plus, or low profile implant placed either under the muscle or in a subfascial pocket. This allows a more modest volume enhancement with a less artificial upper pole fill and a more natural teardrop shape.

Modest breast surgery generally involves creating a one-to-two-cup-size increase. Fat transfers breast augmentation is a popular for women desiring a more subtle enhancement as fat generally gives about a cup size increase and only enhances the natural breast tissue.

Breast Asymmetry Correction

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Women with breast asymmetry may seek breast augmentation to correct imbalances and achieve a more symmetrical appearance. Customized surgical approaches can address these individual concerns. Asymmetries generally involve differences in breast size or volume, the skin envelope, and nipple position. Often different-sized implants can be placed to compensate for volume differences in the breasts.

If skin or nipple position is an issue, then a breast lift may be necessary on one or both sides. While achieving perfect symmetry is not always possible, getting the best symmetry possible is always important to achieve the optimal aesthetic outcome.

Take The Age Off Your Chest And Breasts

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Breast augmentation can also be part of an overall desire for creating more youthful breast-scape rejuvenation. This may involve addressing sagging or deflated breasts, restoring depleted volume that comes with childbirth and weight changes, and achieving a more youthful breast contour.

Pregnancy and weight loss leave the breasts looking both deflated and droopy. This is often referred to as involutional changes in the breast. Adding back volume helps to rejuvenate the breast, both lifting and filling out excess skin. If the degree of drooping or ptosis is significant, Grade II or III ptosis, then a breast lift might be necessary to rejuvenate the breasts by lifting and shaping.

Read about more about what Dallas moms are going for with abdominal rejuvenation in The Dallas Tummy Tuck

Scars You Won't See

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While scarring is an inherent part of plastic surgery, many women aim for minimal and inconspicuous scars. Plastic surgeons use various techniques, such as placing incisions in less visible locations, to minimize scarring. Most breast augmentation is done using a small incision, 3.0cm, placed in the breast crease. This incision is perhaps the least visible and also gives the surgeon the best control over dissecting the implant pockets. Other options include the areola, periareolar, or endoscopic transaxillary (armpit) incision. These techniques can also be used effectively to hide scars but limit the ability to truly customize an augmentation result.

Volume Restoration After Babies and Weightloss

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Women with breast asymmetry may seek breast augmentation to correct imbalances and achieve a more symmetrical appearance. Customized surgical approaches can address these individual concerns. Asymmetries generally involve differences in breast size or volume, the skin envelope, and nipple position. Often different-sized implants can be placed to compensate for volume differences in the breasts.

If skin or nipple position is an issue, then a breast lift may be necessary on one or both sides. While achieving perfect symmetry is not always possible, getting the best symmetry possible is always important to achieve the optimal aesthetic outcome.

It's crucial for women considering breast augmentation to have open and honest discussions with their plastic surgeon. Clear communication about aesthetic goals, lifestyle considerations, and any concerns will help the surgeon create a personalized treatment plan that aligns with the patient's expectations and desires. Additionally, a board-certified plastic surgeon can provide valuable guidance and recommendations based on their expertise and experience.


If you're ready to talk more about procedure would work best for you, click the link below to  ask our team a question or to schedule your consult with Dr. John Burns.