This is the most common type of patient presenting for breast augmentation, so we’re very familiar with dealing with this issue. Firstly, women with little breast tissue also generally have small frames, as well as very little in the wide-soft tissues, so to create a natural non-implanted look, which is the most common request we receive, we must take all of these factors into consideration and plan appropriately. My approach is to use an anatomic or teardrop shape implant placed in a dual plan pocket.

The advantage of the anatomic implant is that I can vary the height, which is this, to the width of the implant, which you can’t do with a round implant. For thin women with small frames, this is critical because we generally need an implant that’s wider than it is tall. Also because the implant essentially controls the final shape, because there’s no natural breast tissue, a round implant will look very obviously round in these women, whereas an anatomic implant will look more natural.

Also, we can use a higher profile implant to create more cleavage without creating a step off the top of the breast, which is a complete giveaway that a woman’s had a breast implant. Then next, an important strategy is to utilize the fat grafting to help cover the implant, particularly in the cleavage area. This will help give a tighter cleavage, as well as hide the implants and deal with their soft tissues. The fat can be harvested either from the tummy or the inner thigh, and because we’re using small volumes, the amount of fat that survives is quite high.

The next consideration is the fold. Most women with little breast tissue have a very soft infra-mammary fold. This is what my friend and colleague Michael Miroshnik refers to as a blank canvas breast. In many ways this is an advantage, because we can borrow skin from the abdomen without creating a double bubble, and so use a slightly larger implant. However, if not addressed with reinforcement of the new fold, it will lead to bottoming out of the implant. So small breasts and thin soft tissues are not a barrier to creating a natural breast shape with implants if done correctly.