4 min read
By Dr. Suzanne A. Trott, Double Board Certified Plastic Surgeon in Beverly Hills
If we're taking bets on a woman who is at least partially clothed, without X-ray vision even a plastic surgeon has to admit, "No." But that doesn't mean there isn't some help going on. There's all kinds of smoke and mirrors out there. The bionic push-up bras aside, I've had patients go down two cup sizes in the exam room once they remove the Victoria's Secret water bags. And even though they're only meant to be tried on in the office, I swear my supply of sample "try-on" breast implants has definitely dwindled over the past few years.
Don't even try to decipher the ones you see in magazines. Even the implants are photoshopped.
Of course, there are the obvious ones — the ninety-five pound woman sporting a DD cup, or the one who looks like she has melons pushing up to her chin. But those are obvious to everyone. So maybe a better question to ask is:
"Why do some breast jobs look fake and others don't?"
Even here in Beverly Hills, most women seeking breast augmentation — whether it's a college graduation present or part of a mommy makeover — want to look "natural," "in proportion to their body," and often want it done so "nobody can tell."
In my experience, the most important variables in achieving a natural-appearing breast augmentation with an implant are:
1) The size of your breasts to begin with — especially the width.
As implant size increases, so does base diameter. Your goal may be a D cup, but if your chest wall is too narrow the implants will stick out on the sides and disrupt your natural anatomy — a set-up for unnatural shape, rippling, and implant malposition down the road. When I help a patient choose an implant, I recommend keeping the base diameter about one centimeter narrower than the base of her breast.
2) Your skin envelope.
Is there room in there for the size implant you want, or will it be so tight that the implant never drops? If you've had children and breastfed, there is usually plenty of room — but not always. Skin in darker and Asian patients is often thicker with more elasticity, so it doesn't stretch as much for a large implant.
3) How much breast tissue do you have now?
Can you pinch at least two centimeters of thickness? If so, with a size-appropriate implant you probably have enough tissue to camouflage the upper border, so there won't be that obvious ledge. Placing implants "under the muscle" — sub-pectoral — also helps avoid this.
4) What is the distance from your nipple to your inframammary crease?
This usually depends on whether you have tuberous breasts or not. If that distance is closer to ten centimeters than five, you are more likely to get a natural, tear-drop shaped result rather than a round one.
You can see how these variables play out in real patients in our before and after gallery.
What I actually tell people
I grew up in New York, where everyone got nose jobs, but I'd never even heard of anyone having a "boob job." You just started every high school summer promising yourself that this was going to be the year. What I eventually learned is that unless you're talking about a twenty-one year old with perfect natural C-cup breasts, breast implants often look better than the real thing.
I remember when my plastic surgery chairman at UCSD took his daughter to a Britney Spears concert — long before any of this was hinted at in the media — and said she'd had breast implants. I asked how he could possibly know without seeing her naked. He said, "Because they look too good."
So ever since, whenever someone asks me, "Do you think those are fake?" my expert plastic surgeon's answer is always:
"If they look too good to be real, then they're probably not."
If you're considering breast augmentation in Beverly Hills or Los Angeles and want a result nobody can identify as surgery, request a consultation and we'll go through your anatomy together.
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