Dr. Patrick Mallucci is a leading Consultant Plastic Surgeon based in Chelsea and Kensington. This interview is part of a larger article on cosmetic breast surgery, entitled 'Do I Really Need Surgery? An Unbiased Cross-comparison With 3 Of The World’s Best Plastic Surgeons.' The article also features advice from Dr. Dan Marsh and Dr. Raj Ragoowansi so, if you are considering cosmetic surgery, we highly recommend reading it.
1. How do you feel the field of cosmetic breast surgery has changed in the past 5-10 years?
The biggest change is that we’re focusing more on understanding what breast attractiveness actually is. The 80s and 90s, even the 2000’s, were called the Volumatic Era. People were mainly concerned with pumping breasts up but paid little thought to the attractiveness of those breasts. However, nowadays, more people are realizing that the assumption that big is beautiful is not only wrong, but it’s also highly outdated. Adding too much volume in the form of an implant to a breast, especially a small breast can distort it and that distortion generally produces an ugly result. Understanding the concept that it’s the shape of the breast that counts, not the size has been revolutionary.
However, as much as increasing numbers of women are realizing this, it still surprises me that so many women focus the initial parts of their consultations on the cushioning and the size, so perhaps women don’t understand this. They think that changing the size automatically fixes the shape but they’re two different things. It’s only when we start discussing it that it suddenly makes sense on them, and I think that understanding this concept is definitely influencing their decisions on they type of breasts they want and also how they feel about themselves; they become much more confident and reassured in their decisions which, with something as major as surgery, is very important.
‘I always say to women that ‘It’s not big breasts you want, it’s nice breasts.''
‘To design the perfect breasts, we first need to consider the individual woman’s body frame, lifestyle and reasons behind the surgery. The ‘perfect breasts’ will be different for each woman so we first need to understand what makes a nice breast, and then try to translate that into surgery to recreate it.’
2. How do you know which breasts are best for your proportions?
We conducted a population study - the largest one ever conducted - that established 4 main parameters equating to breast attractiveness, and published the findings in literature. The 4 parameters constituting breast attractiveness were:
1. The volume distribution of the breasts between the upper pole (i.e. above the nipple) and lower pole (i.e. below the nipple). We found that, paradoxically, attractive breasts have more volume below the nipple than they have about it.
2. The nipple should point skywards.
3. The curvature of the lower pole should be a nice tight convex curve.
4. The upper pole slope should be either a very straight line or very mildly concave, not convex.
‘That’s very interesting because a reason why many women have surgery is because they lose fullness in the top of their bust so to know that they don’t have to enlarge that area too far and that there is a fine line is an important factor, and something that they don’t necessarily realize.’
3. How have the treatments and techniques available changed?
The standard treatments have stayed the same. They’re still implants. However, the style and shape of the implants, where they’re positioned and the techniques used to insert them have changes. People now know that the idea that implants have to make you look like Jordan [Katie Price] is completely wrong.
Implants. Even though the implants themselves are standardized, woman can almost tailor the look of their breasts in any way they want to. Implant selection is very important and, again, very important for women to understand. There are very small implants, very large ones, different shaped implants etc. For example, using the anatomical implant (or the teardrop implant) is far more conducive to producing that nice shape that we discussed above.
Fat Transfer. The only other way to improve bust size, if you don’t want to use an implant, is the use of fat and fat transfer. However, it’s actually quite rare to use fat alone. Often women will opt for a combination of the two; mainly because they very few women’s bodies meet the conditions required to just use fat. Moreover, fat transfer is very useful but it’s also slightly unpredictable. I can’t guarantee you anything with fat. For example, if you say to me ‘I want to be a cup size bigger’, I can’t guarantee that. During the transfer some fat is lost so you always need to over compensate with the amount extracted and inserted. It also depends on the amount of fat you have available and its composition so, it might be possible for you to achieve that extra cup size but, simultaneously, it might not.
Combination Treatment. It’s becoming increasingly popular for women to opt for Composite Breast Augmentation. Instead of relying on the implant to recreate volume, we can use a combination of implant and fat transfer. For example, by using a slightly smaller implant and adding some fat on top of it, it creates a natural feeling and looking breast, with better skin condition (i.e. less stretched skin, better retained skin elasticity and quality) and greater longevity. As a rule, the more of you there is, the better.
‘One of the motivations behind the latest generation of lightweight implants is women who like to exercise; who want better breasts but, at the same time, still want to lead an active lifestyle, performing high-impact activities without the breast dropping. B-Lite implants are 30% lighter than standard silicon implants, and facilitate better movement, mobility and reduced impact of weight on the breast’
DID YOU KNOW… After surgery, there’s a 6-8 week settling in period where you need to avoid any strenuous exercise or activity, particularly of the upper body?
4. What are the most common reasons given by women considering cosmetic breast surgery?
Increasingly today, the majority of women who visit me are in their 30s or 40s, and post-pregnancy mums who had reasonable boobs pre-pregnancy but have since lost them all (in size or fullness) or they’ve gone south. They’re simply looking for restoration of what they’ve had. They don’t want to be page 3 models or porn stars. They just want to be able to feel confident again, to wear pretty dresses without worrying or perhaps not have to wear a bra. They’re looking for a natural look, with many not wanting people to realize they’ve had surgery at all.
‘The Gold Standard Breast: When you can wear a bikini, feel good on a beach and people won’t be pointing the finger at you, saying ‘She’s had a boob job.’ That’s most women’s ideal.’
5. In terms of breast changes, everybody always talks about augmentation but less is said about reductions. What’s the best form of treatment for people who want a reduction in size but with a perky, full effect?
Breast reduction is completely different to augmentation but, nonetheless, very important. Overly large breasts are extremely heavy and can dramatically impact a woman’s quality of life, not only physically but also psychologically. They incur bra strap pain, postural issues, skin irritation underneath the breast, slumping, they might not be able to wear the clothes they want to or exercise… For those women who desperately to eradicate that weight, breast reductions offer the perfect solution because we can sculpt a much nicer, much lighter breast for them and lift it in the process.
There’s also an in-between category. That’s when the woman used to have a lot of volume in her breasts but now there is little or none, and the breasts have dropped. These women won’t have enough volume for the surgeon to simply lift them so they’ll require a combination of an implant and a lift in order to create the fuller, perkier look they desire. Following that type of surgery, the woman’s cup size will generally increase by one size.
6. How important is it to do your research and to hire a surgeon who’s also a scarring specialist?
‘I think you get what you pay for and from working with so many people on Harley Street and Wimpole Street, you notice who the good surgeons are and who the bad ones are. The same applies to dentists, gynaecologists etc. Just because people say they’re on that street or in a similarly renowned location, they’re not necessarily good. It’s important for people to do their research, seeking several consultations and recent patient references, and also to look for a surgeon who’s also a scarring specialist.’
Absolutely. That’s an extremely important point. Like with anything in life, you get what you pay for and one of the problems with seeking cheap cosmetic surgery is that you’re unlikely to get good results and you’re quite likely to get bad results; and, ultimately, the whole thing ends up costing you much more (not just financially but physically and emotionally) because when you have to go and have it fixed, it’s a whole world of pain that perhaps you hadn’t expected in the first instance.
The surgeon shouldn’t just be skilled at inserting the implant during the surgery but he/she needs all of the skills and knowledge surrounding it, and should be proactive in their academic research and up-to-date on all of the latest techniques and findings. Minimal scarring is a key factor in this. For example, some surgeons will leave nasty looking large scars down the breast but this is unnecessary. The more you research what you want in terms of surgical technique, the breast shape, the healing process etc, and the better the surgeon you hire, the smoother the process should be, both in terms of the surgery itself, the recovery and the final aesthetic.
There are plenty of lotions and lotions out there that claim to have an effect on breasts and none of them work. If a surgeon offers you Macrolane (i.e. a substance is made from Hyalauronic Acid that’s often used in lip- and facial-fillers), don’t hire them. Macrolane was used by some surgeons previously but it’s highly problematic and can form clumps or lumps in the breast.
7. Is there a perfect bust size for a natural effect?
No, there’s no such thing as the perfect bust size because it’s all relative to the size of the individual. For example, on one woman, a D cup might seem huge, whereas on another woman it might seem small or proportionate. The best guide is the 4 parameters (see question 2). They’re independent of cup size (you can have a large cup size with them or a small one) but will provide a beautiful result.
One of the phrases I always use with women is ‘It’s not what you want, it’s what you can have’ - and there is a difference between the two. What you can have is determined by your anatomy and I always believe in is respecting anatomy because doing so always produces the nicest looking breasts. When you try to make the anatomy do something it doesn’t want to, that’s when distortions can occur. That’s something that, as a surgeon, I won’t do. I won’t go against a patient’s natural anatomy just because they want to be bigger. If I don’t think it’s in your best interest, I’ll advise you against it and won’t do the surgery. Simple as that.