Breast Surgery 101


One very interesting phenomonon I’ve observed (particularly amongst fans of Japanese models) is the willingness – even need – by many people to believe that their favourite models are all natural. The fact of the matter is, very few models today haven’t had some kind of surgery: for example, these days it is (sadly) almost considered compulsory for Asian models to have a nose job. But the thing that seems to always cause the most controversy in online fora is whether or not a model has had a boob job – witness the debate in badboy’s Sora Aoi post, for example.Speculation on the psychology behind this phenomonon would make for a very interesting post in itself, but first I think it would be instructive to do a post explaining the pros and cons of the various modern breast surgery techniques, and how to recognise whether a model has had it. As I’ve indicated in the photo above, Sora displays several of the tell tale signs of having implants, so initially I found it surprising that people thought she was natural. However, this seems to be based on the very common misconception (amongst Americans at least) that implants are always hard and stiff. Yet as we shall see it is actually quite easy to make implants soft and bouncy – with the right surgical techniques.

Types of Implants

It is widely known that there are two basic types of implants: silicone and saline. However, even amongst these there are a few variations.

Liquid silicone: This was the original breast implant, as the feel is closest to human breast tissue. However, early implants had very thin shells, meaning they would rupture easily. This meant that an ‘unnatural’ substance could enter the bodily tissues. As such, this type of implant is no longer in use, and resulted in silicone implants being banned in the US.

Saline: As silicone entering the body was a problem, it seemed logical to replace it with a ‘natural’ substance – hence salt water (saline) implants. This is the type now used almost exclusively in the US, and is also the type most commonly used in Japan. However, even with the same implant it is possible to vary its size and firmness depending on how much you fill it.

Try filling a plastic bag with water yourself. If you don’t fill it up too much, it stays pretty soft. However, if you really fill it up, it becomes very firm. Herein lies a key difference in the techniques of American and Japanese surgeons. American surgeons generally prefer to overfill saline implants, resulting in a very firm breast. On the other hand, Japanese surgeons generally prefer to underfill them, resulting in a softer, more ‘jiggly’ breast.

So why do American surgeons overfill them? To try and avoid another problem known as ‘rippling’. If you move the water bag around, ripples will form in its surface. But the more you fill it, the smaller those ripples will be. There are however other ways to combat this problem, as we shall see.

Silicone gell: Another, more modern and advanced solution to the problem of silicone entering the body are silicone gell implants. Basically, these are filled with a thicker silicone gell instead of liquid. By its nature, this gell will not leak, even if you cut the implant in half! And the properties of silicone gell mean it is still soft and squishy, like natural breast tissue – while they don’t feel quite as soft as liquid silicone, they feel much more natural than saline.

As you can imagine, they are also much less prone to rupture and rippling than saline, so they are widely considered to be superior to saline by the medical community. However, while they are readily available in Australia and Europe, they have been made illegal in the US due to an overreaction to the problems with earlier liquid silicone implants. Also, they do have one cosmetic disadvantage relative to saline: whereas saline implants are usually filled after they are inserted, silicone implants are always premanufactured, so they require a larger incision than a saline implant of the same size (so they leave a larger scar).

Textured vs. Smooth

Whether saline or silicone, modern implants come in a choice of textured or smooth surfaces. Smooth implants actually move around freely, whereas textured implants are locked in place by attaching themselves to the body’s scar tissue, so they don’t sag as much. Textured implants are also less prone to medical complications, and feel much more natural: with smooth implants, it always feels like there’s a bag inside the breast. However, because they move around freely, smooth implants bounce around a lot more than textured implants – sometimes even more than natural breasts! This fools a lot of people into thinking smooth implants are actually real: this is one of the ‘tricks’ Japanese surgeons use.

Another reason Japanese surgeons perfer smooth implants is because rippling is less visible, as the implants are not in direct contact with the breast tissue – this is one of the reasons they are able to use underfilled saline implants. Another reason is because they don’t tend to go for as large an implant, and also because of how the implant is inserted.

Over the Muscle vs. Under the Muscle

Another technique Japanese surgeons usually use is to insert the implant under the chest muscle. This means the entire breast as well as the chest muscles cover the implant, which means they sag less, makes them appear softer and more natural, and also helps to cover up any rippling. However, this type of surgery is more difficult and more painful, so most American surgeons prefer to insert the implant over the muscle, in the breast tissue itself. This does however make them appear harder and less natural, and makes rippling more visible – hence the fact that American surgeons tend to overfill them, making them even harder.

One frequent side effect of submuscular placement is the reduction – or even elimination – of the natural ‘crease’ under the breast. You will often see this amongst the Japanese models who’ve had breast surgery (such as Sora). However, even though this is unnatural, it is often considered attractive, as it makes the breast look more youthful and ‘perky’. I certainly like it!

Different Insertions

Placing the implant over the muscle means having to cut into the breast itself, either around the edge of the nipple or along the crease under the breast. Hence, this results in visible scarring on the breast. However, submuscular placement allows the surgeon to insert them from another part of the body, usually the armpits (where the scar is very hard to see). Hence the fact that the Japanese models almost never have visible scarring on their breasts.

I hope it can be seen from all of the above why the Japanese models usually have softer, bouncier and more natural looking implants than most of the American models. So how can we tell if a Japanese model has implants? I’ve pointed out some of the signs in the Sora Aoi pic above. As an example of what I believe to be natural breasts, I refer you to my Saori Nanami pic below:

Saori Nanami

Note how her breasts not only flatten out when she leans back, but also change form. This is almost always associated with natural breasts. Even underfilled saline implants will tend to retain the same form, even if they move to the side and flatten out. This is probably the single most reliable way to tell if a model is natural or not.

There is a difference in the way smooth implants move around relative to natural breasts: the implant will tend to bounce about as a round ball, whereas natural breasts will undulate. However, with the relatively small, underfilled submuscular implants that Japanese surgeons prefer to use, it can still be very hard to tell the difference.

If you could feel the model’s breasts(!), you would know if they have smooth implants every time. However, textured submuscular silicone implants in particular feel almost completely natural, so even this method isn’t completely reliable!

Just one more thing: don’t trust a model when she says she’s natural, especially Asian models! Their promoters will often even come up with ‘growing up’ shots to ‘prove’ they are natural, but these are usually bogus: clothed breast pics can be very misleading!

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0 thoughts on “Breast Surgery 101”

  1. One of my ex-girlfriends had her breasts enlarged from a very (very) small A-cup to a large B-cup. I was (and still am) against all forms of implants if you naturally have a cup B or larger. For her it was more like a way to be normal instead of a way to stand out from the crowd.

  2. I got 95%!

    The one I did get wrong I wasn’t sure about: if I had more pics I probably would have gotten it right. Honest! 🙂

    When a breast is really small (as in the case of the one I got wrong), it is very hard to tell reliably. But in the case of small breasts, most people don’t care whether thay are real or not anyway! 🙂

  3. random question to you guys: if you look at my photos from Badboy’s post, what’s your judgement: do I have implants, or are my breasts natural?

  4. … I took the test too. I only got 90%, and that scares me a bit. I see a lot of breasts on the other girls in the clubs I work with. I thought I’d do 100%!!!

  5. Amazingly, as far as I can tell Anna actually is natural, although these days I can never be 100% sure. If so she definitely has one of the biggest pairs of natural boobs in Asia!

    I will be doing a post on her soon.

  6. Thanks for extra comments, guys. 😉

    Kudewa, that’s usually true, but not always. My breasts are larger than most japanese (but maybe average for American girls), but my nipples are smaller.

    But I dance with a lot of other girls, so I can compare a lot of natural & artificial breasts. Here’s a good example of big natural breasts with large nipples — her name’s Uruka Kitamura, she’s a model I dance with a lot when I tour in Tokyo:

  7. It is true that one of the things that SUGGESTS breast surgery is small nipples relative to the size of the breasts, but it is far from conclusive. It needs to be considered along with other lines of evidence. 😉

  8. When have breasts become such a hot topic? I guess it always has, huh?

    I personally think her breasts are natural. You know some Asians do have big breasts. My grandma and my aunt from my father’s side all have big breasts (D-DD range).

  9. I know some Asian girls have big breasts – that’s why I used Saori Nanami as an example of a naturally busty Asian girl. Sora Aoi most definitely is not natural, however.

  10. That Stacey Lee girl I featured recently hasn’t by the look of things, and I don’t think Naomi Cheung has either (yet). Beyond that I don’t really know. I’m sure many of them haven’t, but apart from the ones who obviously do have implants I’m not sure.

  11. Agreed on all counts, with the possible exception of Christine, but in her case the evidence isn’t clear one way or the other, so I’ll give her the benefit of the doubt. Not 100% sure about Sasha but she does look natural to me.

  12. Lee, if you saw this video taken relatively recently that I saw with Sasha Singleton fully nude, you would have no doubt that she doesn’t have breast implants. I also saw her in person live at the same HIN with Natasha Yi. She was actually in the same booth with Christine Mendoza.

  13. Hmmm, looking at Amy’s bubble bath pic I’m not 100% sure about her either. She certainly could be natural, but her breasts appear to have more ‘resistance’ to compression (in this case from Amy’s hands) than is usually the case for natural breasts.

  14. This is the sort of thing that would have most people absolutely convinced they’re natural, but I’m not certain. They could be smooth underfilled salines, but I’d need to see more to be sure.

  15. what what i gathered Honoka was at some point a real actress, who somehow jumped into japanese AV. a perfect girl, in my opinion – great body, face, eyes & those breasts!!! real, i’m inclined to think. Doc will figure out 😉

    by the way, Graphis is an amazing throve for pics of beautiful japanese women. mostly adult starlets & nude models.

  16. I believe that’s smooth, underfilled saline implants (the most common type in Japan). Interestingly, it’s only really obvious on her right breast – based on her left breast I couldn’t be sure.

  17. You are so right, Dr. Lee. Many JAV lovers still refuse to believe that Sora Aoi has fake’uns. I am an admitted perv who loves natural boobies, and I turned off the tv the first time I ever saw an Aoi vid because I knew without doubt they were fake the first time I saw’em.

    On the flip side, there are still a few very nice naturally breasted ladies out there. Reiko Yamaguchi, Maria Asakura, Maki Tomoda, for example.

  18. Yeah, the fact that many JAV lovers refuse to accept that a lot of the girls have implants is quite interesting. Especially are there are plenty of truly natural girls to choose from, some of whom are much bigger than Sora e.g. Anna Ohura or Miki Sawaguchi. Being truly natural, however, their breasts obviously aren’t as round and firm as Sora’s. I hate to break it to these guys, but big natural breasts are almost always a little saggy. 😉

  19. I am so glad I found this post…I’m spellbound..all these years I thought I was a breast man…

  20. Quite frankly, if you like Asian girls, I wouldn’t be worried about it – they really do not like them to be too large in my experience. Besides, it’s only really men who are obsessed with penis size – women are much more concerned about how you treat them.

  21. So I’ve read Dr’ Lee’s breast augmentation dissertation a few times on different occasions now, and I must say I enjoy the detail as well as his writing style.

    My question is if someone and his wife were starting to look at the pros-cons-and details of breast surgery, what would be Dr. Lee’s suggestion for the most pleasing resulting breasts (over/under, saline/silicon, textured/smooth, performed in US/overseas)? If it matters, lets say she’s a B now and wants to be a middle to full C.

  22. It really depends on what you want. Japanese style implants produce a very natural look and bounce, but not a very natural feel. The most natural feel will be provided by submuscular textured silicone gell implants. They will look quite firm, but trust me – they feel fantatsic! In fact they have this delightful “spring” to them that I like even better than natural breast tissue. This type of surgery is the safest medically as well, with the least chance of rupture and capsular contracture. It will be quite painful for your wife immediately after the operation though.

  23. Oh, and thanks for your compliments Nate! Most of the time I just get attacked by Japanophiles for bursting their “all Japanese girls are natural” bubble. 😉

  24. when motor city asked for the most pleasing resulting breasts, you recommended “submuscular textured silicone gell implants”. but in the article u pointed out tht silicone gel is less natural than silicone.
    as well, if textured= soft texture
    smooth implant= look soft so which one is better? can we discuss this via email? my email is thanks so much dr. lee! 🙂

  25. I tried to respond to your earlier email but it bounced. Anyway, non-gel silicone implants are no longer available, so they simply aren’t an option. I speak from personal experience when I say that textured, submuscular silicone gel feel the most natural, but they look firm. Smooth, over the muscle implants look more natural (bouncy), but feel odd (like a bag inside the breast). So it depends on which you want.

  26. Oh yes, a compromise that provides a fairly natural look and feel is smooth submuscular – this what Japanese surgeons use most of the time. But my personal preference is textured submuscular silicone, as they feel fantastic, and I actually like the firm, perky look. And perhaps most importantly, it is the safest option, and the longest lasting (with this type of implant, the owner doesn’t need to wear a bra).

  27. dr lee, do you have msn/skype/aol/email? may i please i contact you that way? i have no idea why my email isnt working for you. i apologize for that and the inconvenience made. i’ve been doing some research online and you are truly the most helpful and resourceful person i’ve found online. i sincerely hope you can help me out with the questions i still have. (and i would really prefer talking in private) thanks so much.

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