Shape, proportion and balance.
Breast surgery is not about achieving a standard size or shape. The appropriate operation depends on the existing breast, the skin envelope, chest proportions and what the patient hopes to change.
My approach begins with understanding those relationships and selecting the operation—or combination of techniques—that can address them most reliably.
Most aesthetic breast concerns involve some combination of three elements.
The amount and distribution of breast tissue determine fullness, projection and the relationship of the breast to the chest.
The position of the breast and nipple on the chest changes with anatomy, pregnancy, weight change and ageing.
Skin quantity and elasticity influence how well the breast supports its contents and whether reshaping requires removal of excess skin.
Cup size alone is a poor way to plan breast surgery.
I consider the breast in relation to the width and shape of the chest, shoulder and torso proportions, existing breast tissue and the patient's own preferences.
The objective is a breast that belongs naturally to the patient's frame rather than one designed around a predetermined measurement or aesthetic ideal.
The procedure follows from what needs to change: volume, position, skin envelope—or a combination.
For patients seeking increased breast volume or a change in shape and proportion. Planning considers the existing breast, chest dimensions, soft-tissue coverage and the desired result.
Explore Breast Augmentation →Mastopexy reshapes and repositions the breast where descent and skin excess are the dominant concerns. Volume can be preserved, redistributed or supplemented where appropriate.
Explore Breast Lift →Reduction surgery decreases breast volume while reshaping and lifting the remaining tissue. The aim is improved proportion, comfort and a stable breast shape.
Explore Breast Reduction →Some breasts require both restoration or addition of volume and correction of tissue descent. In selected patients this may mean combining augmentation with mastopexy.
The balance between implant volume, existing breast tissue, skin excess and scar pattern is considered carefully rather than treating augmentation and lift as independent decisions.
Some degree of breast and chest asymmetry is normal. Surgery can often improve meaningful differences in volume, shape or nipple position, but perfect symmetry is neither realistic nor necessary for a harmonious result.
Recognising the starting asymmetry is an important part of planning.
The consultation is used to define the objective before choosing the operation.
Breast volume, base dimensions, tissue thickness, skin envelope, nipple position, chest wall and asymmetry.
What you would like to change—and equally, which characteristics you would prefer to preserve.
Scars, implant-related considerations where relevant, recovery, longevity and the limitations of what surgery can reasonably achieve.
My reconstructive practice includes breast reconstruction following cancer surgery and other complex breast problems.
Reconstruction and aesthetic breast surgery are closely related. Reconstructive surgery requires an understanding of how breast volume, skin, scars and the chest wall can be assembled to recreate a natural breast form; aesthetic surgery applies many of the same principles from a different starting point.
Complex reconstruction is usually coordinated through the treating breast and multidisciplinary teams rather than approached as a routine cosmetic consultation.
Consultation allows us to assess the existing breast, understand what you would like to change and discuss the different ways that might be achieved. The most appropriate plan may involve changing volume, position, the skin envelope—or sometimes deciding that surgery is not the right option.
Arrange a consultation →Written and reviewed by Dr Constant van Schalkwyk, Specialist Plastic Surgeon ·