What makes an excellent breast augmentation different from the classic “boob job”? Plastic surgeon Dr. Grant Stevens suggests breasts that don’t look augmented, but rather completely natural, are the ultimate goal for any breast surgeon. Sophie Gordon reports.
An excellent breast augmentation can look natural, feel real and
have a natural shape. Plastic surgeon Dr. Grant Stevens, makes
a distinction between successful breast surgery and the obvious “boob job” where it’s
easy to tell a woman has had surgery.
“Part of an excellent breast augmentation is
the fact that the breasts look as if they could actually occur in nature,” he explains. “There should be a question in the viewer’s mind as to whether or not these are real or are
surgically created.”
A good breast augmentation has a natural fullness and gentle sloping off the chest wall. There should be natural cleavage, without webbing between the breasts and a certain amount of perkiness.
Dr. Stevens lists five basic considerations that make for a desirable breast augmentation:
Before having surgery, you should go over
photographic examples of the breasts you
want with your surgeon so that you both have
a clear, visual understanding of the desired
result. “My job is to make the breasts look like
the photographs,” says Dr. Stevens.
There are four choices regarding where to
make the incision for a breast implant:
underneath the arm, around the nipple, or in the
inframammary fold (where the breast meets the
chest wall). The fourth is the umbilical incision,
but is not as preferred as the others. There are
advantages to each incision.
“I allow the patient to direct me as to which
incision she wishes to have,” says Dr. Stevens.
“We know that each incision has a certain
amount of scarring, but our goal is to have the
scar so minimal it’s inconspicuous.”
Sometimes there are ethnic factors (in terms
of skin type and color) that might encourage
one incision over another. Dr. Stevens refuses to
recommend any incision per se but notes that:
“Of all the breast augmentations I have
performed on nurses, physicians or even my
own employees, none have ever asked me to
do either the inframammary fold or armpit
approach. I find it highly significant that women
who have been surrounded by the plastic
surgery industry, and have seen the most
results, have never asked for an incision other
than beneath the areola.”
The type of implant used has certain
limitations in terms of availability. Currently,
there is a moratorium on silicone implants;
the silicone gel implant has been limited to
women who fit into specific inclusion criteria.
“If there were no moratorium I would be
putting in far more silicone gel implants than
saline implants,” says Dr. Stevens. “The
silicone gel implants, in general, feel more like
a breast and look more like a breast. However,
we can certainly adjust the saline implants
and in most cases are able to give the woman
a natural-looking breast.”
The next question is where to put the
implant. It can be placed either on top of or
behind the muscle. “I place implants behind
the muscle so the implants are partially
covered,” says Dr. Stevens. “The muscle
allows a nice smooth take-off from the chest
wall. If put directly on top of the muscle they
can look like a half-grape fruit or rounded
ball on the chest.”
The fourth criterion in an excellent breast
augmentation is the choice of specific implant.
Should it be smooth, textured, low profile, high
profile or anatomic? It’s important that each
implant is individualized to achieve the size
and shape the patient desires. According to Dr.
Stevens, that individualization should dictate
the decision.
“It’s my feeling that if the surgeon is wedded
to only one type of implant then all the breast
augmentations will look the same. This is not
cookie-cutter surgery. Cookie-cutter breast
augmentations are, in my opinion, ‘boob jobs’.”