Many women seeking breast implant surgery or breast enlargement will search  the internet looking at pictures. They will often make judgements about surgeons based on examples of pictures on websites.  It is very important to understand that every case is different, and the results in one case cannot necessarily be compared with  the result in another case. There are a number of factors that affect the outcome but  there is also  a degree of unpredictability that must be accepted.

Apart from the type and size of the breast implant, the main factors that determine the shape and the quality of the breast enlargement are the initial size and shape of the breasts, as well as the shape and proportions of the woman’s chest. The woman’s body fat  and overall physique will also affect the outcome. The other factor is the firmness and elasticity of the skin and this varies greatly  amongst women.

Breast Augmentation

Here are some of the broad groups into which most women fall when presenting for breast augmentation;

1. Small firm breasts but not very thin.

Many women fall into this category. These women tend to be relatively straight forward to augment .Their skin and tissues are flexible and accommodate the implant very well giving a natural shape and soft natural feel. Because there is sufficient tissue cover , minor imperfections are difficult to see or feel. As long as the woman doesn’t develop capsular contractures , the results in this situation tend to be excellent and it is usually very difficult to tell if she has had implants.

This woman already has a reasonable amount of breast tissue and skin and gets a very natural result from implants. (280 cc subglandular)

3. Very small breast in a very thin woman

Many patients seeking breast augmentation are very thin (very low body fat) and have very small breasts, ‘A’ cup or less. These patients are often in their early twenties and have not had children. Breast augmentation can have very significant benefits for these women, however it is important not to be too ambitious in terms of the implant size (aiming for a size greater than B cup). Smaller implants deliver more natural results in most cases. It is usually necessary to place the implants in sub muscular pockets.
Sometimes, the results in this group of women can look a little unnatural , over firm and lacking the mobility of a normal breast. Their skin and tissues tend to be very tight and do not accommodate the sudden volume expansion so well. Because the skin cover in the lower half is so thin, minor ripples /kinks in the implant can be easily felt. Occasionally there is a tendency for the implant (particularly a big one ) to over expand the lower half of the breast which can lead to an unnatural shape with a high nipple. It is for these reasons that placing an over large implant is not recommended in many of these women.
It is possible , over a series of breast augmentation to create larger breasts in this group. Although the proportions are often wrong for their slim builds.

This woman is very thin but has a sufficient breast tissue to allow a natural result, with submuscular implants (250 cc)
This woman has very little body fat and has virtually no breast tissue . She opted for an augmentation that was perhaps a little large for her frame and situation. The implants look a little ‘stuck on’. Also, every ripple or irregularity in the implant will be visible because she has only a very thin layer of skin covering the lower half of the implants.( Submuscular 300 cc implants) . The appearance should improve with time. However is she develops even mild capsular contracture, it will be very obvious.

3. Droopy/empty breasts

Most women with this problem, have had children and may have breast-fed. Their breasts have been larger during and shortly after pregnancy, but later the breasts lose their volume and firmness , sometimes leaving excess skin.
If there is minor volume loss, then replacing the loss with an implant will yield the excellent and natural natural results. However if there is a significant excess of skin , the implant may drop to the lower end of the skin envelope , (like a ball in a sock), which is a very unnatural appearance and will leave most patients very unhappy with their result.


In these cases a breast lift operation, which tightens the skin is necessary to achieve a good result. Breast lifting will create additional scars, which can be an issue for some patients.Sometimes, in moderate cases of droopy breasts, it can be a very difficult call, deciding whether to lift the breasts and use implants, or try and address the issue with implants alone.  It is also difficult to know whether to do these operations together or in two separate procedures. Patients prefer to have both done at the same time, but this can be more risky than doing the operations separately.

Another option for moderately droopy breasts may be to consider firmer shaped implants (tear shaped / gummy bear). These implants can occasionally rotate leading to a very unnatural result. A newer solution to this problem are conical implants which do not rotate.

These decisions can only be made, in careful consultation with an experienced aesthetic surgeon. Sometimes an unplanned second operation is required in these women because implants alone have produced a worse result than expected.

In this case of breast ptosis(droopy breasts), augmentation alone has delivered a very good result Subglandular 380 cc implants
This woman has very droopy breasts but is also quite thin . Because of her thin elastic skin, augmentation alone is not as successful in this case as the implant tends to drop down into the lower half of her breast envelope. The only way to achieve an excellent result here is to do a breast lift at the same time or later.(300 cc submuscular implants)
This picture shows augmentation mastopexy scars which can be very obvious for a long time.

4. Breast asymmetry

Most women have a small degree of breast asymmetry, (one breast bigger than the other). Sometimes there can be a big difference in size between the breasts. Often, in this situation different sized implants are required to compensate for the size discrepancy.
A more unusual scenario can occur when the breasts are not only a different size but also a very different shape. This is a more complicated situation and may require a number of breast augmentation procedures. Often one or both the breasts can be mis-shapen and droopy (tubular breasts).
Sometimes the smaller breast may have to be enlarged gradually with a tissue expander (type of saline filled balloon), before insertion of the final implant. Frequently the larger breast requires a breast lift in order to achieve a good shape match. These breast augmentation cases require a good deal of planning and consultation with your plastic surgeon.

This woman has very asymmetrical breasts with severe droop of the larger breast,She required an expander type implant on the right side and and implant with a breast lift on the left side.