Breast Practice

By: Mr Patrick Malluci
Created on 19th June 2011

When top cosmetic surgeon Patrick Mallucci was asked to prepare a lecture on breast augmentation for trainee surgeons, little did he know he was about to change the face of breast surgery for good

In 2007 I was asked to give a lecture to some trainee plastic surgeons on breast augmentation. I wanted it to be something they would remember so I spent a long time trying to think of something that was new and different.

It occurred to me that it might be interesting to conduct some research into what constitutes the ‘ideal’ breast – many studies have been performed to assess the dimensions of the perfect nose, or the face, the results of which are then used by surgeons as a template to work towards, and I didn’t recall ever having seen anything similar for the breasts.

I started to look into it, and believe it or not, if you look at the medical literature a lot of vague things have been written on the subject, but no one has ever done the maths and come up with anything specific. So I had the idea for my talk – the problem, of course, is how to put that theory into practice.

It is always difficult to be objective about beauty; you need to look at several different subjects that you know are considered to be attractive, and that’s a lot easier with faces than it is with breasts!

However, I remembered someone telling me once that the Sun has a rule that says their page three girls – who are of course selected because they have attractive breasts – are not allowed to be surgically enhanced. So I figured that if these are all natural breasted women, chosen by a panel on the basis that they have nice breasts, then maybe they should be the subjects of my study.

I then asked the question, is there something about their breasts that links them all and makes them attractive. You’re able to recognise that that’s an attractive breast, but it’s difficult to articulate what it is that makes it attractive.

So we looked at 100 different models and we took various measurements from the photographs and compared them, and it turns out there are four key elements (see below) which link them all, and if you’ve got those four elements then you’ve essentially got an attractive breast.

But more interesting than that from a surgical standpoint is that the further you deviate from those four elements, the less attractive your breast. The fascinating thing about these findings is that a breast’s attractiveness actually has very little to do with its size.

So long as the four key elements are present, it is possible to have a very attractive small breast, and if any of these are missing, it is equally possible to have an unattractive large breast.

It is important in plastic surgery to have a goal to work towards. With these four elements to use as a yardstick, it is possible to come up with an objective assessment of the breast, both before and after surgery.

For example, you can state that it is improved after surgery, because the proportions of the upper and lower poles are better, or the nipple angulation is better. Or, conversely, you can see when someone has done a botch job and actually made things worse.

Whether I’m performing a breast enlargement, uplift, reduction or even a reconstruction, these findings serve as a template for me to base my surgery on. You’re always trying to make the breast look as natural and as attractive as possible, and this research allows us to do that more easily.

I have presented the findings from this research all over the world, and it has been very well received by surgeons. There will always be people who say that defining the ‘ideal breast’ is just another thing for women to have a complex about, alongside the trend for size zero models.

But I think the really positive thing about this is that it’s moving away from the notion that an attractive breast is one that’s been inflated with implants. This is the era of shape, rather than size, and interestingly a lot of women don’t understand that distinction until you point it out to them.

Having done this research, I am able to give my patients beautiful breasts, without necessarily inflating them beyond recognition. There is a very fine line between enhancement and distortion, and without some sort of measuring stick it is very easy to cross that line.

The Fab Four

The 45:55 ratio

If you look at the breast side on and draw a horizontal line from the nipple, that’s known as the ‘nipple meridian’. The 45:55 ratio refers to the amount of breast above and below that line. The part below the meridian is known as the ‘lower pole’ and that should always be fuller than the upper pole (above the meridian)

Nipple angle

The second thing is that the nipple should generally be upwards pointing, at an angle of about 20 degrees from the meridian

The upper slope

Then we come to think about the slope of the upper pole, and that should always be either straight or slightly concave

The lower slope

Number four is that the lower pole should be convex. That may seem obvious, but there are conditions which give you straight or indented lower poles and that creates a very awkward shape