The Big Impact of Small Breast Implants

Taylor Swift is keeping the experts guessing. Did she or didn’t she have implants?  From recent photographs of her profile there is a discreet fullness that wasn’t evident in pictures from a few years ago. Taylor Swift isn’t the only one: other celebrities are opting to pump up the volume of their breasts by just a small amount for a flattering look on the red carpet or a photo op on the beach.

The Cup Does Not Floweth Over

Breast augmentation is the most widely performed cosmetic surgery in the world.  Even with its long-standing popularity, breast implant surgery is not immune to changing taste, trends, and the public’s ever evolving definition of a well-formed body.  One could reasonably argue that parts of the body can almost be considered accessories, and like all accessories, styles change. So do preferences in breast size and appearance.

Case in point, voluptuous bodies were popular in the 16thc century when Peter Rubens was filling his canvasses with curvaceous women. Big bustles adorned the backsides of women in the 1870’s and today, a Kardashian-sized rear end is considered attractive. Waif-like models strutted the runways in the 1990’s and in the 21st century we are seeing an appreciation for a toned, athletic beauty. Now, muscles rule. The new Wonder Woman Gal Gadot’s average-sized chest was a hot topic on social media and was widely compared to her predecessor Linda Carter’s bountiful chest.

There are many factors driving the trend toward smaller breast implants. Millennial women and women age 60 and up are driving the demand for subtly fuller breasts. Millennials seem to have a natural preference for “natural” ingrained in them, while women in their 50’s, 60’s and 70’s are also wanting to take advantage of the positive outcomes a fresh new look can have.  Both Millennials and Boomers are moving away from uncomfortable underwire bras and are opting for sports bras, a garment that cannot support very large breasts.

This Is Not a “Mini Boob Job,” So It Is Still Surgery?

Regardless of a patient’s age, there are always health issues to consider prior to undergoing any surgery. Patients should receive clearance from their primary care doctor and they should discuss all medications and their medical history with their plastic surgeon.

Women of all ages can be candidates for breast implant surgery as long as they are healthy. Smoking has a big impact on your skin. It can prevent women from healing correctly from surgery. If you smoke, quit.

Even if you don’t smoke, skin elasticity decreases as we age. If a lift is done together with your implant you might be able to address both aging and volume loss.

Your Consultation: Your Chance to Meet the Doctor

When it comes to breast implant size, the sky may not be the limit.  Now is the time to share all your concerns with your board-certified surgeon.   Your consultation will include an assessment of your medical history, including any medications and supplements you may be taking. Your doctor will discuss the pros and cons of various size implants, incision options, placement of implants meaning sub muscular vs sub glandular implants, reasons to choose silicone implants over saline implants and vice versa.  All your questions are important. Don’t hesitate to ask them.

If you are under 40, you might need to get a mammogram before your breast augmentation. In the future, you will need to let the mammogram technician know you have implants.

Some doctors may give you the opportunity to place both types of implants in your bra so you can get an idea of what a certain size implant will feel like on your body.

You may also want to think about having a “lift” at the same time you are augmenting your breasts.  One test to determine if a lift is necessary is by seeing if your nipple areola complex falls below the inframammary fold. If it does, a mastopexy (breast lift) might be needed to elevate the breast.

Thinking About Size

To help you decide on what size your implants should be, we’ve listed some benefits of relatively smaller breast implants:

  • If you are slender and lean or have a petite build, a subtle augmentation will look more natural
  • Your clothes will fit and look better
  • Subtle curves are more “2017”
  • Big breasts can be heavy
  • Big breasts can feel cold in the winter
  • Some large augmentations look unnaturally high
  • Some large augmented breasts look too round, especially on thinner, smaller women
  • A smaller shape implant is good for women with thinner tissues
  • Recovery time maybe somewhat easier because the implant requires a smaller “pocket” for placement
  • Smaller incisions.
  • You can more comfortably participate in sports
  • You can comfortably wear a sports bra.

Bra size and implant are very hard to correlate. Most of breast implant sizing depends on the physique of the patient.  The same size implant may look different on each patient.

SOS: Silicone or Saline Implants?

All implants have a silicone shell.  Some implants are filled with a silicone gel, while others are filled with saline.  Silicone implants are softer, more pliable, more natural looking, and are closer to the natural feel of the breast.  Saline is an option for those women who like the fact that saline can be safely absorbed in the body.

The new fifth generation silicone implants are highly cohesive, so they’re more likely to stick together than leak. There is a chance that saline may leak through the valves found in certain saline implants.

Saline and silicone implants are available in similar sizes.

When it comes to size of the implant you choose, your age does not make any difference. You can choose to be as endowed as you like, but the diameter of the implant should be the same size or smaller as the breast; otherwise, the implant will squeeze together in the middle of the chest or spread apart.

Saline and silicone implants are also available in similar sizes.

Nip and Tuck

Not all incisions are the same.  But with any breast augmentation, even a subtle one, you will want to ask your surgeon how visible the scars will be.  Scars will fade over time, and once they’ve sealed they can be covered up with makeup.  If you opt to have a breast lift, you may also have additional scarring around the nipples.

The scars will depend on what incisions you choose for breast augmentation.  Saline implants are inserted while deflated and then inflated inside the breast, so the incision is generally small. Silicone implants are inserted when they’re completely full, so the incisions need to be longer.  There are four types of incisions that are generally employed for breast augmentation.

  • TUBA: Trans-umbilical breast augmentation. The incision is made around the navel. Implants are slipped through the navel and moved up to the pocket in the breast
    • Benefits: Fewer visible scars.
    • Drawbacks:  According to the American Society of Plastic Surgeons this method is more prone to complications than others.
  • Peri-areolar. An incision is made around each areola from the 3 o’clock to the 6 o’clock position.
    • Benefits:  Incision is hidden. This incision is smaller but it works better for smaller implants and saline implants.
    • Drawbacks: Possible numbness of the areola and the nipple.
  • Trans-axillary. An incision placed under the arm.
    • Benefits:  No scar on the breast.
    • Drawbacks: Scar may visible when lifting arm.
  • Inframammary fold. This is the typical incision of choice, especially when augmenting with silicone implants because they allow for great access to the breast tissues.
    • Benefits: The incision is hidden in the fold of the breast and after it heals, the scar becomes nearly invisible.  The site like peri-areolar incision can be reopened if necessary.
    • Drawbacks: It will be difficult to change the breast size in the future. If the patient decides she wants to have a larger implant inserted, the scar will move up and become visible on the breast.  In case the patient decides she wants a smaller implant, then the scar could move down and be seen below the fold of the breast.

Submuscular vs Subglandular Implants

A submuscular implant is placed under the pectoralis muscle (chest muscle) and pushes the muscle and breast forward. This makes the breast tissue more easily visible during a mammogram. A submuscular implant eliminates the “step” appearance and allows for more natural curves.

Sub-glandular implants may be right for someone who is very athletic.  They do not tend to move as much during activities where the arm is involved.  They also offer more projection, but the “step,” is more visible.

Breast Lift

Sometimes, it’s not all about size. One of the most common issues women face are sagging breasts, and that can’t easily be addressed with a breast augmentation. In fact, overly-large implants might make the sagging worse! One option for women that want a more youthful cleavage is the breast lift, a procedure that reshapes and repositions the breasts.

A breast lift is done by removing excess skin and resizing the nipples—so patients should expect some scarring around the breasts. There are different kinds of incisions your surgeon can use, but the shape and length of them will all depend on how much tissue the surgeon needs to remove or reshape. Either way, a great surgeon will ensure the incisions looks as subtle and hidden as possible when they heal.

Keep in mind—a breast lift alone will probably result in some volume loss or keep your breast volume relatively the same. If you’re keen on enhancing volume as well as shape, we highly recommend that patients pair their breast lift with an implant. With a reasonably-sized implant, patients will be able to enjoy a perkier, more youthful shape as well as a curvier figure.


Everyone recovers differently.  Shortly after surgery there may some bruising and swelling around the incision or in the lower part of the breast. The bruising and swelling will fade and diminish after a few weeks to a few months, so your breasts may look larger at first and then decrease to their final size.

Discomfort:  There may be some stiffness and discomfort when moving your arms, but you will be given medication for pain and nausea.  You should refrain from lifting heavy items for 3-6 weeks.  You can drive when you’re no longer on pain medication.  You can return to work in about two weeks, but it might take longer if your work is physically strenuous.  You can return to exercise gradually after 3 weeks.

Self-care: You can shower a few days after the surgery if you have a waterproof dressing. It is best to have someone help you wash your hair. Arnica Montana, a homeopathic gel may be recommended to you for bruising.  Keeping the scar covered with Arnica for three or four weeks following surgery will result in a flatter, less noticeable scarring.  You will be given a surgical bra, and as the swelling subsides you then can transition to a wire-less bra of your choice.  You will be given an appointment to see your surgeon after a week or two following your surgery.  If one breast swells more than the other or if you start to experience substantial pain then you should contact your surgeon.

Instant Gratification

We recommend that you look at many photographs of augmented breasts prior to committing to a size. You should understand and articulate the reasons why you have decided to undergo elective surgery because it will help you decide on what it is you really want.  Consider whether a certain implant material, size, or placement will get you what you want.

You should make sure that subtle augmentation is truly what you want prior to making your final commitment. Occasionally patients do regret that they did not go larger.

For the best possible results always consult with a board-certified plastic surgeon. Dr. Ali Sajjadian is one of few plastic surgeons in the United States who holds triple board certification.  He is certified by the American Board of Plastic Surgery, the American Board of Otolaryngology, as well as the American Board of Facial Plastic and Reconstructive Surgery. He is a former Assistant Professor of Plastic Surgery and a faculty member of the Plastic Surgery Residency Program at the University of Pittsburgh Medical Center.

For four consecutive years, Dr. Sajjadian received the honor as one of “America’s Top Physicians.” He is known all over the world for his exquisite breast augmentation work.  Excited to get started on your new journey to looking great and feeling confident?  We invite you to contact Dr. Sajjadian at 949-515-0550.