A breast consultation at Ocean Drive Plastic Surgery is done in a friendly, pressure-free, and informative meeting with our Patient Care Coordinator and our Board Certified Plastic Surgeon, Dr. Alan Durkin. Our goal is to share our knowledge and expertise with you through conversation, examination, virtual simulation, “breast implant tryouts”, and to give you a tour of our facility. Dr. Durkin dedicates his time to meet with you personally to answer all of your questions, examine your breasts, and to discuss his surgical plan with you prior to any commitment from you. The process of a breast consultation takes around 1 hour, but will be customized to meet your needs.
It is very important to us that you are comfortable with our plastic surgeon, nursing team, operative plan, risks and anticipated outcomes, post operative recovery plan, and choice of surgical implant (when applicable). While some women have a rather precise idea of what they want to look like, other women are less certain and that is OK. It’s not necessary to know which type of lift you want or which implant size will be best on you. Dr. Durkin will help you make an informative decision by discussing all of your breast surgery options. Some women do find it helpful to bring photos of themselves when they were younger and/or photos of other women. Some women also bring in bras and bikini tops that they want to fit into, but it is not a requirement.
So, what does Dr. Durkin look for during a breast consultation and how does this information help you to make a decision about your breast surgery?
First, know that Dr. Alan Durkin underwent rigorous training to understand the fundamentals of beauty, anatomy, and how plastic surgery techniques can improve the female breast. To start, let us define the characteristics common to what is considered the ideal female breast.
There are a number of anatomic landmarks that Dr. Durkin use to maximize therapeutic results during breast surgery. First, he assesses your posture. Women with better overall posture tend to have more symmetric nipple positions. Any leaning or listing is immediately identified during your examination. Next, Dr. Durkin takes specific measurements of each breast. There are three fairly static surface landmarks that Dr. Durkin uses to quantify and analyze your breast:
- Sternal notch
- Xiphoid, or xiphisternal process
- Umbilicus (aka the belly button)
Evaluating the relationship between these three points gives significant information on overall posture, and allows Dr. Durkin to evaluate and compare one breast to the other. Next, measurements from the sternal notch to the nipple is taken on each side. The “ideal” distance is defined as 21-22centimeters, although depending on height, this can be variable.
Next, the overall shape and droop of your breasts are evaluated. The amount of droopiness the breast has is called “ptosis”. There are three grades of ptosis, named grade 1, grade 2, and grade 3. A simple way to think of ptosis is this:
Grade 1 – Your nipple looks at the eyes of people you talk to.
Grade 2 – Your nipple looks at the shoes of the people you talk to.
Grade 3 – Your nipple looks at your shoes throughout the day
Picking an implant Size
Example of Ptosis
After Correction of Ptosis
The importance of this evaluation cannot be overstated. Evaluation of the breast mound and ptosis is what Dr. Durkin uses to decide whether or not you require a breast lift.
Next, the position of the inframammary fold is evaluated. The inframammary fold refers to the point where your breast meets the chest wall. The position and integrity of the inframammary fold is always evaluated, and its position in relation to the gland and nipple-areolar complex markedly impacts how we manage the breast shape.
Finally, the overall shape of the breast gland itself is evaluated. In some cases, the gland itself has ptosis, but the nipple-areolar position is in normal position. In other cases, the nipple and the gland both show droop. Sometimes, only the nipple has ptosis and the gland is in appropriate position. All of these different presentations are evaluated during your breast consultation, and each type of presentation requires a different type of intervention.
For example, the two “normal breast shape” presentations shown above represent Grade I and Grade II ptosis of the gland and nipple. These patients are normally managed with dual-plane breast augmentation, and do not require any sort of lifting procedure. Conversely, patients with nipple and glandular ptosis normally require some form of implant placement in conjunction with a lollipop or anchor-type breast lift. Taken altogether, the analysis of the female breast goes beyond merely volume. It should appreciate and comprehensively understand the harmony of anatomy all ideal breasts have. While the ideal breast comes in many shapes and sizes, they all share common anatomic characteristics:
- Nipple areolar position facing above the inframammary fold
- At least 60% of the gland should be placed above the inframammary fold, with nipple position roughly approaching the level of the inframammary fold
- The two breasts should insert medially on the chest wall to create natural, but ample cleavage.