Every consultation starts with a conversation at normal volume. I ask patients to describe what “natural” means to them, then I listen for the details. In Fort Myers, where weekends often include beach time and fitness is a shared language, natural usually translates to balance: a chest that suits the frame, clothing that fits off the rack, and movement that still feels like their own. The techniques that deliver that result are less about a specific implant and more about judgment, planning, and a series of precise choices made in the operating room.
What “natural proportion” really looks like
Natural is not a cup cosmetic surgeon fort myers size, and it’s not an influencer photo. It’s harmony between the shoulders, waist, and hips, and a breast profile that fits the rib cage and soft tissues. When we measure, we pay more attention to base width than bra labels. A 5-foot-2 runner with a narrow thorax and low body fat will tolerate a very different implant than a 5-foot-8 mother of three with a broader chest and slightly lax tissues after breastfeeding. The same 300 cc device can be transformative on one person and excessive on another.
I keep an old analogy in my clinic: imagine hanging a picture straight, not bigger. The breast footprint on the chest wall should guide implant width, projection, and the location of the fold, not the other way around. When we respect the footprint, implants look like they belong there, not like an accessory on top of the breast.
The Fort Myers context
Surgeons here see a wide range of patients: young professionals, retirees who stay active, and many women after pregnancy hoping for restoration rather than reinvention. Sunscreen is common sense in this climate, and so is a low-profile, swim-friendly aesthetic. That means pocket control, soft edges, and careful handling of the inframammary fold. It also means we talk frankly about beach recovery, sports timing, and avoiding tan lines on new incisions.
Anatomy first: the measurements that matter
Three numbers guide most of the discussion: breast base width, nipple to inframammary fold distance, and soft-tissue pinch thickness in the upper pole. Base width anchors implant selection. The nipple-to-fold distance tells us if the fold has descended or if the breast has settled lower than the implant would, which changes whether we need a small lift. Soft-tissue thickness helps choose between smooth silicone gel options and surface characteristics that can soften edges and reduce visible rippling in lean patients.
I also look at sternal notch to nipple distance, degree of asymmetry in the rib cage or soft tissue, and the position of the pectoralis major footprint. Athletic patients who do lots of pressing movements often have a more lateralized pec, which affects how a dual-plane pocket will perform.
Implant choices that favor subtlety
Silicone gel remains the workhorse for natural results. The modern gels come in different cohesivities, which you can think of as firmness levels. Softer gels drape more like natural tissue, while slightly firmer gels hold shape in the lower pole and resist minor rippling. If someone has very thin coverage in the upper pole, a mid-cohesive gel often looks the most natural after the swelling subsides. Saline has a role, especially for those who prefer it, but its tendency toward palpable edges in lean patients makes it less common for the most natural finish.
Projection matters as much as size. Moderate or moderate-plus profiles usually match the chest geometry of the average Fort Myers patient, filling the footprint without pushing the breast too far forward. High-profile implants have a place in narrow chests, but exaggerated projection can betray the illusion of natural proportion. We match implant width closely to the measured breast base, then adjust projection to achieve the desired volume.
Pocket selection and the dual-plane nuance
The pocket is where natural proportion lives or dies. Subglandular placement can look beautiful on the right candidate with enough tissue thickness to cover the implant edges, but most patients seeking a subtle, long-lasting result benefit from placing the implant at least partially under the muscle. The dual-plane technique splits the difference: the upper portion of the implant sits under the pectoralis muscle for soft, tapered upper poles, while the lower portion lies under breast tissue for a natural slope and fold.
There are flavors of dual-plane, adjusted by how much we release the lower pectoralis attachments. In a mild deflation after breastfeeding, a dual-plane type II approach often restores the lower pole without a formal breast lift. In a more pronounced descent, even a careful dual-plane will not move the nipple enough, and a lift enters the conversation. A seasoned plastic surgeon will recognize when the implant alone will create a high nipple on a low mound, which is one of the fastest paths to an “augmented” look rather than a natural breast.
Incision placement with an eye for recovery and visibility
The inframammary incision remains the most precise and most controllable path to the pocket. It allows accurate definition of the fold and direct control of bleeding, which helps limit inflammation and reduce capsular contracture risk. In a beach town like Fort Myers, patients often ask if that scar shows in a two-piece. Positioned correctly, it hides in the natural crease. Areolar incisions can be reasonable in select cases, but cross a pigmented boundary and you enter the domain of pigment mismatch. Axillary approaches have aesthetic appeal but trade off pocket control and can increase animation deformity in some athletic patients.
Fold control: where natural edges are made
The inframammary fold is the unsung hero of natural augmentation. Respect it when it’s in the right place. Reinforce it when it’s not. If the fold sits too high for the implant width, a measured lowering of the fold can create room for a rounded, gentle lower pole without “double bubble.” If the fold has stretched downward after pregnancies or weight changes, suturing techniques can restore its support and prevent the implant from migrating south. Pocket strength matters more over years than any early swelling does in weeks.
The role of a breast lift for proportion
Many mothers hope an implant alone will lift the nipple. It will not, at least not in a durable way. If the nipple sits well below the fold or points downward, adding volume without repositioning the nipple will make the lower pole heavier and the breast appear more ptotic, not less. A short-scar mastopexy paired with a modest implant can yield a smaller number on the implant box but a larger effect in the mirror. Fort Myers patients who want to return to paddleboarding, golf, or tennis appreciate the functional benefit of the lift: the breast moves as a unit, which feels more secure than a heavy lower pole.
Avoiding the “augmented” tell
Three details tend to give away an augmentation: an overly round upper pole that does not soften after three months, nipples that sit too low on a fuller breast mound, and a fold that looks artificially high or doubled. Technique counters each.
- Taming the upper pole: a dual-plane pocket with careful muscle release allows the implant to settle without sharp edges. Choosing a moderate projection instead of high profile in borderline cases prevents a hard step-off near the clavicle. Nipple position: if the nipple is too low preoperatively, staging a lift in the same sitting preserves the illusion of a natural breast. Avoid banking on “skin stretch” to raise a nipple; it rarely behaves the way we want. Fold integrity: deliberate pocket dissection with suture reinforcement sets the lower border. Over-dissection leads to bottoming out, and once that occurs, revisions require more than wishful thinking.
When fat grafting completes the picture
Subtle contour issues can make a good result great. Fat transfer allows us to soften the décolletage, blend visible implant edges in thin athletes, and correct minor asymmetries without changing implant size. The trade-off is variability. Fat takes where it’s well vascularized, and not every milliliter survives. Realistic expectations are key: a 60 to 70 percent take rate is a typical target, which is why overfilling by small, planned margins is part of the technique.
Harvest sites for fat often include the flanks, abdomen, or thighs, and while this overlaps with liposuction, the goal here is shaping and fuel, not dramatic debulking. If a patient is already planning a tummy tuck, we can coordinate to harvest safely once the abdominal blood supply has been secured. Patients should know that grafted fat behaves like fat elsewhere in the body; significant weight change will affect the result.
Planning around lifestyle and sports
I ask about push-ups, yoga inversions, open-water swims, and pickleball because they influence timing and technique. Heavy pec activation can exaggerate animation changes in submuscular pockets, which we can minimize by thoughtful release patterns and pocket dissection that respects the muscle’s natural vectors. Most patients return to light lower-body exercise within a week, gentle upper-body work after three to four weeks, and more vigorous chest movements around six to eight weeks, adjusted to healing.
Sun exposure is another local reality. Early scars tan easily and permanently. A six-month sunscreen habit over the incisions pays dividends. Rash guards and supportive swim tops help during the healing window, both for scar protection and for comfort when wave activity or pool laps jostle healing tissues.
Managing asymmetry with precision
Perfect symmetry does not exist, and chasing it blindly can lead to overcorrection. The aim is perceived symmetry. If one breast is slightly smaller but also narrower, we might use a fractionally narrower implant with a touch more projection, rather than simply adding volume. If one nipple is lower, a small crescent lift on one side paired with matched implants can align the areolae without committing to larger scars. When rib cage asymmetry is the culprit, pocket depth and fold support can create the illusion of balance, even if bone structure still differs.
Sensation, scars, and what patients notice at six months
Nipple sensation changes in a minority of patients. Most experience temporary hypersensitivity or numbness that improves over weeks to months. Permanent changes are less common when dissection respects the nerves entering the breast from the fourth lateral intercostal space. Patients who choose larger devices relative to their base width accept a slightly higher risk of sensory shifts.
Scars fade in stages. The first month brings reddish lines that feel firm at the edges. Months two through four are often the most discouraging because the scar turns pink and can thicken slightly. By month six to twelve, color fades and lines soften. Silicone gel applications and predictable scar care, along with sun protection, do most of the heavy lifting. Steroid injections or laser treatments have a role for stubborn hypertrophy.
How breast augmentation interacts with other procedures
Augmentation rarely lives alone in a practice that also offers body contouring. After pregnancies or weight changes, restoring proportion can involve a breast lift or augmentation alongside a tummy tuck, sometimes with targeted liposuction of the flanks. The advantage of combining procedures is a single recovery window and a coordinated aesthetic plan, especially for patients whose main concern is overall silhouette rather than a single feature. The trade-off is longer operative time and a need for meticulous VTE prevention and staged activity reintroduction.
For the right candidate, subtle liposuction around the axillary tail or lateral chest can enhance the frame and make the breast shape read as more delicate. I caution against aggressive fat removal in these zones, because it can create hollowing that exposes implant edges. Balance, not maximalism, wins here.
Capsular contracture and long-term behavior
Most patients never experience capsular contracture, but no honest surgeon pretends the risk is zero. A low bacterial burden during surgery, pocket irrigation protocols, and choosing an inframammary incision are steps that correlate with lower rates. If contracture occurs, it often reveals itself as firmness or shape change over months or years. Early physical therapy does not reverse a true contracture, despite myths. Surgical correction with capsulectomy or pocket change addresses the cause.
Implants are not lifetime devices. The industry-standard counsel is that they may last 10 to 20 years, sometimes longer, sometimes shorter. Saline failures declare themselves quickly with deflation. Silicone devices, especially cohesive gels, require surveillance. Fort Myers patients, like anyone else, benefit from periodic check-ins. If a patient notices shape changes, new rippling, or discomfort, it deserves a look. Routine imaging can be discussed based on device type and evolving guidance.
An anecdote from the clinic
A Fort Myers Pilates instructor came in after her second child. She lifted heavy for her size, and her pecs were engaged even when she reached to shake my hand. She wanted to “fill a C,” but more importantly she wanted to keep doing teasers without feeling a shift. Her base width measured 12 centimeters. We tried sizers and landed on a moderate-plus implant that matched her width, with a dual-plane pocket that preserved the upper taper and reduced animation. We added 40 cc of fat along the inner upper pole to soften the junction near the sternum. She returned to reformer work at four weeks, held off on chest presses until seven, and by three months she told me that the breasts felt like part of her, not something to manage. Her photos did not scream surgery, which is exactly what she wanted.
The consultation: setting expectations with clarity
Numbers help, but so does language. When a patient says “round,” I ask if they mean full, because round in a surgeon’s vocabulary can imply a firm, artificial upper pole. When they say “sideboob,” we discuss lateral pocket boundaries and bra behavior. When they want “perkier,” we clarify whether that means nipple elevation or simply upper fullness. This conversation weeds out mismatched goals early, which saves time and regret later.
Here is a brief, practical framework that patients in Fort Myers find useful before surgery day:
- Bring two or three favorite tops and a non-padded bra to your sizing appointment, so we evaluate volume in real clothing. Consider your most demanding activities, from lap swimming to overhead lifts, and share them. Technique can be tailored to minimize interference. Decide how you feel about scars you can hide in a crease versus scars around the areola if a lift is needed. Trade-offs are personal, not generic. Plan your calendar around real downtime. Most patients take five to seven days off desk work. If your job is physical, you might need two to three weeks. Protect your incisions from sun for at least six months. In a coastal city, that’s not academic; it’s the difference between a faint line and a persistent reminder.
What careful technique looks like in the OR
Natural proportion is the end product of many small moves. Meticulous hemostasis reduces inflammation. Pocket dissection follows a measured game plan tied to preoperative markings and chest measurements, not guesswork. A no-touch insertion technique protects the device and lowers contamination risk. The inframammary fold gets the attention it deserves, with sutures that hold shape without excessive tension. Symmetry is checked with the patient elevated on the table because gravity tells the truth in ways a flat position cannot.
I decline to oversize in the operating room even when swelling makes larger look briefly attractive. Swelling lies. What stays true are the landmarks and the soft tissue limits we mapped beforehand. That discipline is what yields a soft, unforced result at six months and beyond.
Recovery with purpose
The best outcomes follow a predictable rhythm. Day one is for rest and controlled movement of the arms within a comfortable range. By day three, most patients feel ready to walk laps around the house and handle light tasks. By day seven, desk work is on the table for many. I encourage gentle postural exercises to prevent shoulder rounding, which is a common overcompensation after chest surgery. At two to three weeks, low-impact cardio feels good. True chest loading waits until the pocket has settled and incisions are solid.
Supportive bras matter. I prefer a non-underwire, supportive garment for the first six weeks. Underwire can sit on the healing fold and irritate the scar. Patients can switch to their preferred bras once the fold feels comfortable and the pocket is stable.
Candid talk about trends and requests
Trends flow through Fort Myers like the tides. Surgeons hear requests for upper-pole dominant looks one season and minimal implants with heavy fat grafting the next. Natural proportion means we sometimes say no to a request that would strain the tissues or telegraph surgery from across the room. It also means we embrace conservative choices that age gracefully. A modest implant today often looks better in a decade than a maximal implant looks in two years, particularly for women who run, lift, or spend time in warm water where tissue support can relax faster.
Collaboration with your plastic surgeon
A natural-looking augmentation is a dialogue, not a lecture. Patients bring their goals and their daily routines. The plastic surgeon brings an understanding of anatomy, physics, and the behavior of implants in living tissue. When that collaboration is honest and specific, the result is proportionate, soft, and believable. It fits your lifestyle as readily as it fits your clothes.
In Fort Myers, the surgical techniques that create that outcome are consistent: measure the base, match the width, choose a projection that respects the chest, favor a dual-plane pocket for most, reinforce the fold, lift when indicated, and use fat grafting selectively to soften edges. Recover with intention, protect your scars from the sun, and give the tissues time to settle. Done that way, “natural” becomes less of a promise and more of an expectation.
Farahmand Plastic Surgery
12411 Brantley Commons Ct Fort Myers, FL 33907
(239) 332-2388
https://www.farahmandplasticsurgery.com
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