“The Perfect Breast”!!

In the most recent publication of Plastic Surgery News (PSN), one of the articles was about a study published in the Journal of Plastic and Reconstructive Surgery. (PSN referenced a online publication that summarized the study at Shape.com )

The study asked, “What is the prefect breast shape?”.  The answer came from 1300 men and women who where asked to look at a series of breasts pictures.  The assessment concluded that the perfect breast shape had a distribution of breast tissue above and below the nipple of a 45:55 ratio.  That is 45% of the total breast volume was above the nipple and 55% of the breast volume was below the nipple.  A slight tear drop shape was also preferred.

I, like 95% of plastic surgeons polled agree with that ratio.  Having more breast fullness below the nipple is not hard to do.  Getting breast fullness above the nipple can be a little more problematic in some cases, especially after pregnancies.  A tear drop appearance is fairly routine with all types of implants.

I favor more the round implants than the teardrop shaped implants because most women I see lack upper pole fullness.  The tear drop shaped implants are volume weighted toward the Breast Implantsbottom and they have a deficit in the upper pole region of the implant (i.e they are flatter).  The final upper breast fullness is always the addition of the volume of the upper portion of the implant plus the volume of the patient’s tissue above the nipple.  I’ve never seen “too much upper pole fullness” in anybody over 25, before or after a breast augmentation.  After pregnancy it is very rare to have any tissue thickness in the breast’s upper pole.  This area is essentially flat.  This thin upper breast tissues cannot add very much at all to the 45% volume needed in the upper breast region of the “perfect breast”.

That why I prefer round high profile implants over the anatomic tear drop shaped implants in the majority of patients. (The images are from Allergan’s website.The top is an anatomic shaped implant, the bottom a high profile round.)

Most women bring more than their share of tissue below the nipples and they certainly don’t need much more.  (I do use other styles of implant depending on the shape of a woman’s’ breasts.)  I have always believed that women seeking a breast augmentation predominately want  three things.  Of course larger breast, but also better breast projection and upper pole fullness.  I haven’t had any woman ask me to make the lower breast bigger, with the exception of those with “tubular shaped” breast.  Even then a high profile round will usually fits the bill.

The perfect breast is not always possible and certainly over time does not last.  (Sorry, girls.)

In reality, it is not the “perfect breast” that we work to obtain, but the “perfect pair of breasts”.  A single “perfect breast” by itself on the chest wall is irrelevant, it’s a pair of “perfect breast” that we are after.  However, many woman don’t bring all the feature to the “table” that would resemble the “perfect pair of breast”, despite any implant shape.  The perfect pair of breast cannot be taken out of context with the chest wall features that “frame” them.  For instant, a woman may have a “perfect shape to her pair of breasts”, but may have a large gap between the breast.  This large gap is due to the fact that “you bring your own cleavage to the table”.  I can’t make cleavage if there is no tissue that covers the lateral portions of the breast bone (sternum) then a wide cleavage is normal.   The reason is that, if you undermine thin skin over the breast bone and that all the coverage you have over an implant, that is a mistake.  You will see implant issues if you do.  In a consult I have to be realistic with a patient about what I can and cannot do and what features may prevent them from having their ideal breasts.  (That is the problem with some of the “photographic breast enlargement simulation programs” that demonstrate what your breast will look like after a breast augmentation.  Wide sternums without overlying tissues will alway produce breast that have a wide cleavage.  Many times this isn’t apparent in those programs.)

The bottom line is that a “pair of perfect breasts” is what everyone is after not just a single breast that is perfect.  It’s an interesting study however.

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