ORIGINAL ARTICLE BREAST Breast Augmentation With Anatomic Implants: A Method Based on the Breast Implantation Base Jose L. Martin del Yerro • Manuel R. Vegas • Ignacio Sanz • Emilio Moreno • Veronica Fernandez • Susana Puga • Maria G. Vecino • Thomas M. Biggs Received: 17 March 2013 / Accepted: 22 June 2013 / Published online: 4 September 2013 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013 Abstract Currently, aesthetic and reconstructive surgery of the breast should be considered in terms of contouring, and hence in terms of dimensions. Based on experience performing more than 5,000 breast augmentations with highly cohesive anatomic implants, the authors explore the aesthetic anatomy of the (augmented) breast and explain the importance of the breast implantation base (BIB), the aesthetic proportions of the lower breast pole, and the patient’s somatotype in the implant selection for a natural- appearing breast augmentation. A method is described for transferring all these concepts and proportions to the pre- operative marking of the individual patient. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords Aesthetic breast anatomy  Base implantation base  BIB  Breast augmentation  Number Y  Somatotype Currently, aesthetic and reconstructive surgery of the breast should be considered in terms of contouring, and hence in terms of dimensions. Different reports have addressed the concept of the ideal breast and tried to translate it into dimensions [1–5], although, as pointed out by Brody [6], trying to define the ideal breast might be unrealistic. Currently, for most patients and surgeons, an attractive, natural-appearing breast augmentation is the goal in aug- mentation mammoplasty, and it can be attained only if the aesthetic proportions of the breast and their relationship with the torso are preserved. Different publications [7, 8] have addressed the natural, aesthetically pleasing aug- mented breast, although ultimately, breast augmentation should meet the patient’s expectations [9] and not the surgeon’s preferences. Hence, the preoperative interview should clarify the patient’s wishes related to intermammary cleavage, lateral fullness, upper pole fill, and projection. For a natural long-lasting result, however, tissue dynamics must be considered, and this is something that must be stressed preoperatively with patients requesting a larger implant or a high-projecting augmentation [10, 11]. Understanding the aesthetic anatomy of the breast is crucial in augmentation mammoplasty because volume and proportions are equally important for a successful result. In contrast to round prostheses, anatomic implants have a differential influence in every breast dimension, and because different dimensions are manufactured for a given implant volume, the importance of selecting the right implant for the specific patient cannot be overemphasized [12]. Materials and Methods From May 1998 to November 2011, a total of 5,123 patients underwent uni- or bilateral breast augmentation with highly cohesive anatomic implants in our service, for a total of 9,727 implants used. Based on this experience, the authors analyzed the basic aesthetic proportions of the J. L. Martin del Yerro (&)  M. R. Vegas  I. Sanz  E. Moreno  V. Fernandez  S. Puga  M. G. Vecino Plastic, Reconstructive and Aesthetic Surgery Service, Hospital Quiro ´n, C/ Diego Velazquez 1, Pozuelo de Alarcon, Madrid, Spain e-mail: mdelyerro@yerro.com; jmrv2020@gmail.com T. M. Biggs Plastic Surgery, Baylor College of Medicine, Houston, TX, USA 123 Aesth Plast Surg (2014) 38:329–337 DOI 10.1007/s00266-013-0190-5