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Background:  The overwhelming priority question for most women who seek breast augmentation is what implant size should they choose. While the interpretation of breast size is highly subjective the end goal ultimately falls into descriptive categories, a natural or an augmented look. Women will generally fall into these two camps of breast augmentation results and the implant size to get there will vary accordingly.

A natural breast augmentation result is one that fulfills two basic criteria that relate to upper pole fullness and breast base width. In a normal non-augmented breast there is less fullness in the upper pole and more in the lower pole. This ratio is usually about 1/3 volume upper pole to two-thirds volume lower pole. In addition the natural breast base width is not dilated or expanded by that of the implant. Choosing an implant size whose diameter stays inside of the breast base width and does not make the upper pole as full as the lower pole would general the considered natural

An obvious augmented breast look is one that often does the opposite from a natural look. It usually creates as much fullness in the upper pole as the lower one, hence the rounded breast look. The base diameter of the implant strives to create as much cleavage as possible (medial implant movement) and may go beyond the natural lateral border of the breast.

While the augmented breast look typically is a larger implant size, that is not always true. The effect of an implant is highly dependent on numerous anatomic factors including the amount of overlying breast tissue and skin, the size of the chest wall, sternal width and the overall body shape that they will reside within.

Case Study: This female presented for breast augmentation with small but well shaped breasts with good nipple postition. She had a larger chest size and was not a petite woman. Preoperative sizers were used to select implants in the 400cc range. Her concerns was that she did not want to be ‘too big’.

Under general anesthesia and through a transaxillary approach, moderate plus profile 400cc smooth silicone implants were placed in the partial submuscular position using a final device.

Her six week postoperative result showed a natural breast augmentation result which had good symmetry. When asked what she thought about size she stated she could have gone bigger but would not have been able to accept a 500cc implant preoperatively as she would have thought that would have been too big.


1) Natural breast augmentation can be defined as choosing an implant size that stays within the breast base diameter and does not create too much upper pole fullness.

2) Preoperative sizing using volumetric sizers helps patient avoid too much volume if their goals is a natural breast augmentation result.

3) Larger silicone breast implants today can be put in through an armpit incision using a funnel device.

Dr. Barry Eppley

Indianapolis, Indiana

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