What is the Ideal Breast?

Smaller or larger? Full cleavage or subtle cleavage? Pendulous or perky? More fullness in the upper pole or the lower pole?

Certainly, a matter of opinion. However, among patients presenting for a breast augmentation, there is a consensus. Most women prefer more fullness in the top part of the breast. This is despite the fact that the normal breast typically is fuller in the lower pole. We should not be too surprised, in view of the purpose of bras and corsets before bras, meant to augment the upper poles of the breast. Few, if any, Greek statues portray a sagging or deflated breast! Most women prefer larger breast sizes over smaller sizes. Of course, too much of anything can be detrimental, by definition, and very large breasts are undesirable to most women. The desired breast shape is parabolic in the upper pole, the shape of an umbrella held forward, and semicircular in the lower pole. Loss of fullness in the upper pole and excessive sagging of the lower pole are common complaints and universal ones, regardless of age, race, or culture.

No plastic surgical procedure has received as much public attention, and scrutiny, as breast augmentation.

Breast augmentation decreased in popularity in the early 1990's due to media attention regarding the safety of silicone gel implants, and the 1992 FDA decision to make silicone gel implants unavailable to women desiring cosmetic augmentation (but allowed back on the market in the United States in 2006). Breast augmentation has resumed its place as one of the most popular cosmetic procedures today, recently overtaking liposuction as the most popular cosmetic operation.

The procedure is not perfect and there are problems. However, even when complications are encountered, almost all women are still satisfied with their decision to have the procedure and would do it again. Fortunately, provided there is excellent communication and trust between patient and surgeon, almost all complications can be managed successfully. Very few women decide to have their implants removed and not replaced. These are usually older women who have had their implants removed and a simultaneous breast lift. But even this situation is unusual. Most women of all ages will have replacement implants. To this date, I have never had to tell one of my patients: "I'm sorry. We have to take out your implants and you cannot have replacements."

It is important for the surgeon to try his or her best to reach an acceptable outcome with implants because the alternative, "deflated" breasts, is unattractive. Excellent communication, trust, skill and patience are needed between patient and surgeon because revisions are not without risk, and several procedures may ultimately be required. Like a marriage, the patient-physician relationship is tested when there are problems.

The outcome is different from patient to patient, depending on what is there to start with. Human tissues are not like clay and this is the difference between a sculptor and a plastic surgeon. A plastic surgeon has to work within the limits of real materials (the nature of the skin, existing breast tissue, the shape of the chest, implants). Fortunately, there is a range of breast shapes that are aesthetically pleasing. A breast need not be perfect, and perhaps there is some advantage in not having every woman resemble a Barbie^™ doll. Although gross asymmetry is distracting and unappealing, small differences are well-tolerated. Within general guidelines, such as appropriate nipple level on the breast mound, more upper pole fullness than lower, and a tight lower pole, various breast shapes, even slightly pendulous breasts, can be attractive.

Breast augmentation – Usually a One-Way Ticket

Furthermore, most changes are one-way. There is simply no "back button" on the computer to push and get you back to where you were before. A breast augmentation creates irreversible changes by stretching the skin and breast tissue. However, the change is so pleasing that few patients would reconsider their decision. In our own survey, 99% of women would have the surgery again.