Breast enhancement surgery such as mastopexy and breast augmentation is supposed to provide results that look not just attractive but also natural and proportionate to the body frame.
But what is the ideal breast appearance and shape?
A recent study published in the September issue of Plastic and Reconstructive Surgery journal has suggested that the “perfect breast shape” is having an “upper pole to lower pole ratio of 45:55.”
The British researchers came up with the findings after conducting a survey involving more than 1,300 respondents who were asked to rank the attractiveness of the breasts images that were altered using Photoshop.
The researchers used photos of breasts of various sizes and proportions, which were digitally altered to have ratios of 36:65, 45:55, 50:50, and 55:45. The nipple area was the dividing line between the upper and lower poles.
The vast majority of respondents chose the 45:55 ratio as the “ideal breast proportion” in which 45 percent of the breast mound was above the nipple level and 55 percent was below it.
The respondents were categorized into groups based on age, gender, and ethnicity. The study also included 53 plastic surgeons.
Despite the demographic differences, the results were consistent, with 94 percent of plastic surgeons, 90 percent of men, and 87 percent of women in their thirties favoring the 45:55 ratio.
All the racial groups also favored the 45:55 ratio, while the 50:50 ratio came as a distant second choice.
But the researchers noticed that women over 40 were less likely to choose the 45:55 ratio than their younger counterpart (76 percent vs. 86 percent), concluding that the “more mature group” favored more fullness in the upper breast poles because it could be a “reflection of their own loss of projection.”
The findings have disproved the common belief about men preferring the “oversized or fake” look.
The researchers believe the findings will help plastic surgeons plan their surgeries, particularly breast augmentation in which implants are used to increase the bust size and/or correct the deflated upper poles.
They also believe the results can serve as an “aesthetic template” not just in breast augmentation but also in mastopexy or breast lift, breast reconstruction, and breast reduction.
In a statement, the researchers said the “desire for an overfilled and oversized [breast] look” of some women has more to do with how they would look in clothing, rather than achieving a natural breast proportion.
Many forms of breast enhancement surgery use incisions around the nipple-areola complex or NAC that could injure some of the nerves, which play an important role in breastfeeding that relies on stimulation and sensation. Nevertheless, there are ways to increase your success rate of “naturally” feeding your baby after surgery.
It is important to note that breast implant surgery is less likely to affect breastfeeding because it uses very short incisions and does not remove skin and tissue the same way as the breast reduction and mastopexy.
Meanwhile, breast reduction and mastopexy (or breast lift in layman’s term) could pose a higher risk of sensation-related problem that could mean more breastfeeding difficulties. However, there are ways to increase your rate of success.
These are some of the basic tips that could increase your breastfeeding success rate after a surgery:
* If you are considering breast augmentation with implants, ask for incision techniques that use your armpit, inframammary fold, or even navel because they cause very little nerve injury around the NAC.
On the other hand, stay away from the peri-areolar technique in which a U-shaped incision is positioned within your NAC if you want to breastfeed in the future.
* If your breast reduction is only for cosmetic reasons and not for physical relief from spinal curvature and back pain, you may want to postpone the surgery until you are done having children. The same thing applies to mastopexy, a surgical enhancement in which the drooping breast is reshaped and lifted.
* But if it is not possible to postpone breast reduction or mastopexy, ask your plastic surgeon about pedicle procedure in which your NAC remains attached to its donor site and is simply repositioned to a higher place without severing the original blood supply.
Take note that completely removing the NAC may cause severe damage to the milk ducts, breast tissue, and nerves that may limit your sensation and amount of your milk flow.
* Increase the timespan between your surgery and pregnancy. Studies have suggested that most women who had surgical breast enhancement were able to produce a decent amount of milk supply after five years.
Experts suggest most of the severed nerves are able to repair themselves over time, a process they call reinnervation.
* Contact a lactation consultant well in advance of your delivery. He or she can help you make a breastfeeding plan.
The traditional way to perform mastopexy, or more commonly referred to as breast lift surgery, is through an inverted-T scar pattern in which the incisions go around the nipple-areola complex, from the bottom of the nipple to the inframammary fold, and within the “natural crease.”
The standard breast lift is reserved for patients with poor skin quality, noticeable amount of drooping (e.g., NAC falls far beyond the inframammary fold), and breasts that are on the larger side.
With the rather extensive use of incisions in the standard technique, some women choose to undergo a modified form of breast lift that results in shorter scars and possibly quicker recovery.
A technique called donut breast lift, which is also referred to as Benelli mastopexy, only uses incisions around the NAC where the scars can heal and blend well. But despite the apparent benefits in terms of the scar appearance, the procedure is not for someone with a true case of breast ptosis or drooping, explains leading body contouring expert Dr. Tarick Smaili.
In essence, a donut lift does not lift the tissue itself but rather only reposition the NAC by 1-2 cm on the breast “mound.” For this reason, the vast majority of women asking for mastopexy will not benefit from this technique and in fact may even lead to deformity especially in the upper aspect of the breast.
Another common problem with the donut lift technique, according to Dr. Smaili, is that over time the nipple area has the tendency to expand.
Nevertheless, for a few patients with pseudo-ptosis—i.e., the NAC is at the level of their inframammary crease—a donut lift may be an option. In some cases, it is performed in conjunction with breast augmentation, which provides additional volume and potentially some lifting effect.
For most breast lift patients, the renowned surgeon says that internal re-arrangement and tightening of the tissue is the ideal choice because it results in a highly predictable breast shape, which is achievable with the use of standard technique and vertical lift.
With vertical lift the incisions go around the NAC and vertically between the nipple and inframammary fold, leading to a lollipop-shaped scar, thereby it is also referred to as a lollipop lift.
The vertical incision allows the surgeon to tighten a good amount of breast tissue and skin, and in fact may favor patients who have a markedly wide breast, says Dr. Smaili.
And by eliminating the horizontal incision within the inframammary crease, the plastic surgeon says the vertical lift tend to result in quicker recovery than the standard approach.
Breast reduction surgery or reduction mammaplasty is commonly performed to eliminate or at least minimize the physical symptoms related to overlarge breasts such as rounded shoulders, poor body posture, systemic discomfort, and spinal curvature. Nevertheless, some patients also ask for the procedure for cosmetic reasons.
Due to its weight that weakens the ligaments and stretches the skin, an overly large breast is prone to sagging than a smaller one. For this reason, some patients expect that reducing the amount of soft tissue could also lead to a perkier appearance.
But could breast reduction create some lifting effect, which in essence, is the goal of another procedure called mastopexy or lift surgery?
As a stand-alone procedure, breast reduction could create an illusion of a less saggy breast. Nevertheless, the ligaments and tissue still need some tightening to further achieve a perkier look.
Fortunately, reduction surgery and mastopexy share the same incision sites so in many cases it is even considered cost-effective to combine them in one surgical setting. However, the approach could lead to a longer operative time because the deeper tissue needs some tightening and possibly internal sutures.
For patients who need the most amount of correction, breast reduction and mastopexy require the use of an anchor-shaped incision pattern wherein the scar runs within the inframammary fold (breast crease), around the edges of areola complex, and vertically between the nipple and crease.
To further create an illusion of a firmer, perkier breast, it is often necessary to reposition the areola complex to a higher area. The general rule of thumb is that it should lie at the center—or at least near center—of the breast mound.
While a modified form of breast reduction can address the saggy appearance, it is important to note that all types of breast enhancement do not stop the natural aging process of the skin and soft tissue. But with smaller, lighter breasts at least the patients can postpone the “drooping syndrome.”
Meanwhile, it is possible to prolong the lifting effect of any breast enhancement surgery. One way to do this is by maintaining a healthy, stable weight through regular exercise and balanced diet.
Many experts also highlight the importance of regular use of supportive bra, especially when one is doing sports and exercise. In essence, most of the support should come from the band rather than the shoulder straps, while the cup should completely cover the breast mound.
The position of nipple-areola complex or NAC plays an important role in creating natural-looking results with breast enhancement surgeries such as augmentation with the use of implants, reduction mammaplasty, and mastopexy or breast lift.
Currently, breast augmentation is the most commonly performed breast enhancement surgery in the US. While recent development in fat graft technology allows doctors to use their patients’ own fat to increase the bust size, breast implants still remain the standard approach because they provide “larger” augmentation.
But breast augmentation is not only about placing implants on top of or behind the pec muscle. For many patients, their NAC should also lie in a way that the overall results look natural.
But what really constitutes natural-looking breast?
Leading plastic surgeon Dr. Tarick Smaili says the NAC should lie at the center—or at least near center—of the breast mound. For this reason, some patients may need a modified form of mastopexy or breast lift performed in conjunction with their surgery to achieve a more balanced appearance.
Breast ptosis or sagging is not only exhibited by tissue laxity but also low-lying NAC that needs to be repositioned to a higher place. It is important to note that using implants alone without addressing some of the underlying problem could lead to poor aesthetic results including “double bubble” wherein the soft tissue looks herniated on top of the prostheses.
In mastopexy-alone procedure, the position of NAC remains an important issue. Aside from raising it slightly above the inframammary fold or breast crease, the renowned surgeon says that some patients can also benefit from size reduction to further create a more balanced appearance.
Meanwhile, there is some concern with reduction mammaplasty’s potential effect on the appearance and position of NAC. According to a recent report, lateral displacement of the areola complex has the tendency to become more obvious after the procedure.
To prevent or at least minimize the appearance of lateral displacement of NAC, the consensus among skilled plastic surgeons is to make sure the vertical pattern incision encompasses the entire area between the areola and inframammary crease.
Older women, due to their skin laxity, generally need tightening of the tissue possibly with the use of internal sutures to prevent lateral displacement of their NAC—regardless of the type of breast enhancement they will have.
Aside from NAC, some women also need their inframammary fold to be readjusted to achieve a more natural look.