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Design for Natural Breast Augmentation: The ICE Principle

Mallucci, Patrick M.B.Ch.B., M.D.; Branford, Olivier Alexandre M.A., M.B.B.S., Ph.D.

Plastic and Reconstructive Surgery: June 2016 - Volume 137 - Issue 6 - p 1728-1737
doi: 10.1097/PRS.0000000000002230
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Background: The authors’ published studies have helped define breast beauty in outlining key parameters that contribute to breast attractiveness. The “ICE” principle puts design into practice. It is a simplified formula for inframammary fold incision planning as part of the process for determining implant selection and placement to reproduce the 45:55 ratio previously described as fundamental to natural breast appearance. The formula is as follows: implant dimensions (I) − capacity of the breast (C) = excess tissue required (E). The aim of this study was to test the accuracy of the ICE principle for producing consistent natural beautiful results in breast augmentation.

Methods: A prospective analysis of 50 consecutive women undergoing primary breast augmentation by means of an inframammary fold incision with anatomical or round implants was performed. The ICE principle was applied to all cases to determine implant selection, placement, and incision position. Changes in parameters between preoperative and postoperative digital clinical photographs were analyzed.

Results: The mean upper pole–to–lower pole ratio changed from 52:48 preoperatively to 45:55 postoperatively (p < 0.0001). Mean nipple angulation was also statistically significantly elevated from 11 degrees to 19 degrees skyward (p ≤ 0.0005). Accuracy of incision placement in the fold was 99.7 percent on the right and 99.6 percent on the left, with a standard error of only 0.2 percent. There was a reduction in variability for all key parameters.

Conclusion: 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.


London, United Kingdom

From the Cadogan Clinic; the Department of Plastic Surgery, Royal Free Hampstead NHS Trust; and the Royal Marsden Hospital.

Received for publication October 1, 2015; accepted January 29, 2016.

Presented at the Akademikliniken’s Beauty Through Science 11th International Annual Aesthetic Symposium, in Stockholm, Sweden, June 4 through 6, 2015; and the Aesthetic Surgery of the Breast, Milano Breast Meeting, Scuola di Oncologia Chirurgica Riconstruttiva, Sixth European Symposium, in Milan, Italy, December 10 through 13, 2014.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Patrick Mallucci, M.B.Ch.B., M.D., Cadogan Clinic, 120 Sloane Street, London SW1X 9BW, United Kingdom,

Copyright © 2016 by the American Society of Plastic Surgeons