Breast Augmentation vs. Boob Jobs

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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:

  • which incision to use
  • what type of implant to use
  • placement of the implant
  • texture of the implant
  • size of the implant

    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, text