Beautiful breasts. Men adore them. Women often enjoy showcasing them in low cut cocktail dresses and revealing bathing suits. Make no mistake, breasts remain a preoccupation among the human condition. They are a symbol of femininity for the woman, an object of sexual attraction for the man, the staring point for fashion in many western cultures, and a source of erotic pleasure in the bedroom. Since antiquity, carvings, paintings, and sculptures have recognized the admiration of the beautiful female breast. Imperfections in their size, shape, symmetry, or proportion often have profound psychosocial effects on those who own them. Famed plastic surgeon Jacques Maliniac in his 1934 publication, "Sculpture of the Living" elegantly writes "To the girl who can never don an evening gown or bathing suit because of a gross abnormality of the breasts, her deformity is a tragedy indeed."

Of course, the erotic appeal of large breasts is not universal in time or place despite its pathological obsession among modern western cultures. For instance, among many African cultures that do not socially clothe the breast, the breast fetish just doesn't exist. Among the last one hundred years in American culture, recall the twenties' more ‘boyish' smaller chest fashion with the flappers. Following in the late fifties and early sixties big busted Marilyn Monroe and pin-up girls dominated the sexy scene. Paralleling this era was of course, the Barbie Doll obsession, where if fit to true human proportions, endows double Ds with a 39 inch bust line and 18 inch waist! Although there may indeed be some Darwinian, genetic wiring inside the male brain that flashes ‘big boobs are better', it may be argued that its innate signal power is far less dominant then our cultural influences given our historical breast preference ambivalence.

But what has been a constant is female breast development. It begins roughly between the ages of 9 and 14 with the emergence of a breast bud. By early adulthood, the breast occupies a large area of the chest with enormous variation among individuals. On average, this represents 300 to 500 grams in the Western world. The nipple and surrounding areola, too, range quite variably in size, and sit ideally at or above the breast fold yielding a ‘perky' appearance. Breast tissue is composed primarily of fat and fibrous tissue, the proportions of which vary from person to person. In heavier people, there exists a larger percentage of fat relative to the firmer, fibrous elements. As one ages, much of the fibrous tissue becomes displaced by softer, fatty tissue resulting in softer and often smaller breasts with loss of projection and perkiness. Pregnancy accelerates this process as many mothers can attest to their post-pregnancy breast loss. In addition, the areola complex enlarges with the natural stretch from the lactating breast. Unfortunately, there is no known compound available to eliminate or even retard the natural evolution of breast deflation and descent. The result is loss of the perky, youthful appearance enjoyed in early life.

Luckily, plastic surgeons are armed with several safe and effective techniques to restore youthful breast shape and volume. Sometimes, a breast augmentation alone with either silicone or saline can have a lifting effect as the breast is ‘filled' with volume, particularly when the implant is placed over the muscle or ‘subglandularly'. Many of my patients are surprised by the simple restoration of volume lifting the breast. The results are immediate and can be stunning as a once deflated breast is restored to its youthful shape and size. In cases where the breast is sagging which is termed ‘ptotic' (pronounced tot-ic), additional incisions on the breast or around the areola may be needed to redrape the breast and nipple to a higher position on the chest wall.

Aesthetic ideals tells us that the nipple should rest on a location on the breast higher than the breast fold. When it falls below this point, a breast lift, or ‘mastopexy' may be indicated to restore the perkiness of the breast lifting the nipple to a higher, more youthful position. Often with age and particularly after pregnancy, two things occur. Breast volume is lost and the breasts become ptotic. In situations like this, breast volume can be restored with an augmentation with an implant and lifted with a mastopexy. Depending on the complexity of each case, combination ‘mastopexy augmentations' can either be done in one surgery or staged in two procedures. The choice should be left for you to discuss with your surgeon, as surgeon preference for combining the procedures varies around the country.

Generally speaking, breast enhancing procedures can be done safely in the hands of a skilled plastic surgeon in an outpatient setting where patients go home the day of their surgery. Downtime is usually small.

In 2007, there were almost 400,000 breast augmentations, over 126,000 breast lifts, and over 150,000 breast reductions performed by plastic surgeons in the United States according to the American Society of Aesthetic Plastic Surgery. The numbers don't lie. Indeed, for many women beautiful breasts are not only an obsession, they are a priority. And they will likely continue to preoccupy our television, magazine, movie screen, and collective psyche, for many, many years to come. More information on aesthetic breast surgery can be found at The American Society for Aesthetic Plastic surgery website at www.surgery.org.

Story by Timothy Neavin, MD.

Timothy Neavin is a plastic surgeon at Beverly Hills Body in Los Angeles, California. He has written and lectured nationally on the topics of plastic surgery's influence on one's sex life, body sculpturing, and lectured nationally on the topic of injectables, and the safety of outpatient surgery.

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310.276.3183