How One Surgeon Is Reinventing the Female Breast [SFW]

All plastic surgery reshapes the human body, but would-be electrical engineer turned plastic surgeon Gary Horndeski goes one step further.

Gary Horndeski meant to become an electrical engineer when a quirky turn of events redirected him to medicine. Some 40 years later, he’s using his engineering training to overhaul two increasingly popular surgical techniques.


The first uses geometry and mechanical engineering to lift and reduce breasts. The second applies systems engineering principles to weight loss, through controlled increased intra-abdominal pressure.

“A lot of people hate me for doing this,” says Horndeski, who runs a plastic surgery practice in Sugar Land, Texas. “It will cause a lot of controversy, because it presents a departure from standard techniques. It evolved gradually, from the same proven surgical techniques, but in a more aggressive manner.”

Medical procedures in America change slowly because of the fear of malpractice lawsuits. “The medical establishment here wants small, not radical changes,” Horndeski says. “But in engineering, you design what you want to build to work, without the same fear of being sued. That’s why there’s more innovation in medicine happening overseas, where it’s less litigious.”

Horndeski creates what is essentially an internal push-up bra.

Horndeski has been perfecting his breast reduction and lift technique for the past decade. To achieve cleavage and lift without the use of implants, Horndeski creates what is essentially an internal push up bra. He uses the excess skin to fashion 60-degree angle cones and three “straps” in the 12, 4 and 8 o?clock positions, pulling them, respectively, to the 12, 3 and 9 o?clock positions. The result is a hammock that he sutures over the sternum, the breastbone connecting the ribs. In the right breast, the 8-to-9-o?clock strap attaches to the pectoral (chest) muscle for a more natural lift (and 3-to-4 o?clock in the left). In addition, the approach produces fewer scars and more effectively hides the inevitable ones. (NSFW: Click for a real life before and after.)



The weight loss technique is akin to an increased negative feedback loop. It uses polypropylene mesh to reinforce weakened or torn abdominal fascia, the elastic leathery tissue that supports the abdominal wall. The mesh pushes on the abdominal muscles, which in turn pushes on the stomach to create the sensation of being full. Horndeski inserts an expander that incrementally increases pressure on the stomach, so the person wants to eat less. After the desired weight loss, he removes the expander and puts in mesh to maintain the pressure permanently. The technique is less invasive and produces fewer complications or side effects than gastric bypass and lap-band surgery.

It’s an unusual approach to surgery for someone who became a doctor almost by accident. In 1971, Horndeski was a senior in rational mechanics (applied math) at Case Western Reserve University in Cleveland, intending an electrical engineering career, when he drew a low number (13) in the Vietnam War draft.

“I call plastic surgery human engineering.”

“My next door neighbor had gotten killed in the war and my brother had gone to Canada,” he says. “I heard that you could defer service by going to medical school. I’d taken most of the pre-med prerequisites, so I took the MCATs (the standardized entrance exam required for medical school) and scored in the 90th percentile without ever having taken a biology course.”

By the time he graduated from Case Western’s medical school in 1976, the war had ended, but Horndeski was already on a surgical track, opening a practice in 1981.

Unhappy with the mediocre results and scarring patterns left by established breast reduction and lifting procedures, Horndeski used his engineering background to incrementally improve methods. “I did it gradually, one step at a time, over a period of 10 years to make sure I didn’t interfere with nerves and blood supply,” he says.

Horndeski developed the weight loss technique after noticing his abdominoplasty patients easily losing and maintaining their reduced weights. He began to wonder if the body controlled weight through a negative feedback system, where pressure on receptors within the stomach signals a person to stop eating. Some sleuthing in medical libraries uncovered animal and human studies that supported his hypothesis.


Horndeski now has a patent pending on the concept and is awaiting approval from the hospital where he operates, Angleton Danbury General Hospital, to engage this surgery for weight loss.

“I call plastic surgery human engineering,” he says. “I?m solving medical problems by thinking like an engineer.”

[Top image, of cupcakes created for a Breast Cancer Awareness fundraiser, by Kevin Rawlings]


About the author

Susan Karlin, based in Los Angeles, is a regular contributor to Fast Company, where she covers space science, autonomous vehicles, and the future of transportation. Karlin has reported for The New York Times, NPR, Scientific American, and Wired, among other outlets, from such locations as the Arctic and Antarctica, Israel and the West Bank, and Southeast Asia