ICE Principle: How Surgeons Aim For Natural Breast Augmentations

ice principle: how surgeons aim for natural breast augmentations

Breasts come in all shapes and sizes, as those who may be considering breast augmentation surgery well know. But it turns out there is an “ideal” breast out there that the overwhelming majority of people find to be universally appealing, and plastic surgeons have figured out how to reproduce this breast consistently and accurately, which is good news for people considering the surgical route to more aesthetically pleasing breasts.

What is the "Ideal" breast?

Just what determines the “ideal” breast shape? Think of the breast as a vertical cross section of a globe, with the equator being the nipple, the northern hemisphere being the “upper pole” of the breast, and the southern hemisphere being the “lower pole.” In this analogy, the ratio between the upper pole and lower pole is 50:50 (symmetrical). Now, imagine the globe is slightly bottom-heavy, with greater volume below the equator. Turns out that breasts with greater volume in the lower portion of the breast (below the nipple) are more appealing than breasts with 50:50 even distribution of volume. To be more specific, an upper-to-lower pole ratio of 45:55 has been found to be “the most natural and attractive shape of the breast.”

If you think about it, that may seem like common sense—everyone knows breasts aren’t perfectly symmetrical and that breasts that seem unnaturally full or round tend to look fake. What’s important to note is that more naturally shaped breasts are perceived as more attractive, and this has been found by research to be consistent for men, women, plastic surgeons, and racial/ethnic groups. “The results were remarkable consistent, with all groups rating breasts with the 45:55 ratio as most attractive.” Turns out men DON’T find unnatural looking, perfectly round breasts to be the epitome of desirability. Who knew?

What is the ICE Principle?

Ok. So as a plastic surgeon, you want to be able to create beautiful, natural-looking breasts for your patient using the empirically proven 45:55 ratio. Is there a way to do this? Enter the “ICE Principle.” What is the ICE principle? Glad you asked.

A study titled “Design for Natural Breast Augmentation” published in the Journal of the American Society of Plastic Surgeons in June 2016 outlines a method for achieving natural beauty in the breast consistently and precisely. For the purposes of this study, “natural breast augmentation” is defined as “seek[ing] to enhance shape without distorting it by adhering to the principles of tissue-based planning and focusing on aesthetic outcome.” That’s a fancy way of saying, “the goal is for these things to look natural and aesthetically pleasing when we’re done here.”

ICE is an acronym, where the letters represent the following concepts:

I-implant dimensions

C-capacity of the breast

E-excess tissue required

These letters are then combined into the following formula: I (implant dimensions) – C (capacity of the breast) = excess tissue required (E).

The plastic surgeons in this study used this formula to determine implant selection, placement, and incision position in 50 women undergoing “primary breast augmentation by means of an inframammary fold incision with anatomical or round implants.” (In case you don’t know what an “inframammary fold incision” is off the top of your head, it’s plastic surgeon speak for an incision made under the breast.) The results were that using the ICE principle produced over 99 percent accuracy of incision placement and an average post-operative upper pole to lower pole ratio of 45:55 (the magic ratio!). There was also “a reduction in variability for all key parameters” (read: “greater consistency”).

The conclusion of the study was that “the authors have shown using the simple ICE principle for surgical planning in breast augmentation that attractive natural breasts may be achieved consistently and with precision.” 

Whew! So what’s the takeaway? Why is this important? It’s important because unlike a decade or so ago, when the overfilled, oversized “fake” look was the norm in breast augmentation, today’s women are increasingly requesting breast augmentation resulting in a more “natural look.” Breast augmentation is about achieving an aesthetic, and being able to consistently achieve the most attractive breast shape is a tool every plastic surgeon needs and every patient should want them to have! 

By Margaret Durkovic