The Natural Breast

Creation of The Natural Breast
James Romano, MD

I continuously receive compliments about The Natural Breast results I obtain. This is because I never take for granted how women trust me to operate on a most important part of their body; the breast. Whether this involves breast enlargement, breast reduction, breast lift, or breast deformities I am totally committed to create the most Natural Breast result your body will allow. I met with one of my patients operated on 12 years ago and she offered this compliment “Dr. Romano I married soon after my augmentation and my husband still does not know I have breast implants.” This is my goal; to look and feel natural with an imperceptible incision and to have these qualities last forever. Here is my distinctive formula to create this:

The natural breast needs to look natural. This means smooth on the top (not bulging), roundness to the bottom and the nipple in the middle of the breast mound, proportioned, and meeting your aesthetic goal. Many times, when patients say they like the “Baywatch” look or like their nipples to “point up” I have to explain how I clearly consider these as deformities created by doctors where the implants are intentionally placed too high or too low respectively. In order to obtain The Natural Breast, I do numerous things rarely done by other doctors. This goal means that it takes extra time in consultation and in surgery and in follow-up, but my patients and I are always thankful for the superior results this obtains.

The things I do different that create the most Natural Breast are:

1. Consultation
   1. This is a lengthy detailed conversation with me, answering all your questions, and determining clearly your expectations and lifestyle
   2. A detailed physical exam describing what your anatomy will allow me to do safely and predictably to obtain such a result
   3. Sizing. This means using five different criteria to determine what cup size will be best:
      1. Measuring your breast dimensions, stretchability and chest wall position and recording this on a chart.
      2. Trying on specially made round or contoured breast implant silicone sizers in a bra with your own clothing on top.
      3. Reviewing photographs that are used only to get a sense of shape and size and proportion you like.
      4. Making an anatomic assessment of your body proportions and the relationship of your shoulders:breasts:hips and how this fits your body
      5. Determining your “aesthetic vision” and making sure that you know that “I see what you see” as the basis of going forward in our “partnership” to obtain the best possible result
      6. 14 Point Program. This is a ritual of extreme attention and dedication to a number of antibacterial and anti-infection maneuvers to prevent capsular contracture.
2. Surgery
   1. Anesthesiologist. This is a handpicked excellent board-certified anesthesiologist experienced in cosmetic surgery patients who knows all my very detailed requests and requirements (for no nausea, pain on wakening, grogginess or bruising)
   2. Facility. The surgery is done only in a certified outpatient hospital operating room, not in the corner of some office.
   3. Incisions. I use a very concealed cosmetic incision that will allow me to see everything, loose only a teaspoon of blood, and insure minimal trauma to tissues.
   4. Intraoperative. The “saline test” where I place a temporary disposable inflatable implant that matches the dimensions we anticipate, then inflate this to match the size and shape we determined in the office.
   5. Sit up. There is a hinge in the OR table which allows the anesthesiologist to sit you up while asleep during surgery. This is where I determine if this is the size you want to be, adjust the pocket as necessary and create symmetry. This is the most important step in creating the “natural breast”. I ensure the nipple is in the middle and the bottom is rounded and smooth to the top. I don’t quit until all this is done and your result is as perfect as your body will allow.
   6. Permanent implant selection. In the surgery center itself, I have a personal and complete “inventory” of all the different sizes and shapes of implants and choose the one that matches the size of the saline test. Here I am not limited, unlike most doctors, that pick a number size, bring only two implants to surgery and put them in without the above steps.
   7. Insertion of implant. Use of “Keller Funnel” is a specific device designed to insert the implant under total sterile conditions; it goes from the manufacturers box into this special funnel that inserts it into your body so that the implant never touches your skin or any gloves and thus lessens the risk of bacterial contact and contracture.
3. Postoperative
   1. Use of a stabilizing band or bra after surgery to encourage the implants to create the final shape we desire and heal in the right place
   2. Diligent and frequent follow up to make sure you are healing correctly, doing the massaging exercises, and that we have met your expectations
   3. Attention to your breast health. Teaching you about breast self-exam, mammograms, compression exercises, and not forgetting about forever monitoring for anything unusual in your breasts.

Collectively these contribute to creation of The Natural Breast.