Lara Devgan, MD, MPH, is a Yale-educated, Hopkins-instructed, and Columbia-trained plastic and reconstructive surgeon in private practice in New York City. For more information, please visit

BLOG: The secret to beautiful, natural breast augmentation

Breast augmentation, or breast implant surgery, is the most frequently performed cosmetic surgical procedure in America, and the most common procedure in my Manhattan private practice. Over 300,000 breast augmentations are performed each year in the United States alone.

Women's motivations for breast augmentation are as diverse as their surgical goals. While most of us have seen women with extremely large and exaggerated breasts, most patients in my practice-- and most women in the United States-- seek a more natural, subtle result. In my practice, women who seek breast augmentation are often in one of two major categories: young women in their twenties who desire a fuller, more proportionate, more feminine figure, and women in their thirties, forties, and fifties who would like to restore youth and fullness to their breasts, after aging, childbearing, breastfeeding, and weight fluctuations have changed their figures.

So what is the secret to beautiful, natural breast augmentation? Safe surgery, appropriate expectations, and working within the constraints of your anatomy.

Pre-operative Evaluation

Breast augmentation is an elective procedure, so before undergoing surgery, women must be in good health, with an adequate exercise tolerance. For women with preexisting medical conditions, a full pre-operative medical clearance, including blood testing (BMP, CBC, PT, and PTT) and pregnancy testing must be performed. For those over 50 with cardiac or pulmonary issues, a chest x-ray or EKG may also be required. A mammogram is recommended for women who are over 40, or women who have a strong personal or family history of breast or ovarian cancer.

When meeting with your plastic surgeon, you will have a detailed discussion of your goals and expectations for surgery. You should discuss your current and desired breast size, any changes in your breasts over time, your history or future plans for childbearing and breastfeeding, and your personal and family history of breast or ovarian cancer and anesthetic complications. You will also discuss your full medical and surgical history. Breast augmentation has increased risks in women who are smokers, and in my practice, I require that patients cease smoking for at least four weeks before and after surgery before proceeding.

Your pre-operative physical examination is one of the most critical aspects of your initial plastic surgery consultation. Your plastic surgeon will palpate your breasts and axillae for lumps, masses, or evidence of irregularity or skin puckering. Your nipples will be assessed for any evidence of abnormal discharge. Your plastic surgeon will then assess your tissue quality, including skin pinch (the thickness of your subcutaneous tissue), skin elasticity, and body habitus. A number of measurements will be taken with a millimeter-marked measuring tape, including the sternal notch-to-nipple distance, the nipple-to-inframammary fold distance, the base width of the breasts, the intramammary distance, and the areolar diameter. It is very common for women to have some baseline degree of asymmetry in their breasts. Preoperative photographs in five views (front, left side, right side, left three quarters, and right three quarters) are important in surgical planning.

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