Nagor - Making the Breast Choice

By: Douglas McGeorge
Created on 15th January 2012

Douglas McGeorge: In the 1980s and early 1990s, it was always very easy to tell if a woman had undergone a breast augmentation, as it always resulted in that very round, high projection, ‘Baywatch' look. That's because historically, breast implants were all one shape - they were all round, high projection implants, and the only decision that had to be made was about the volume, i.e. how big the patient wanted to go. One of the reasons for this was that in those days there was a very high incidence of capsular contraction. During the healing period after breast surgery, the body forms a scar around the implant, and if that scar shrinks it will make the implant go rounded and feel firmer. That used to occur in about 45 per cent of people, and of course if the implant was any shape other than round to begin with, you would have ended up with very oddly shaped breasts. About 20 years ago they changed the way that implants are made, so that the outer coating was rough instead of smooth, and that dramatically reduced the incidence of capsular contraction to less than five per cent. Once you can control capsular contraction, you can start to use different shaped implants, because you know that the implant won't be distorted, and so that opened up new opportunities to create more natural looking breasts.

Spoilt for choice
These days, there are a wide variety of different implant options available, and that means we can tailor the breast enhancement to the individual. The majority of women who come to my practice want a nice aesthetic shape, which is a sloping upper pole, maximum projection in the lower pole, and a nice curve at the bottom. Occasionally women do want a fuller, false look, and we can achieve that too. So in order to get the optimum result, firstly you need to understand from the patient the look that they want to achieve, and then secondly you need to look at how much volume they have to start with. Imagine the breast as a simple cone: if they have the end of the cone, all you have to do is give them the base; if they have very little tissue of their own, you may need to give them a shaped implant, because if you use a round implant in someone who doesn't have much tissue, you can only produce a round shape. These shaped implants are known as ‘anatomical' implants, because they mimic the natural shape of a breast. Leave it to the professional

The decision about which type of implant to use should be made by the surgeon, based on the information the patient provides. Occasionally, a patient will come in requesting a particular shape of implant, because that is what their friend has had and they want the same result, but if you use the same implant on four different people, you will get four very different results, so the choice of implant needs to be based on what the patient has to begin with. It doesn't necessarily follow that if you use a round implant, you will always get a very fake looking result; if someone has the slope at the top of the breast and is just looking for a fuller curve at the bottom, then you would use a round, low projection implant to achieve that.

Breast of British
The implants I use are made by Nagor, a British company who manufacture
their implants under strict controls and test them in accordance to both European and international standards. Nagor offer a full range of round implants, which includes the low and moderate projection implants that you can use for a more natural result, as mentioned above, as well as some high projection implants for those women who do want that very full, rounded shape. They also offer a range of shaped implants, and these come in different vertical heights and different projections, as well as different widths, so you really can tailor the implant to the individual to try to get the best possible result.
Having different widths and heights is important, because you need to choose an implant that sits nicely on the chest wall. You don't want a little ping pong ball in the centre and of course you can't use anything that's too wide, so you need to measure the width of the chest wall and base your implant choice on that. Equally, you need to look at the height of the chest wall - if someone has a very long chest you want to fill that space as much as possible, so you would use an implant that's oval in a vertical direction. But if you have a very short chest, with your breasts starting close to your collar bone, you wouldn ‘t want to use a full height implant, because it will look as though your breasts start on your clavicle, so you would use one with a lower vertical height.

Choose wisely
People - even some surgeons - tend to think that there are two types of implant: round and anatomical, and you choose between those two depending on whether you want a very natural, or a more false looking result. However, the truth is that there are many different variations within those two wider brackets, and to get the best result for you, your surgeon needs to tailor the exact implant he chooses to your individual requirements.