Breast size and shape play a very important role in our culture. Functionally the primary purpose is clear and obvious and that is to provide nutrition to newborn babies to help them grow big and strong and healthy. That is the essence of their purpose – – functionally.
However, culturally the breasts play a far more inclusive and diverse role psychologically, fashionistically, and sexually.
Breasts come in a variety of sizes and shapes. And throughout the adult world various sizes and shapes have flexible and diverse appealability. That is a nice way of saying some people like large breasts, some people like small breasts, some people like breasts in between.
Also, large pendulous breasts have some followers as well. As plastic surgeons we are routinely confronted with and faced with breasts of all types. Furthermore we get to discuss different tastes and breasts size and shape. These discussions during consultations usually take place with couples. The consultation process begins with the doctor reviewing the medical history documents that the patient provides.
Information Gathering
I must discuss very personal information in order to provide the safest most efficient and effective care. Therefore, I must discuss information such as medical history, medications, and past surgeries. Once I determine if a particular patient is suitable for plastic surgery we get to the specific reason they are here. If it’s for breast surgery initially, I must do a complete and thorough breast exam to check for any abnormalities both within and on the surface of the breast. Next I measure distances.
The first measurement is sternal notch (where the collarbones meet). Distance to the left nipple, then distance from sternal notch to the right nipple. Back in the day some inquisitive plastic surgeon did a study to determine the ideal and best looking breast. A distance that essentially makes up an equilateral triangle is the result. The distance from sternal notch to right nipple equal the distance to left nipple equal the distance between the nipples.
Western culture says this combination of distance gives us what most of us believe to be the best looking breasts.
Size Matters
Small to medium breasts rarely need a lift, and these distances are usually accurate and spot on. As the breasts get larger and the nipple distance increases the idea of a lift becomes more apparent and necessary.
So the essence of the decision making process is this: does the skin have a significant relationship to the inside tissue so the breasts look their best. As a plastic surgeon I often have to enlighten a woman that she has more skin than is necessary to produce the best looking breasts.
Larger or Perky Breast Size and Shape?
I ask a woman to show me how she creates the breast size and shape she wants on her breasts. Invariably the woman who lifts her breasts and says I want them up here needs a lift. Alternatively I ask a woman to choose one word – larger or perky.
The lift patient will almost always say perky. Therefore this patient has made the wrong diagnosis – the treatment to achieve her goals is a mastopexy or Breast lift. Now that wasn’t too difficult and pretty straightforward. What comes next can be challenging. In order to achieve this lift we must do a very specific surgical procedure requiring an incision around the areola, vertically down to the infra-mammary crease, and horizontally in it. This produces an up side down T. In my opinion this is absolutely the best way to achieve a breast lift.
There are situations where a 1 to 2cm elevation is the requirement for breast size and shape and in this case there are more conservative procedures to achieve this goal.
Breast Surgery Facts
The nipple is not removed – I repeat the nipple is not removed it is repositioned but remains attached, this is the magic of the plastic surgeon.
I can adjust size either by removing excess breast tissue or adding an implant – usually some muscular.
I do not use drains.
Scars are permanent but usually they do fade somewhat.
One of the biggest mistakes is to try and insert too large an implant in which case you compromise on the lift. In my opinion this should be avoided.
With or without implants this procedure is done as an outpatient – with regular office follow-ups.
A real or diameter can be controlled to varying degrees.
Lift patients most always have excessively large aureoles which I can reduce.
The goal is to achieve perky full attractive breasts that meet the patient’s expectations and goals.
Post operative activity including sex needs to be curtailed.
I always advise patients not to shop for price. Your body is not only your temple but it is valuable and the only one you have…
I trust only someone who has respect for that value and the knowledge and experience and skill to deliver your best possible result – safely.
Plastic surgery is a performing art requiring a great degree of creativity and anatomic knowledge to create your ideal breast size and shape.
The best know their worth and convey it to you.
Be happy, be healthy and make your best choice – – and choose to be your best in all things!
