Posted in: Spotlight Series , Tuesday July 28, 2015
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By Noel B. Natoli, MD, FACS 

 Today, women have more options than ever when considering plastic surgery. Many women, for instance, are opting to consult female plastic surgeons for sensitive issues like breast augmentation.  Some women feel more comfortable talking about their self-image and their desire to reshape it with another women. But whether you choose a male or female plastic surgeon for your initial consultation, one of your first goals should be to establish a rapport and a bond of trust.

Patients are often nervous and self-conscious about their first appointment to discuss changing the contour and volume of their breasts, but they shouldn’t be. A good physician will immediately make a patient feel safe, understood, and cared for, as well as answer all the questions a patient might have about the procedure.  When a patient comes away from her first consultation with me, I want her to feel that she has a road map to her desired appearance and knows what that entails every step of the way.

I will usually begin the consultation by discussing what research they have done and what their level of knowledge on the subject is so I can properly educate them on the different breast augmentation options. These options include saline versus silicone implants, round or anatomical implants, and the placement of implants.

I also take time to get a full picture of the patient’s personal history: previous surgery, medical problems, smoking history, history of mammograms and any abnormalities, prior biopsies or breast surgeries- cosmetic or otherwise, family history of breast-related disease.

After a 15-20 minute discussion we will do a breast examination where we also take measurements and patient photos.  After the exam, I make general recommendations and then with the patient’s desires in mind, we come up with an operative plan.  I generally show before and after photos of previous patients to help them see the scar types and implant types. It’s important to manage expectations of surgical outcomes, and many times women can identify with a previous patient’s body type and breast augmentation choice.

Implant selection is the next step.  We trial implants in a bra to see what breast size they desire, and then using a 3-D imaging system, called Vectra, we can give a 3-D rendition or approximation of what they can expect to look like with varying implant choices.  After we’ve completed our appointment, I introduce the patient to one of our cosmetic coordinators who will go over various other details about the surgery including scheduling and pricing.

While technical aspects like 3-D imaging are important, so is the personal touch. Listening to a patient and learning what their goals are is one of the most important parts of the consultation. I encourage patients to be really upfront about what they want their breasts to look like, even to bring images if they want to.  Women routinely bring pictures of what they want their hair to look like to stylists. Why shouldn’t they have the same feeling of empowerment with their plastic surgeon?

Although most patients are good candidates for augmentation, I will sometimes suggest that a patient go home and think about the procedure and what it will do for her if I feel that the patient has unrealistic goals for the surgery.

Breast augmentation is a procedure that enhances a part of your body. It can and does make women feel great about themselves and instills newfound confidence. However, there are limits to be considered.  Potential breast augmentation patients should be doing the surgery for herself, rather than to please others. Plastic surgery doesn’t repair difficult marriages or make you into a teenager again.

A good candidate for breast augmentation is a patient in the right mindset, and someone who is a nonsmoker.  Nonsmokers pose the lowest risk for complications with general anesthesia, wound-healing, and implant- related complications such as capsular contracture.

There is so much that we have learned to do as surgeons technically, but one of our most important skills is still listening to a patient.  If a potential candidate for breast augmentation can take the first step in making her first appointment, as surgeons, we will do everything we can to help her feel that we are here for her every step of the way. I am also happy to meet with patients for additional consultations if they have post-visit questions, concerns, or if they’d like family members to be present.

For me, one of the most gratifying aspects of breast augmentation is the high degree of patient satisfaction I see for the procedure. Results can be excellent and predictable given the relatively low complication profile for breast augmentation. With the properly selected patient–it can be a real quality of life enhancer, and that’s really what so much of plastic surgery is about–enhancing our patients’ lives.

If you have specific questions for Dr. Natoli on breast augmentation, send us an email at

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