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  • Newer breast enhancement techniques and implant shapes have made it easier to achieve more natural looking results.
  • This doesn’t mean that women are necessarily opting for smaller implants, which may fail to produce noticeable augmentation.

Smaller breast implants offer a number of potential advantages, including a discreet look, a more natural shape and feel, smaller incisions, and fewer short- and long-term complications.

Has the popularity of smaller breast implants increased, as some media reports suggest? We spoke with several plastic surgeons to learn more.

Are smaller breast implants a growing trend?

According to Suzanne A. Trott, MD, a board certified plastic surgeon in Beverly Hills, the Pamela Anderson look that was more common in the nineties has certainly lost some of its appeal.

“Relatively smaller implants have been a trend,” Trott says. “I rarely have a patient come in that wants huge, obvious implants. Women are very specific about it — they don’t want to look fake, they want to look natural.”

“Athletic women are another cohort that is being careful not to overdo it,” says Gregory A. Buford, MD, a board certified plastic surgeon in Englewood, CO. “We spend a great amount of time discussing this during the initial consultation.”

In such cases, women are less likely to request round, protruding implants that will hinder their activities; instead they will seek a more natural look, while still enhancing volume and cleavage.

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More natural, but not necessarily smaller

“Despite many articles suggesting that smaller implants are a trend, in Colorado we are really not seeing this,” Buford says.

Dr. Eric Chang, MD, a board certified plastic surgeon in Shrewsbury, NJ, agrees.

“I think most patients are still interested in average size implants (300-400 cc) because they want a noticeable difference, without going to extremes,” he explains.

According to Trott, even women who want a small look are choosing larger implants than they used to. “During their first consult they may try on implants and pick a smaller size, but most of the time when they come back for their pre-op they choose something a little bit bigger,” she says.

One thing that has made this possible is the advent of new implant shapes, such as the teardrop and the low-profile implant. A larger implant may be less noticeable if it has a natural shape and doesn’t stick out as much.

Another reason small implants may not be as popular: some of them are so small that they may be unnoticeable. According to Buford, this is definitely true of the smallest available implants (100 cc), which is why he advises against them.

“I generally recommend going no lower than 200 cc so that there is enough volume to actually create a meaningful — yet subtle — improvement on the overall breast mound,” Buford says.

If subtlety is the goal, what are the options?

Women interested in achieving a subtle breast enhancement have a few options:

  • Small implants, the smallest being about 100 cc
  • Low-profile implants that don’t project as much
  • Teardrop-shaped implants, which have a more natural appearance
  • Fat transfer breast enhancement procedures
  • A combination of small, low-profile, or teardrop implants with fat transfer

Breast augmentation with small, low-profile, and teardrop implants is similar to other breast augmentation procedures with implants — the implant is inserted into a pocket either under the pectoral muscle or behind the breast tissue, and the incisions are closed with sutures, skin adhesive or surgical tape.

Breast augmentation with fat grafting, sometimes referred to as autologous fat transfer or lipofilling, involves extracting fat from a different area of the body and strategically injecting it into certain areas of the breast. This procedure can be performed in conjunction with breast implants or on its own.

Is fat grafting a good idea?

Fat grafting can be used to disguise an implant and make it more subtle. It works by injecting fat taken from a different area in the body near the visible edges of the implant with a blunt cannula.

According to Chang, the technique can also be used to minimize visible rippling (folds or wrinkling), and can be a good way to add volume to the breast without using an implant.

Trott agrees, explaining that unlike breast implants, fat grafting is ineffective for adding volume in the upper pole (top portion) of the breast. Ironically, this “ineffectiveness” makes it a more natural-looking option: while many women seek fullness in the upper pole, a natural breast is only full in the lower pole.

Fat grafting can also be an option for women who are concerned about the potential complications associated with placing a foreign body (the implant) in their breast. However, Trott says that many of these women end up changing their minds once they see the results.

“Many times women get fat grafting because they want to look small and natural, but then decide that they really need an implant to achieve the look they want,” she says. This can be achieved through a second surgery.

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Not for everyone

Another problem with fat grafting is the fact that not all patients have enough fat for the procedure.

“Fat grafting can be an excellent way to achieve more conservative results but the issue is often the amount of fat that can be obtained for this,” says Buford. “A majority of our patients are very fit — they simply don’t have enough body fat to make it worthwhile.”

According to Chang, those with a family history of cancer should be aware that breast augmentation with fat grafting may interfere with a doctor’s ability to interpret a mammogram. There has also been concern that it may be associated with an increased risk of breast cancer.

The long term effects of fat grafting remain undocumented, as extensive clinical trials and long-term follow-ups have yet to be performed. While encouraging results have been reported in small studies, it may not be suitable for all women. How long the results last also remains to be determined.

However, the American Society of Plastic Surgeons’ (ASPS) Fat Graft Task Force has issued a statement based on a review of the scientific evidence, indicating that “there are no reports suggesting an increased risk of malignancy associated with fat grafting.”

Which option is right for you?

All breast implants have an outer shell comprised of silicone, but patients can choose from different filling options and shapes.

Many women don’t know which option is best for them until they speak with a few plastic surgeons. This is normal, and you don’t have to know the exact procedure, implant size, or implant type before scheduling a consultation.

To prepare for the discussion about size, Buford recommends looking at before-and-after photos to identify the look you’re going for.

“The best way to start is to identify two or three photos of a proportionate look that you are trying to achieve and bring these with you to your consultation,” he says. “When it comes to breast augmentation, cup size is really less important than the ‘look’ that you are going for because cup size can mean so many things to different people.”

Choosing a breast augmentation surgeon

The success of your procedure and your level of satisfaction with the results depends on a number of factors, not just the size. All of the experts we spoke with emphasized the importance of choosing a good surgeon.

“We are not only creating volume, but also addressing preexisting asymmetry,” says Buford. “A strong aesthetic eye is critical in achieving the best results. Otherwise, anyone could simply stuff an implant through an incision and create larger breasts. A good outcome requires far more than that.”

Trott advises patients to make sure the surgeon understands their goals.

“In my opinion, patients get the best idea of what size they want by trying on implants in the office under a tight shirt,” she says. “But they should always feel that the surgeon understands what they are going for in terms of size and look. This can take some time spent together and more than one visit. Most importantly, the patient and the surgeon must be on the same page.”

» As you do your research, make sure to compile a list of questions for your surgeon. Then look for a few board-certified plastic surgeons in your area.

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