Can you always tell if someone’s breasts are fake?

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’s not 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 just meant to try on in the office, I swear that my supply of sample “try-on” breast implants has definitely dwindled down over the past few years.

Don’t even try to decipher the ones you see in magazines. Even the implants are photo-shopped----here's a lovely video about that from one of my old posts that I highly recommend :)

Of course, there are the obvious ones, like 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 their “mommy makeover”--want to look “natural,”  “in proportion to their body,” and often have it done so “nobody can tell.”

In my experience, the most important variables involved in achieving a natural-appearing breast augmentation with an implant are:

1) The size of your breasts to begin with.

Especially the width. As a breast implant size increases, so does the base diameter. Your goal may be a D cup, but if your chest wall is too narrow, the implants will not only stick out on the sides and disrupt your natural anatomy, but this is a set-up for unnatural shape, rippling and implant malposition down the road. When I help a patient choose a breast implant, I recommend keeping the base diameter of the implant at about one centimeter narrower than the base of her breast.

2) Your skin envelope.

Is there room in there for the size implant that you want, or is it going to be so tight that the implant will never drop? Chances are, if you’ve had children and breast fed there will be plenty of room, but not always. Also, skin in darker and Asian women is usually thicker and has more elasticity, so it doesn’t stretch as much for a big implant.

3) How much breast tissue do you have now?

Can you pinch at least two centimeters of thickness? If so, if you go with a size-appropriate implant, you probably have enough tissue to camouflage the upper border so there won’t be that obvious ledge. Having your implants placed “under the muscle” or sub-pectoral also helps avoid this problem.

4) What is the distance from your nipple to your inframammary crease (the fold underneath your breast)?

This usually depends on whether you have tuberous breasts or not. If the distance is closer to ten than five centimeters, you are more likely to get a natural, tear-drop shape result with a breast implant, as opposed to a round one. So--again, keeping it G-rated—with all of the above information, can you tell which of the women below has had breast implants?

The answer is, of course, ALL OF THEM (I mean, come on, this is L.A.)

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, you were just a late bloomer and somehow you were going to show up at school in September with a C cup. And if it didn’t happen, well…the only option was to learn to live with it and develop your personality. Even in Northern California where I went to college, I remember hearing about one girl on campus who was rumored to have had breast implants and it just seemed so unfathomable to me. I mean, how could her parents let her do that, and where would you go to even do such a thing?

Well, I soon found out. And what I also found out was that unless you’re talking about a twenty-one year old girl with perfect natural C-cup breasts, breast implants actually usually look do better than the real thing.

I remember when my plastic surgery chairman at UCSD took his daughter to a Britney Spears concert (yes, this was a long time ago, before she'd even been married the first time or had any kids). They had really bad seats, and although they’d had to watch the show through binoculars,  he did get a good close-up look at Britney in her risqué costume, and he said that she had breast implants. This was when she was a teenager, long before such an accusation was even hinted at in the media, so I asked him how he could know such a thing without seeing her naked and he said, “Because they look too good.”

So since then 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.”

X0,

LQ