title: Design for Natural Breast Augmentation: The ICE Principle.
abstract: 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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: London, United Kingdom.|From the Cadogan Clinic; the Department of Plastic Surgery, Royal Free Hampstead NHS Trust; and the Royal Marsden Hospital.
authors.forename: Patrick
authors.initials: P
authors.lastname: Mallucci
authors.affiliation: London, United Kingdom.|From the Cadogan Clinic; the Department of Plastic Surgery, Royal Free Hampstead NHS Trust; and the Royal Marsden Hospital.
authors.forename: Olivier Alexandre
authors.initials: OA
authors.lastname: Branford
mesh_terms: D018427:Breast Implants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000592:standards*; D009558:Nipples / Q000601:surgery*; D017060:Patient Satisfaction; D010781:Photography; D017410:Practice Guidelines as Topic; D011446:Prospective Studies