Byrdie ran a first-person review of a “ballerina boob job” in September. The writer, Charlotte Bickley Meller, learned at her first consultation that she had tuberous breasts. She had the operation in New York and wrote down the wait, the tightness, the slow settling, and a change that was mostly mental.
Good review. I read it with a tape measure in my head, because half my patients now ask for this look (I wrote about why a year ago). Here it is, annotated.
What Is She Asking For?
“The patient that comes in looking for the ballerina look is usually asking for a subtle augmentation with an upper pole slope, without too much upper pole fullness, and an overall natural, not done look. This is usually a look that is achievable with a patient that is not very large breasted to start with.”
Upper pole: the top half of the breast. Slope: the line from collarbone to nipple, kept soft.
How I Get There: Fat, Implants, or Both
Byrdie’s writer needed her tuberous tissue reshaped plus a small implant. Without that shape problem, the menu is wider.
“If the patient is already happy with their breast shape and they just want a little bit more fullness, then this can be achieved with fat transfer alone. It usually gives you at least a cup size, preserves the current breast shape, and just augments the volume by 100 to 200 cc.”
“It can also be achieved with implants for a more predictable result. To achieve the ballerina look, we often use the Motiva Preserve technique, which preserves the arteries, the nerves, and the ligaments of the breast without performing any cutting, and the implant is placed just under the gland, above the muscle. It can also be done with a traditional breast augmentation.”
On the implant itself: “The implant of choice here would be a lower profile implant, like a Demi or a Mini, and the Motiva Ergonomix implant, which flows with the breast and lends itself to more movement. Because of this, the upper part of the implant becomes tapered when the patient stands and takes on a teardrop shape, which is the more natural ballerina look.”
A lower profile implant sits flatter against the chest for the same width. And sometimes it takes both: “At times, if the patient has a small amount of subcutaneous fat and breast tissue, then the implants can be complemented with fat as well, to even and smooth the edges and create that natural contour.”
When a Lift Is Not Optional
The review does not involve a lift, and the writer did not need one. Many women who want this look do, and this is where a first-person account cannot help you.
“The level of droopiness determines whether the patient will require a lift or not. If the nipple areola complex is below the inframammary fold, then a full lift, anchor type incision, will be necessary. If the nipple areola complex is at or slightly above the inframammary fold, I will often recommend a circumareolar lift or donut lift.”
Translation: the nipple areola complex is the nipple and the colored skin around it. The inframammary fold is the crease under the breast. An anchor lift uses an incision around the areola, down, and along the fold; a donut lift is a circle around the areola only.
The deciding number: “The ideal sternal notch to nipple areola distance is anywhere from 19 to 22 centimeters.” That is the distance from the notch at the top of the breastbone to the nipple. Any patient measuring more than that should consider some type of lift.
What happens if you skip it: “If the lift is not performed during the augmentation and there is considerable sagging, then the implants will appear to be higher up, even though they are in the right place, and the nipple areola and breast tissue will hang over it.”
On the lift most people have heard of, the vertical or lollipop lift: in my experience it has a high rate of bottoming out, where the breast tissue settles below the implant over time. “Nevertheless, it is a good procedure on very select patients.”
And the honest line I give every patient who hoped for no scars: “Although most of the patients seeking a ballerina breast want to avoid scars, a lift is necessary for optimal results when it is indicated. A lot of the patients seeking the ballerina look are already happy with their breast shape, therefore a simple augmentation is possible.”
Who Should Not Chase This Look
“The ballerina look is very appropriate for patients that already have a ballerina type structure. These are patients that are usually thin and athletic, so a ballerina breast is very proportionate in these cases. The ballerina breast can look disproportionate in heavier set patients, or those with wider bony structures. But in all reality, it really just depends on what the patient wants and what they will be happy with.”
That is where the simulation comes in. “One of the advantages in my practice is that we can simulate the results using the Vectra 3D system and the Crisalix system to visualize the results even before the surgery. This really helps the patient decide on the look, the size, the profile, and whether or not a lift will make the final results look better. So this takes away a lot of apprehension or anxiety.”
What a Review Leaves Out
She told you her diagnosis. Most reviews do not.
“What a first-person review usually leaves out is that the writer’s result started with the writer’s anatomy. A thin, athletic patient with good nipple position and a little breast tissue will get the ballerina look with a small implant or fat transfer alone. A patient with more sagging, a wider chest, or a longer sternal notch to nipple distance will need a lift or a different implant to get anywhere close, and the review will not tell you that. The other thing missing is the measurements. A consultation with 3D imaging and actual numbers tells you what is achievable on your body, which no review can.”
Her result started with tuberous breasts and a surgeon who reshaped them. Yours starts with yours.
Why Choose Dr. Agullo
Double board-certified. Mayo Clinic fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly Top Doctor for 13 consecutive years. Fat transfer, Motiva Preserve, traditional augmentation, and every kind of lift, under one roof, with 3D imaging in the consult room.
Ready to Talk?
Read the review. Then bring your own anatomy in and let us measure it.
Call (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com/appointments. Pricing starts on the fees page. #StayBeautiful
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