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4 Key Components of Aesthetic Breast Perfection

The annals of art history have been graced by the depiction of women with exquisite natural breasts through sculpture, painting, and photography. Nevertheless, the plastic surgical literature has, until recently, lacked substantive data to establish an objective standard for the aesthetic dimensions of breast shape and proportion. A fundamental aspect of aesthetic surgery involves comprehending the ideals of bodily aesthetics, providing a framework for interpretation, manipulation, and modification to achieve a predetermined aesthetic result.

The origins of aesthetic ideals trace back to the Greeks and Romans, who first endeavored to define standards of beauty and proportion. Plato, for instance, likened human proportions to the ideal columns of a Greek temple, while Vitruvius, a Roman author and architect, expounded on ideal human and facial proportion. His writings laid the groundwork for Leonardo da Vinci's Vitruvian Man, incorporating geometric principles to correlate human shape with perfection.

Recent literature has extensively explored aesthetic norms in various anatomical features, such as the face, orthognathic angles, and nasal proportions. Notably, Gunter and colleagues established a template for basic nasal ideals, providing a "map" for aesthetic rhinoplasty. However, while much has been written on breast form, it has not been subjected to precise definitions of beauty, often relying on vague terms like proportion, harmony, shape, and flow, which lack objectivity. Unlike other anatomical features, breast aesthetics have eluded precise definition until now. Previous attempts, such as the "Penn triangle," have provided measurements but failed to encapsulate the holistic beauty of the breast.

Studies by Hauben and colleagues and Fabié and colleagues explored breast-nipple-areola proportions but found no conclusive correlation with attractiveness. A limited study by Hsia and Thomson delved into breast profiles, revealing differences in preference between surgeons and patients. This underscores the importance of breast profile as an assessment parameter, even though the study's scope was small. To address this gap, a study try to compared this two studies – an observational analysis of 100 models with natural breasts and a population analysis involving 1315 respondents. From the first study, four key features defining breast attractiveness were identified, with the upper pole to lower pole (U:L) distribution, specifically the 45:55 ratio, emerging as a crucial observation. This ratio challenges conventional notions, emphasizing that a slightly fuller lower pole contributes to an aesthetically pleasing breast.

The significance of these findings lies in the formulation of an "aesthetic template." This template can serve as a guide for surgical planning and implant selection, facilitating a deeper understanding of aesthetic goals and ensuring that deviations from these norms result in less attractive outcomes. The quest for defining and understanding breast beauty takes a step forward with these objective parameters.

What is the Ideal Breast? To find out what is the ideal breast, a study titled Shapes, Proportions, and Variations in Breast Aesthetic Ideals: The Definition of Breast Beauty, Analysis, and Surgical try to compare and analyze aesthetic ideal of the breast in 2 studies: an observational analysis of 100 models with natural breasts,14 and a population analysis with 1315 respondents. The Definition of Breast Beauty, Analysis, and Surgical undertook a comprehensive exploration. The study was conducted through two distinct yet interrelated investigations: an observational analysis involving 100 models with natural breasts and a population analysis encompassing 1315 respondents.

The initial phase of the firsts research involved a meticulous examination of 100 consecutive topless models with natural breasts. These models, sourced from the Sun newspaper's website—an entity recognized for its extensive global circulation and exclusive depiction of topless models without prior aesthetic breast procedures—formed the basis of our observational analysis. The aim was to identify patterns and features common to these natural breasts, serving as clear indicators of attractiveness.

Simultaneously, the population analysis engaged 1315 respondents, further enriching the understanding of diverse perceptions and preferences regarding breast aesthetics. By integrating these two studies, the study sought to establish a comprehensive and nuanced definition of breast beauty that transcends individual preferences and aligns with objective parameters.

One standout observation from the research was the identification of the upper pole to lower pole (U:L) distribution, commonly known as the 45:55 ratio. This ratio challenged conventional notions, defining the lower pole as consistently slightly fuller than the upper pole—a fundamental departure from traditional ideals that prioritize fullness in the upper pole following breast augmentation.

The overarching significance of the study's research lies in its potential to contribute to the formulation of an "aesthetic template." This template could serve as a valuable guide for surgical planning and implant selection, offering a nuanced understanding of aesthetic goals. By combining observational and population analyses, our study aspires to provide a comprehensive and evidence-based definition of breast beauty, empowering both surgeons and individuals seeking aesthetic enhancements with a clearer path toward achieving aesthetically pleasing outcomes in breast surgery.

This study unveils a refined "aesthetic template" for the ideal breast, comprising distinct elements that contribute to an aesthetically pleasing outcome. These 4 key components include:

1. Upper Pole to Lower Pole Ratio (U:L): Optimal Ratio: 45%:55%

A slightly fuller lower pole compared to the upper pole, creating what is termed the "45:55 breast." This ratio challenges conventional ideals, emphasizing a nuanced distribution that enhances aesthetic appeal. Breasts with a U:L ratio of 45:55 were universally scored highest, notably by: 82% of women overall, 87% of women in their thirties,  90% of men, 94% of plastic surgeons, 92% of North Americans, 95% of South Americans, 86% of Europeans, 87% of Caucasians, and 87% of Asians.

2. Nipple Orientation: An upward inclination with a mean angle of 20 degrees. Nipples that point skyward, contributing to a visually appealing breast profile.

3. Upper Pole Slope: Straight to mildly concave slope The upper pole characterized by a straight or gently concave slope, adding to the overall aesthetic harmony of the breast.

4. Lower Pole Convexity: Tight convexity in the lower pole A defined and taut curvature in the lower pole, enhancing the aesthetic attractiveness of the breast.

What is the measurement to achieve the ideal breast?

The determination of the new fold position for a given anatomical implant involves a calculated approach. This calculation is known as the Ice Formula. The formula for this calculation is expressed as follows:

(Implant height/2 + projection)−(Existing capacity (nipple-IMF on maximal stretch)) = Excess skin required or distance by which IMF needs to be lowered

This can be represented as: I=C+E where (I)represents implant dimensions (height + projection), (C) is the capacity of the lower pole (nipple-IMF on stretch), and (E )signifies the excess skin required in the lower pole, corresponding to the lowering of the IMF.

As an illustrative example, consider an anatomic implant with a height of 10 cm and a projection of 5 cm. If placed at the midpoint of the nipple-areola complex (NAC), the vertical height below the NAC is calculated as 5 cm + projection of 5 cm, resulting in a total of 10 cm of skin required below the NAC.

If the nipple to IMF distance on stretch measures 8.5 cm, the degree to which the fold needs to be lowered is determined by the formula I = C + E, leading to E = 10 - 8.5 = 1.5. In this context, 1.5 cm represents the excess skin required or the degree to which the IMF needs to be lowered.

When I and C are equal, E = 0, indicating that the IMF does not need to be moved, as the breast capacity aligns with that required for the selected implant. If I - C = 2, it implies that the fold needs to be lowered by 2 cm. The decision to lower the IMF by this extent involves clinical judgment, considering factors such as avoiding a double-bubble deformity. If this adjustment is deemed excessive, it suggests that the wrong implant has been selected, and a smaller implant with reduced height and projection should be considered, ensuring that I - C = 1 or less. This nuanced approach allows for precise customization in selecting implants and adjusting fold positions to achieve optimal aesthetic outcomes in breast augmentation procedures.

How to measure it?

The picture above provide a clinical example illustrating the application of the ICE formula. In this instance, an anatomic implant with a height of 10.6 cm and a projection of 4.6 cm was utilized, resulting in an implant meridian to the lowest aspect of the implant height of 5.3 cm. Given that anatomic implants are concentrated in the lower pole and are placed at a 50:50 ratio, the nipple to IMF distance under stretch was 8.5 cm.

The ICE formula calculations for this case involved determining what was needed (I), what was available (C), and the extra skin required (E). The results showed that the IMF needed to be lowered by 1.4 cm, as calculated by IC=E. This adjustment was precisely executed during the surgery, as evidenced by intraoperative and postoperative photographs where the scar aligns accurately with the IMF.

This meticulous approach to both formula application and photographic documentation enhances the reliability and clinical applicability of the ICE formula in determining optimal IMF position in breast augmentation procedures. The study's rigorous methodology and detailed analysis contribute valuable insights to the field of aesthetic surgery.

How to achieve the Ideal Breast with Implants?

  • Saline-Filled Implants

Since the FDA approval of silicon gel implants, there has been a notable shift in the choice of breast implants, with a significant decrease in the use of saline-filled implants and a concurrent increase in the utilization of silicone gel-filled devices. In 2009, less than 30% of breast implants used for augmentation were saline-filled. This rapid transition from saline to silicone gel-filled implants is attributed to several factors, including the perceived more natural feel and appearance of silicone gel-filled implants. Additionally, silicone gel-filled implants have been associated with fewer issues related to rippling and puckering, further contributing to their popularity. Concerns over the long-term safety and durability of the newer generation silicone gel-filled breast implants have also diminished, contributing to their widespread acceptance in breast augmentation procedures.

  • Silicon Gel Implants

Since the FDA's approval, there has been a notable shift in the choice of breast implants, with silicone gel-filled devices gaining prominence over saline-filled ones. In 2009, less than 30% of breast implants used for augmentation were saline-filled. The reasons for this shift include the perceived more natural feel and appearance of silicone gel-filled implants, along with fewer issues related to rippling and puckering. Moreover, diminished concerns over the long-term safety and durability of the fourth-generation silicone gel-filled implants have contributed to their increasing acceptance.

The fourth-generation silicone gel-filled implants, distinct from those subject to the 1992 moratorium, feature thicker, stronger low-bleed shells and a more cohesive silicone gel filling. These improvements have resulted in a lower implant failure rate, with only 3.5% of patients experiencing failure at six years. Patient satisfaction rates surpass 95% three years post-augmentation, and reoperation rates range from 4.8% to 28%, with an average of 15% within three years. Common reasons for reoperation include capsular contracture, patient requests for size changes, and implant malposition, with implant failure/rupture being the least likely cause. Patients with fourth-generation silicone gel-filled implants are enrolled in FDA-approved studies, with continued follow-up for ten years from the time of implantation. Projections suggest that silicone gel-filled breast implants will dominate nine out of every ten breast augmentation procedures in the foreseeable future, aligning with trends in other developed countries that were never subject to the silicone gel-filled implant moratorium.

  • Gummy Bear Implants

In 1994, the McGhan Company (later Inamed, now part of the Allergan Corporation) introduced a groundbreaking innovation in breast implants with the launch of the first "fifth-generation" implant, known as the Style 410 implant. Initially widely used in other countries, this implant is currently undergoing evaluation in FDA-approved studies in the United States. Distinguished from its predecessors in various aspects, the fifth-generation implants are filled with an enhanced cohesive silicone gel featuring significantly increased cross-links in the silicone matrix. This unique composition provides these implants with a distinct feel often referred to as the "gummy bear" implant, akin to the texture of gummy bear candy.

One of the remarkable features of the fifth-generation implants is their "form-stable" nature, meaning they maintain their shape irrespective of their position. This quality addresses a historical challenge faced by earlier attempts to develop shaped, anatomic breast implants, where filling materials lacked the necessary stability, resulting in distorted or misshapen breast appearances.

The concept of anatomically shaped breast implants became feasible with these implants, as they resist tissue forces within the breast pocket, ensuring shape maintenance. This marked a paradigm shift in implant selection, moving away from reliance solely on volume and introducing a novel approach known as the "Biodimensional Method." These implants involve various dimensional choices, such as full height, moderate height, or low height, coupled with width and projection options based on the patient's breast width and tissue laxity. Control of the implant's orientation is crucial for the success of anatomically-shaped implants. These implants promote tissue adherence and minimizes implant rotation. Surgical precision in pocket size dissection and minimizing fluid accumulation around the implant further ensures minimal incidence of rotation.


Shapes, Proportions, and Variations in Breast Aesthetic Ideals: The Definition of Breast Beauty, Analysis, and Surgical Practice (2015)

Concepts in aesthetic breast dimensions: Analysis of the ideal breast (2012)

Population analysis of the perfect breast: a morphometric analysis (2014)

Differences in breast shape preferences between plastic surgeons and patients seeking breast augmentation (2003)


Discover the Science behind Breast Augmentation & Breast Lifting

in our upcoming Aesthetic Breast Augmentation & Breast Lifting Mini Fellowship happening globally:

IFAAS Mini Visiting Fellowship (Observation)

Korean Advanced Aesthetic Surgeries:

Aesthetic Breast Augmentation & Breast Lifting

Mar 25-26, 2024 - Seoul, South Korea - [Register Now]


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