Breast Augmentation can be performed using a peri-areolar approach.  This is very practical, especially if a lift is also required.  It is my personal opinion that the major focus of breast augmentation should be the creation of a breast that retains the features of a full and natural breast.  Augmentation to sizes greater than DD will eventually result in physical and anatomic issues of neck pain and back pain, as well as impede the ability to exercise effectively.  Like the nose, there is also an ethnic context to breast augmentation. In addition, there is the physical context of the womans unique body shape and size that will frame the implants.  However, the most critical this is for physician and patient to realize that breast augmentation is a FOUR DIMENSIONAL operation.