Detail of sculpture at The Charles Engelhard Court in The American Wing in the Metropolitan Museum of Art in New York

Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body in some form. In order for a surgeon to help create whatever vision their client is looking to achieve, one must be a master at their craft—a skilled artist. The word plastic is derived from theLatin word plasticus and the Greek word plastikos, meaning “capable of being shaped or molded.”

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Art is the expression or application of human creative skill and imagination, typically in a visual form. In comparison, plastic surgery is, in and of itself, a form of art; in order to achieve great results, one must possess an artistic vision as well as expert knowledge and a meticulous technique.

It’s one of the reasons Dr. B. Aviva Preminger, a top plastic surgeon onManhattan’s Upper East Side, loves the specialty.

“Plastic surgery requires an artistic element to achieve an aesthetically pleasing look,” Dr. Preminger explains. “We must listen to the patient and understand what it is he or she wants to achieve.”

While there are many different procedures in which a plastic surgeon’s artistic vision come into play, one of the most popular requests involve the breasts. When it comes to this part of the body, patients seek out Dr. Preminger for procedures such as augmentations and reductions, and oftentimes to help them in correcting something called breast asymmetry.

BELLA sat down with Dr. Preminger to learn more about breast asymmetry and how, through the art of plastic surgery, she is helping women look and feel their most beautiful self.

What exactly is breast asymmetry?

Asymmetry means a difference between two sides. When we talk about breast asymmetry in particular, I like to tell patients that their breasts are “sisters, not twins.” The two breasts are not exactly the same, but for some people that difference is extremely significant, so much so that they feel extremely self-conscious in clothing or can’t fit into a bra without using a pad on one side.

Is this common amongst women?

Yes. Most women have some degree of asymmetry, and many don’t notice it because the difference is so subtle. It is something that I see and will point out during an examination. Women don’t look as closely at their breasts before surgery as they do after surgery, so I like to point out asymmetry beforehand so they know where we are starting. Some of these asymmetries can either become more prominent or first appear from changes that happen to the breast. For example, pregnancy, breastfeeding, and menopause can affect breast development, and so it can become more exaggerated or more noticeable to women later in life as well.

In what ways can you correct a patient’s breast asymmetry?

We have many tools at our disposal now to help correct asymmetry, such as implants, reductions, lifts, even fat grafting. All of these techniques allow me to do such things such as put an implant in one side to add volume and lift and reduce the other side to match. With fat grafting I’m able to liposuction one area of the body and use the patient’s own fat to correct the asymmetry. Often it’s a combination of an implant and fat grafting for a natural lift.

Should women with substantial breast asymmetry be concerned?

Generally, there isn’t a medical concern. In most cases, if the asymmetry is substantial, it can be congenital, meaning it’s something the patient is born with. What we want to look out for is a new asymmetry, which could signify an underlying mass or problem.

Is this one of the reasons patients come in for a breast augmentation?

Patients come to see me for subtle or significant differences between the two breasts. Many will point out that one side is larger or smaller than the other and ask whether anything can be done to compensate for it when I do surgery. I think in these situations, particularly with breast asymmetry, this is where it’s important to draw upon our artistic vision.

In what way would you say art and plastic surgery merge?

This is one of the areas where the art of the field really comes into play, along with listening to what the patient is really trying to achieve. If you have two different breasts, which do you prefer—the larger or the smaller?

It’s also about trying to get a sense of what look the patient actually wants, and how I can best correct the difference. Sometimes that means putting a little more in one breast or taking a little bit out of another, and that really does require a lot of thoughtfulness and an artistic eye. It’s one of the reasons I love the specialty because there is no one answer to the problem. In essence, plastic surgeons are true problem-solvers.

In what way would you say that’s true?

When a patient comes to see me with a problem, like a real breast asymmetry that is making her feel self-conscious, it’s tremendously powerful to be able to help her and to invoke the art of the specialty to achieve it. Some of the cases I see are challenging, but they’re also fulfilling.

Challenging in what way?

It can be technically challenging to make two things that are very different look similar, and I like that challenge. It’s particularly fulfilling when I’m able to figure out what needs to be done to make my patient happy.

So much of what plastic surgeons do is help to improve our patients’ self-confidence so they can feel good about themselves and not feel so self-conscious about the way in which they look in and out of clothing. That is a big part of what I enjoy most—being able to make people happy. It’s why I dow hat I do.


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