What is “natural”?!

Purity Bridge Consultant Plastic Surgeon, Marc Pacifico, shares some thoughts on breast augmentation…

I ask every patient I see about a breast augmentation whether they desire a “natural” appearing result, or one that looks “augmented”. Inevitably the majority ask for a natural look. But what does that mean? After years of experience, I can assure you that not everyone sees natural the same way!

To some, natural means that if they are undressed and their breasts are exposed, they don’t want to look like they have implants in. To others, however, what natural means is that they don’t want to appear as if they are carrying “bowling balls” under their clothes, or they don’t want an obvious step off from upper chest to breast when in a bra…no matter what their breasts might look like without a bra on.

You can therefore understand the challenge as a surgeon, trying to ensure I am on the same wavelength as my patients when discussing implant choice and desired outcome!

Clearly the best thing is to study pre- and post-op pictures together, and only after careful clinical examination to ensure that the pre-operative breasts we are looking at are similar to theirs. Only that way can patients tell me what they like and what they don’t like, which enables me to guide them towards the best implant size and shape for them. However, all my before and after photographs are very standardised clinical views, and none are in a bra or with clothes on. So this too is perhaps somewhat unrepresentative of exactly how the patients in the photographs breasts might look in real life.

In addition, there may be a subjective disagreement between my patient and me regarding “naturalness”. I have had patients comment on how natural some breasts look in the photographs, whilst I feel they look clearly augmented, whilst others tell me that they think some look unnatural which I disagree with! Unless I understand what an individual desires, I will not be able to give them the result they want.

Breast implant sizing has an important role to play. As a rule, the bigger the implant, the less natural the result will be – this is especially true in those with little soft tissue cover (breast volume) to start with, as the majority of the breast volume after surgery will be composed of implant, rather than breast. So the more breast tissue one has before surgery, the more natural the result is likely to be.

The other factor that has to be taken into account is breast implant profile or projection – this describes how far the implant “sticks out” of the chest. The higher the profile for a given implant width, the less natural it risks looking. So, a “moderate profile” implant has a higher chance of looking natural than a “high profile” implant.

The challenge here, is that the less projected an implant is (the lower the profile), the smaller that implant will be. Therefore a compromise needs to be settled on. For example, the choice may be between a moderate profile implant of say, 275cc volume or a high profile implant of 350cc. The patient may want to look natural, but they may also want the higher volume! This therefore has to be a choice by the patient as to what they consider the higher priority – volume or “naturalness”. There is no right or wrong about this – it is very personal. I can guide them, but do not make the final choice – I leave that to my patients.

So…what about the most natural way to enlarge the breast? This is using the patient’s own fat – known as fat grafting or lipofilling. As long as there is enough fat to find elsewhere (such as from the tummy, flanks or thighs) this can be removed using liposuction, processed in the operating theatre and carefully injected into the breasts. The great advantage with this is that there is no implant that will need replacing in the future. However, unlike an implant, there is no support provided, so if the breast skin is thin and has a degree of sag to it, whilst it will be enlarged, it won’t necessarily have the best shape. However, for many breasts it is an excellent alternative. That said, fat grafting may require 2 or 3 operations to achieve the desired result, compared with one operation using an implant.

I wrote this piece more as food for thought, rather than for anything else. I hope it has been thought provoking, and useful in considering some of the reasons for making certain choices prior to a breast augmentation.

If you would like any further information on breast surgery or to see one of our Consultant Plastic Surgeons, please contact us on 01892 536960 or email us at

Purity Bridge Team