For improving patient-physician communication and setting realistic expectations
Class 1: Appears “natural” with no superior pole fullness.
Class 2: Appears “natural” with mild superior pole fullness.
Class 3: Appears less “natural” with moderate superior pole fullness.
Class 4: Appears round with significant superior pole fullness.
Class 5: Appears very round and maximal superior pole fullness.
Careful planning of all technical components of augmentation mammoplasty is essential to ensure the best possible outcome. Implant size and shape selection are two of the most important components of this planning. There have been many descriptions of implant size selection.1-7 However, little is mentioned in the literature concerning a patient’s desired breast shape after augmentation.
With a new assortment of breast implants from low profile to high profile, plastic surgeons have more control as to the outcome of breast shape with breast augmentation. This is a simple classification of breast shape to help improve communication and set realistic expectations for breast augmentation results.
During initial breast consultations, I felt that there had to be a better way to communicate with patients about their goals for postoperative breast shape than by utilizing pictures from lay media.
Often, a patient would state that they wanted a “natural” look but would show pictures with very round breasts. Because of these situations, what is needed is a more objective system to communicate patients’ aesthetic goals and obtainable results after breast augmentation.
A breast shape classification has been created in an effort to improve communication with patients and to achieve the best possible result based on that particular patient’s aesthetic desires.
This classification was used in the initial consultations of 30 patients. Preoperatively, patients were shown the breast shape classification with preop and postop pictures of other patients in each class on a screen. For example, if a patient desired a medium “C” with a class 3 breast shape, then they were shown pictures on the screen matching those wishes.
Paul E. Chasan, MD, FACS, is a plastic surgeon in private practice in Del Mar, Calif. He can be reached at (858) 450-1555.
The author acknowledges the contribution to this article by Karl Nguyen, MD.
- Mentor Corp. Saline-Filled Breast Implant Surgery: Making an Informed Decision. Santa Barbara: Mentor Corp, 2000;11-19.
- McGhan Medical Corp. Saline-Filled Breast Implant Surgery: Making an Informed Decision. Santa Barbara: McGhan Medical Corp; 2000: 10-18.
- Tebbetts JB. Dimensional Augmentation Mammaplasty Using the BioDimensional System. Santa Barbara: McGhan Medical Corp; 1994: 1-90.
- Tebbetts JB. Dual plane breast augmentation: Optimizing implant-soft tissue relationships in a wide range of breast types. Plast Reconstr Surg. 2001;107:1255.
- Gorney M. Preventing litigation in breast augmentation. Clin Plast Surg. 2001;28:607.
- Tebbetts JB. Achieving a predictable 24-hour return to normal activities following breast augmentation: Refining practices using motion and time study principles. Part I. Plast Reconstr Surg. 2002;109:273.
- Tebbetts JB. Achieving a predictable 24-hour return to normal activities following breast augmentation: Patient preparation, refined surgical techniques and instrumentation. Part II. Plast Reconstr Surg. 2002;109:293.
- Lipton B. Are you wearing the wrong size bra? Ladies’ Home Journal. March 1996;46.
- Young VL. The efficacy of breast augmentation: Breast size increase, patient satisfaction, and psychological effects (Letter) (Reply). Plast Reconstr Surg. 1995;96:1237.
- Thomas D. The quest for the perfect bra. SELF. March 1995;146.
- Penn J. Breast reduction. Br J Plast Surg. 1955;7:357.
- Yalom M. A History of the Breast. New York: Knopf; 1997: 172-183.
- Gittelson B. inventor; Triumph-Universa GmbH, assignee. Bust measuring device. US Patent 2 946 125. July 26, 1960.
- Smith DJ, Palin WE, Katch VL, Bennett JE. Breast volume and anthropomorphic measurements: Normal values. Plast Reconstr Surg. 1996;78:331.
- Westreich M. Anthropomorphic breast measurement protocol and results in 50 women with aesthetically perfect breasts and clinical application. Plast Reconstr Surg. 1997;100:468.
- Bouman FG. Volumetric measurement of the human breast and breast tissue before and during mammaplasty. Br J Plast Surg. 1970;23:263.
- Grossman AJ, Roudner LA. A simple means for accurate breast volume determination. Plast Reconstr Surg. 1980;66:851.