HOW TO CREATE BEAUTIFUL BREASTS
Everybody recognizes beautiful breasts, but just how do surgeons create them?
Breast surgeons are artists that understand that augmented female breasts must
have certain aspects and ratios for a natural and beautiful look.
Many patients start the breast augmentation
consultation by telling me what they don't want.
One of the most frequently described -- and thoroughly
rejected -- appearance is one often described by
prospective patients as two grapefruit halves, or two
half coconut shells, stuck to the women's chests.
Highly visible clues of breast augmentation include the
amount of cleavage, the degree of breast softness and
the natural profile. Actually, a well done breast
augmentation will enhance a woman’s natural cleavage, maintain the breast
softness and improve her breast profile.
But, with apologies to Sigmund Freud, what do women really want?
At least when it comes to creating beautiful breasts?
THE ART OF BREAST AUGMENTATION
Beautiful breasts can be created through breast augmentation with careful
planning, precise surgical technique and years of experience. Women want
natural-looking breasts, with an appropriate size, shape and feel that fits
harmoniously with their frame and anatomy. Anybody glancing at the finished
enhancements would think the woman's bosom was created, not by the surgeon's
hand, but by nature.
The perfect breast augmentation, according to one sculptor and admirer of the
classic female form, results in a breast that slopes gently down from just below
her shoulder bones to the peak of the breast at the nipple. That nipple should be
largely in the middle of a teardrop-shaped breast mound.
The most appealing breasts have some perkiness and gentle arcs that sweep
down from the nipple to the base of the breast, along with some natural cleavage
in which the breasts come together naturally over the breastbone, a long plate of
bone that physicians know as the sternum. When you look front-on, you should
see just a little rounded curve at the sides of the breasts - not enough bulge to
interfere with a golf or tennis swing or if you are into contact sports, a left jab or
Many breast augmentation patients have drooping breasts due to child bearing and
nursing – this reduces breast volume and stretches the internal supporting
ligaments. Many patients are a little older and the natural aging process has taken
its toll in a similar way. Some women are just born with less breast tissue and feel
their smaller breasts are out proportion to their bodies and self image.
I start the consultation by first listening to my prospective patient’s concerns about
her breasts – a most important step that many plastic surgeons forget. We talk
about the cup size, breast shape and what they don’t like about there breasts and
what they find attractive. We then examine and measure her breasts and
determine the amount of breast tissue and any chest asymmetry. I then take ten
separate measurements. For example, I measure the distance from the
breastbone notch to her nipples, the distance from the nipples to the center of her
chest and the breast width - a critical dimension.
Only then do we begin to discuss the variety of available implants.
Choices include size, three profiles of projection, (how far from the chest the breast will
project) and implant filler (saline or silicone). Implants can be partially or
completely filled. “Over-filling” will results in a breast that is slightly firmer to the
touch while an implant that is filled below the maximum will results in a softer breast.
Women have a choice of placing the implant over or under their chest muscles.
However, 95 percent of my patients opt for the under muscle position, a location
which offers many advantages
A critical part of our planning is determining proper implant size.
I help my patients determine the proper implant size well before she enters the operating room.
I ask the patient to try on the implants we have selected. She places the implants atop her existing
breast and snuggly beneath a surgical compression bra. This reveals a very close approximation of
the final breast size. The final breast size is usually seen several weeks after the breast
augmentation when the swelling is almost gone.
The Procedure – Creating the Beautiful Breast
When the moment of surgery is at hand, the surgeon’s planning; skill and
experience all come into play. The incision can be placed in one of two locations,
each about an inch long. The infra-mammary incision is placed under the bottom
of the breast where it meets the chest wall. The peri-areaolar incision is placed
just under the nipple along the dark ring of skin known as the areola. After
healing, both scars heal very well and will be very light and hard to see, if not
completely inconspicuous. I don’t place any external stitches on the skin and
prefer gluing the skin edges together for a very fine line scar.
Perhaps the most important aspect of the surgery is performed next – creation of
the implant pockets, which creates a space for the implants. The implant in its
pocket forms the “foundation” of your new breasts. The placement of the pockets
is everything when is comes to breast shape. It will determine the amount of
cleavage and breast fullness others see.
Creating a pocket requires a small release of the chest muscle called the
pectoralis major. This is a critical part of the breast augmentation which creates a
more beautiful breast shape. This technique requires artistic ability, technical skill
and as many years of training and hands-on practical experience.
Breast augmentation also requires a thorough knowledge of human anatomy. The
pockets are only an inches away from the lungs. And if the pockets are too far
apart, the patient will not have natural-looking cleavage. But if the pockets are
placed too closely, the area of the chest separating the two implants can give way,
allowing the implants to roll together and create what is known as synmastia or
a "uniboob." It's a flaw that is very difficult to repair.
Once the pockets are created, I fill the pocket with a long-acting local anesthetic.
This allows the patient to wake up with very little discomfort for several hours
after the procedure. I then roll the implant up like a cigar and slide it into the
correct position and fill it with saline. The procedure can take anywhere from 60 to
90 minutes. All patients are placed under general anesthesia for their comfort
during the procedure.
After the Operation
After the operation, patients usually have a little swelling and tightness in the
chest. But that's temporary and improves daily. The patient wears a surgical
compression garment for about six weeks afterwards to help her heal properly
and provide support for her new breasts. Most women can go back to work about
four days after the surgery.
Virtually all women with beautiful new breasts are thrilled at being able to fit into,
and fill out, clothes and bathing suits again like they did years ago. They also
receive a huge jump in self-confidence because they feel, and look, more feminine
and have a more balanced, womanly figure.
Daniel Reichner, M.D., F.A.C.S.