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1. Understanding Breast Shape and How to Make Breasts Beautiful Joel A. Aronowitz, MD Chief, Division of Plastic Surgery Cedars Sinai Medical Center

8. Severe Tubular Deformity Note medial tightness, large areola typical of tubular breast. 17 yo treated with 500 cc silicone gel prosthesis and keyhole pattern mastopexy

10. The Breast Skin Stretches in a Predictable Pattern Over Time In the breast the largest diameter is in the lower pole therefore the skin below the nipple typically is under greater strain and stretches the most. The nipple decends with the breast.

14. Patient 18 Augmentation with Mastopexy Nancy M., lift/aug

15. Patient 18

16. Patient 19 Mastopexy with replacement of implants Peggy lanier

17. Patient 19

18. Why the Larger Diameter Area of the Breast Stretches More

23. Patient 6

24. Problems with Periareolar or Donut Lift Mastopexy Note large areola with wide scar and flattened shape

27. Improvement after Wise pattern Lift

29. The WISE Pattern Allows freedom to tailor the breast skin envelope

31. Wise Pattern Breast Reduction

32. Wise Pattern in Breast Reduction

36. Ptosis due to relative paucity of breast volume Volume restored with prosthesis, skin envelope unchanged Pt 3; Restoration of Skin:Volume Proportion with Prosthesis

37. Patient 3 Leah, Lift/Aug

38. Patient 3

41. 79 year old woman with Severe Breast Hypertrophy

42. Wise Pattern Breast Reduction

43. Breast Reduction

45. Augmentation with 350 cc saline and Keyhole Mastopexy Post-partum breast atrophy, sagging due to lack of breast volume relative to skin envelope Rx; Reduction of skin envelope and addition of volume; ie, augmentation mastopexy

46. Patient 4: PB., Lift/Aug. Mastopexy before and after retropectoral augmentation with 400 cc saline

47. Patient 4

48. Patient 7: Ilene, Lift/Aug.

49. Patient 7

50. Patient 5: Dawn, Lift/Aug.

51. Patient 5

52. Patient 20: Grade IV capsular contracture, Rx; Mastopexy and Removal and Replacement of Implants

53. Patient 20

58. Breast Augmentation and Keyhole Mastopexy

59. Patient 8: Breast Aug and Keyhole Mastopexy Inez, Aug/lift

60. Patient 8

61. Patient 9: Marsha, lift

62. Patient 9

63. Patient 10: Cheryl lift/aug

64. Patient 10

65. Patient 11: Allison S. Lift

66. Patient 11