Understanding what constitutes breast beauty is essential for those carrying out aesthetic breast surgery. The authors, plastic surgeons from London, Dr. Patrick Mallucci and Dr. Olivier Alexandre Branford, previously identified widely recognized markers of breast beauty in their 2015 International Plastic Surgery Article of the Year in Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
That study in 1315 participants of all demographic backgrounds recognized that the vast majority of people prefer natural beauty in the breast: The desire for an overfilled and oversized 'fake' look seems to have infiltrated practice without challenge over the past decades. The negative consequences of breast implants that are too large are well established and amongst the most common reasons for re-operation.
Perhaps the most significant observation in that study was of the upper pole to lower pole distribution - the so-called 45:55 ratio - defining the lower pole as consistently slightly fuller than the upper pole, with 55 percent of the breast height being below the nipple, and this full lower pole forming the basis for natural breast beauty. This was a fundamental observation and goes against conventional notions of upper pole fullness as being a desirable end goal of breast augmentation: Beauty is in the lower pole of the breast.
The next challenge for the researchers was to put those principles into practice into a consistent and reproducible manner for the benefit of surgeons and more importantly their patients. This is the basis of the 'ICE' Principle, and is all about achieving natural breast beauty and moving away from the vulgarity of oversized implants.
The 'ICE' Principle deals with implant selection and placement, including position of the incisions in order to reproduce the optimal shape and may be applied to either anatomical or round implants. It is a simplified formula for inframammary fold incision planning as part of the process for determining implant selection and placement in order to reproduce the 45:55 ratio previously described as fundamental to natural breast beauty.
The 'ICE' Principle is a formula taking into consideration two implant parameters - height and projection, and for the soft tissue, base width and nipple to inframammary fold-on-stretch values. The formula is: I (Implant dimensions) – C (Capacity of the breast) = E (Excess tissue required, in other words, how much the incision needs to be lowered by). This was tested in 50 patients undergoing breast augmentation. The results showed that implant position and incision placement were very accurate, resulting in natural appearing breasts that were closer to the 45:55 natural ratio. Precise location of the incision in the inframammary fold is critical - it is the defining marker of the lower pole of the breast.
The authors suggest that 'ICE' Principle will contribute to a 'healthier' selection of implants in the long-term interests of patients. The combination of this philosophy with aesthetic goals in place will lead to optimal outcomes. Today women increasingly request a 'natural' look in a bid to restore confidence and femininity. The authors believe that the 'ICE' Principle will be used as the basis for design in aesthetic breast surgery, representing the patient's best interests not only from an aesthetic standpoint but also in terms of longevity and patient safety.