Breast Anatomy—How It Affects the Breast Augmentation Technique

About 307,000 breast augmentation procedures were conducted in 2011, according to data released by the American Society of PlasticSurgeons.  But despite the growing popularity of this surgery, many patients are still not aware that their breast anatomy and even their overall body frame can affect the final outcome.

Breast Anatomy:

* Areola complex

This is the pigmented part of the skin, and at its center is the nipple which contains tiny ducts responsible for breastfeeding and are very sensitive to manual stimulation.

The edge of the areola can be used as an incision site during breast augmentation, allowing doctors to create a “pocket” and insert the implant.  And while this technique hides the scar, the tradeoff is the higher risk of temporary or permanent loss of sensation which happens if too much nerves are severed.

Fortunately, patients can choose from other breast augmentation incisions including breast crease, underarm, and navel.

* Cooper’s ligament and connective tissue

They support the entire breast and define its shape.  But after several pregnancies and weight loss, they start to become slack, leading to sagging appearance.

Breast implant alone cannot correct sagging, although this can further improve the appearance of the bust after a breast lift surgery.  Combining these two procedures are particularly ideal for women who have drooping breasts and want to add more volume in their chest.

* Inframammary fold

Also called breast crease, it separates the breast mound from the lower chest wall.  Meanwhile, this area is a great incision site because it allows plastic surgeons to work close to the chest, making it easier for them to position the implants; for this reason, the technique is ideal for patients with existing breast deformity.

However, the inframammary fold incision is more ideal for women with a defined breast crease as it can prevent them from having a high- or low-riding scar.

Most board-certified plastic surgeons are very familiar with inframammary incision technique that unsightly scars rarely happen.

* Chest width

This breast anatomy dictates the right implant profile which is the projection off the chest wall.  In general, petite women should use high-profile implant that has small base but offers more protuberance.

By contrast, patients with a wider chest width should use low-profile implants which have a broader base but offer less protrusion.

Meanwhile, patients can choose moderate-profile implants that provide projection according to their amount of filling (which is measured by cubic centimeter or cc).

FAQs About Breast Lift or Mastopexy

Breast ptosis or sagging is one of the most common problems associated with aging; however, pregnancy and significant weight loss are also known to contribute to the problem because these may stretch the ligament, tissue, and skin.

Fortunately, breast ptosis can be corrected by mastopexy or more commonly referred to as breast lift surgery.  To better understand the procedure, these are the most frequently asked questions of patients:

1.     Question:  How is breast lift performed?

Answer:  Plastic surgeons tighten and sometimes remove the loose skin and tissue using incisions placed directly in the breasts.  In most cases, the surgery also involves changing the position of the areola and nipple to achieve the most desired result.

2.     Q:  Where do plastic surgeons perform mastopexy?

A:  Mastopexy—or any type of cosmetic surgery—should be only conducted in an accredited surgical center or hospital.

3.     Q:  What are the techniques used in breast lift?

A:  Because the degree of sagging is different from each patient, plastic surgeons have come up with several techniques.  In severe cases, they use anchor lift which uses an incision around the edge of areola, within the breast crease, and another one that travels from the nipple down to the crease.

For women who need less correction, the vertical incision from the areola to the breast crease would be removed.  But for those who have a very small breast, even the donut lift—in which only the incision around the areola is maintained—would be enough to raise the bust.

4.     Q:  Who should postpone the procedure?

A:  Women who are planning to lose weight, nursing a child, and wanting to have more children should postpone breast lift because pregnancy and weight fluctuations can reverse the result of the surgery.

5.     Q:  What are the risks?

A:  As with any cosmetic breast surgery, mastopexy has its own set of risks including increased bleeding, infection, asymmetric appearance, and adverse reaction to medicines.  With this consideration, patients should only consult with a board-certified plasticsurgeon specializing in the procedure.  

6.     Q:  What are the preparations before breast lift surgery?

A:  Plastic surgeons require their patients to undergo physical and laboratory examinations (e.g., mammograms or breast x-rays) to determine any underlying health problems that may lead to more risks. 

And days or weeks before the surgery, patients should avoid aspirin, ibuprofen, warfin, and other drugs that can affect blood clotting; certain types of herbal supplements; alcohol; caffeine; and tobacco.

7.     Q:  Is there any visible scars?

A:  Within a year after surgery, the scars will remain very visible but over time they will fade.  While the incision lines are permanent, they are hidden from view that even if a woman would wear a plunging neckline, they cannot be seen.

8.     Q:  Can breast lift provide fullness?

A:  Breast lift can only raise the sagging breasts but cannot create fullness especially in the upper poles; for this reason, some doctors recommend breast implant surgery as a complementary procedure.

Hottest Celebrity Breast Implants

Breast implant surgery is arguably the most popular cosmetic procedure among female celebrities, although not all of them are willing to spill out their secrets.  Meanwhile, these are the stars who made it to the list of hottest breast augmentation results.

1.     Hilary Swank

After her breakout film “Boys Don’t Cry,” some people have noticed that the actress bust size has increased, however, others just speculated that she might have hidden her “assets” earlier in her career.  But whether she is naturally busty or has sought the help of a plastic surgeon, she looks sultry and beautiful these days.

2.     Salma Hayek

Considered as one of the sexiest Hollywood actresses, Hayek’s mother once told her that the only roles she could get in movies was a servant due to her “weird accent.”  But apparently, she proved her mom dead wrong.

Aside from her exotic beauty and acting skills, perhaps the star’s curvy body, which is rumored to be partly the result of breast augmentation, has also helped her to be always on the limelight.  But in the last few years, some people have noticed her breasts seem to be growing larger.

However, there are some people who believe the actress is naturally busty and the seemingly larger breasts may be the cause of weight gain, but then again, this claim may not be too convincing since only breast implants can create such a dramatic change.

3.     Halle Berry

While the beauty denies going under the knife, not all people believe her claims.  According to rumors, she has gotten breast implants (resulting to a full 36C cup) earlier in her career.

In previous interviews, Berry was quoted saying that she may consider plastic surgery in the future, however, not all were convinced with this statement especially with rumors of nose job and breast augmentation surgery.

4.     Beyonce Knowles

While the singer-dancer is naturally curvy, photos taken between 2002 and 2005 show that there was a considerable increase in her bust size, which is rumored to be the works of breast implants.

While Beyonce denies having any cosmetic surgery, not all people are convinced especially when one photo with her arms raised revealed a small incision in her armpit—a possible proof that she had breast augmentation.

Underarm incision technique is particularly ideal for dark-skinned patients who are prone to keloids.  According to some studies, the armpit is less likely to develop raised scars.

5.     Carmen Electra

Former Baywatch star Carmen Electra’s breast implants probably catapulted her career and made her into a Hollywood sex goddess.  In fact, she has been featured in Playboy magazine four times.

Saline Breast Implants—Pros and Cons

Saline breast implants are filled with a sterile saltwater, for this reason, a leak will not result to serious health problems although patients will need revision breast augmentation to correct the deflated-looking bust.

Saline implants are not superior to silicone version, and vice versa.  Patients should realize that the most ideal option largely depends on their anatomical features (e.g., amount of breast tissue) and goals and expectations.

Meanwhile, these are the advantages of saline breast implants:

*  Shorter scar.  In the US, only saline implants filled at the time of surgery are available (currently there is no pre-filled saline implant).  Once the shell is inside the breast pocket, plastic surgeons inject this with a sterile saltwater before closing the incisions.

Because an empty shell can fit in a small incision, patients who will use saline implants should not be concerned with visible scars.

* Lower cost.  Saline implants cost less than the silicone version (around $900 to $1300 cheaper).  The difference in price is due to the reason that the cost of production for these implants is lower.

* No risk of silent leak.  In case of rupture, patients will immediately know it right away.  By contrast, women with silicone implants have to undergo regular MRI screening to detect silent leak.

* Slightly lower risk of capsular contracture.  This complication happens when the scar tissue surrounding the breast implants becomes too thick that it squeezes the devices.  Some studies suggest that women with saline implants are at lower risk of having this problem than patients with silicone version.  While the difference is just 1 percent per year, it can be as high as 10 percent after a decade of having the silicone implants.

On the other hand, saline implants have their own disadvantages such as:

* Less favorable cosmetic result.  Because saline implants are filled with only saltwater, women with little amount of breast tissue cannot achieve a natural result.  However, this is usually not a concern of patients with a moderate to significant amount of tissue and fat.

For patients with little breast tissue, silicone implants are the best option.

* Prone to sloshing

Unlike the silicone implants which are notable for simulating the natural “feel” of tissue, the saline version is prone to sloshing because it is only filled with water.  For this reason, some plastic surgeons intentionally overfill the shell to make the implants firmer.

* Natural deflation

One study has suggested that saline implants have a natural deflation rate of 1 percent per year due to evaporation and other factors.  By contrast, silicone implants maintain their for volume for years except in the event of rupture

Breast Surgery—Combining Fat Grafting and Breast Implants

Breast reconstruction via implants for cancer patients who had undergone radiation therapy is often not an ideal procedure due to the high risk of complications for the reason that radiation has toxic effects on tissues, which can impede natural healing for many women.

Because breast implants are not ideal for cancer patients who had radiation therapy, tissue-based reconstruction is the only viable treatment in which their own tissue from buttocks, abdomen, or back is used to create a new breast mound.  However, the tradeoff is longer recovery and muscle weakness and scarring in the donor site.

Fortunately, doctors have found ways minimize the radiation-induced complications, making it possible to use breast implants for post-cancer patients who received radiation therapy.  The staged procedure involves injecting a person’s own fats to her breast so the area will receive a “bed of healthy tissue” in the chest wall.

A recent study published in the February issue of Plastic and Reconstructive Surgery medical journal has proven the promising advantage of combining fat grafting and implants for breast reconstruction.

The three-year study involved 16 patients who underwent the new breast reconstruction technique after receiving radiation therapy to fight off cancer cells.  Eleven respondents had mastectomy (partial or complete removal of breasts) while five had lumpectomy and other types of breast-conserving surgery.

Breast reconstruction began three to six months after the respondents received radiation therapy.

All patients have received two to three fat grafts to place healthy tissue in the chest wall, allowing it to accommodate the breast implants and to lower the risk of radiation-induced complications.

The collected fats from the donor site must be subjected to a purification method to separate biomaterials such as blood and connective tissue; in this way, the survival rate of the grafted fats will be high.

After the staged breast reconstruction, the results were highly encouraging in terms of aesthetic improvements, the researchers concluded.  Also, patient satisfaction was rated high to very high.

Meanwhile, an average follow-up of 15 months did not show any complications as all patients have experienced good healing in their tissue surrounding the breast implants.

Performing radiation therapy after breast cancer surgery significantly reduces the risk of recurrence, although the downside is that the treatment can affect the body’s healing because of its toxic effects.

While the new study revealed the promising benefits of fat grafting with breast implant for reconstruction surgery, the researchers said more comprehensive surveys and trials with longer follow-up are still needed to confirm their findings.

Traditional Breast Lift Surgery Vs Surgical Mesh

Traditional breastlift surgery is conducted by making incisions around the areola, across the breast crease, and vertically down from the nipple to the fold, thus allowing plastic surgeons to excise some of the loose skin and tighten the tissue.  However, one tradeoff a patient should remember is that while it can raise and reshape the bust for a period of time, it cannot stop the effects of gravity and skin laxity.

But recently, plastic surgeons from South Africa have developed a new technique called Internal Bra System which uses a “support” to prevent future sagging.  This method is now also used in Europe.

The new breast lift technique uses a mesh-like device called Breform which is similar to the one used in hernia repairs.  Meanwhile, plastic surgeons who developed the method said the material can take the strain off the scars and skin, preventing the breasts from sagging.

While Breform has not yet been approved in the US, experts believe that it will be introduced to the market within the next coming years.

Breform is a cone-shaped polyester mesh that is placed underneath the breast skin and is attached to the fascia using internal sutures.  The procedure is conducted under general anesthesia that puts a patient to sleep.

Plastic surgeons in Europe who are using Breform said the device is incorporated into the breasts over time, with the body naturally producing fibrous tissue holding the new structure in place.  With this technique, they believe the result is like a permanent support bra under the skin.

However, patients should remember that the new technique also involves the same incision sites used by the traditional breast lift surgery.  This means that the risk of scar and the length of recovery of these two methods are almost the same.

While Breform is approved in Europe, it has not been permitted by the US Food and Drug Administration, which is noted for its strict regulations on medical instruments.  And because the breast surgical mesh is quite new, there is no long-term study proving its effectiveness and safety.

Some US plastic surgeons are also concerned if the mesh-like device may affect the accuracy of screening tests for breast cancer or if it may lead to serious complications.

However, a four-year study involving 170 patients in Holland found no serious complications following the procedure.  The trial also revealed that breast X-ray examinations were still possible after the internal bra surgery.

Too Young for Breast Augmentation?

In the US, the legal age requirement for breast implant surgery is 18—and that is if you are going to have saline implants which are filled with a sterile saline (saltwater solution).  But if you want to use the silicone implants, you should be at least 22 years old.

The main reason why silicone breast implants require a higher age limit is that they pose risk in the event of rupture or leak.  For this reason, you have to undergo regular MRI screening to detect any “silent leak.”

By contrast, the examination is not necessary if you will choose the saline implants because in the event of implant failure, your breasts will deflate within hours after the rupture, thus allowing you to seek revisions right away.

Generally speaking, female patients under the age of 18 cannot have breast augmentation surgery unless there is an issue of breast deformity.  The problem with younger people is that their body is still maturing and they may not yet fully understand the ramifications of cosmetic plasticsurgery.

It is important to note that even if you are flat-chested at the age of 15, there is still a chance that your breasts will enlarge as years pass by.  And with large implants and ongoing breast development, you may end up having oversized busts that look unnatural and asymmetric to the rest of your body.

Another concern is that patients below the age of 18 are not emotionally mature.  In fact, a study has suggested that teenagers see cosmetic surgery as a way to fit into their crowd.  By contrast, adults seek the procedure to stand out from the rest.

As mentioned earlier, your plastic surgeon may allow you to have breast augmentation at a younger age if you are suffering from certain types of deformity including tuberous breasts in which they appear too pointy because of the unusual structure of their base.

Breast augmentation performed at a younger age may also be necessary if you develop a very large breast on one side while the other is too small or even “absent.”  In general, age is not an issue in reconstructive plastic surgery.

While the US is quite strict when it comes to cosmetic breast augmentation, certain countries allow the procedure on patients as young as 16.  This lower age limit is not acceptable to many American surgeons who believe that the body should be allowed to mature first before any aesthetic or elective surgery is conducted.

Breast Implant Size and Things to Consider Before hand

The size of breast implants is measured via cubic centimeter or cc instead of “cup” since every bra manufacturer follows its own standard.  Meanwhile, it is important to note that the volume is not the only thing that affects the final results as there are other contributing factors such as implant profile, shape, and placement.

During the previous years, a significant number of women who asked for breast augmentation wanted larger implants even if it meant having a “heavy” top look.  However, plastic surgeons today see a shifting trend toward smaller sizes to achieve the natural look.

The growing trend can be seen on some Hollywood celebrities who replaced their breast implants with smaller ones.  For instance, Denise Richards and Pamela Anderson have been reported to have undergone revision plastic surgery to downsize their implants.

Another good example is Kate Hudson who has been reported to receive small breast implants in 2010.  And because of the subtle changes in her bust size, no one would even know that she had the procedure if not only for her previous photos and videos showing how flat-chested she was back then.

As a general rule, very large implants will obviously look “fake” in addition to higher risk of complications as the body, especially the back and upper torso, has to carry more extra weight.  For this reason, a good plastic surgeon will make every effort to convince his patient that inappropriate implant sizes can lead to many problems.

The problem with inordinately large implants is that they may lead to premature sagging and tissue thinning as the breasts are forced to carry more weight.  To correct such complications, a revision plastic surgery—which may involve implant replacement or permanent removal of the device—is the only effective solution.

For thin patients, particularly those with limited amounts of glandular fats and tissue, very large implants can significantly predispose them to visible and palpable rippling, or sometimes even traction wrinkling especially if they will receive the textured implants with large size “graininess.”

Another consideration to make is that large breast implants can upset the center of gravity of women, which can affect the way they move.  With this consideration, athletes and patients who live an active lifestyle are generally advised to choose smaller implants to maintain their performance and good posture.

Because of the risk of excessively large bust size, implant manufacturers in the US do not sell silicone breast implants that are over 800cc.

Study Shows the Benefits of Reconstructive Breast Augmentation to Cancer Survivors

When breast augmentation is mentioned, the first thing that comes to mind is a cosmetic procedure to improve one’s figure.  While it is true that a significant number of patients seek this to increase their bust size, the surgery is also a way to reconstruct the breasts of cancer survivors who had mastectomy.

In 2010, approximately 93,000 breast reconstructive surgeries were performed in the country.  Most of the patients were cancer survivors who wanted to regain their normal appearance.

According to the American Cancer Society, female patients who have undergone breast reconstruction via breast implants, tissue-based method, or combination of both procedures, have experienced dramatic improvement in their social and sexual wellbeing after their traumatic experience with cancer and disfiguring surgical treatment.

A recent study, which is conducted by researchers from Memorial Sloan Kettering Cancer Center and The University of Toronto, examined the wellbeing of post-cancer patients who had DIEP flap breast reconstruction, a procedure in which their own abdominal tissue was used to create new breast mound.

Before and after breast reconstruction, the respondents were required to answer questionnaires that would determine the status of their wellbeing and self-esteem.  According to the findings, majority had experienced significant improvements in terms of their emotional health just three weeks after the reconstructive plastic surgery.

But as with any tissue-based breast reconstruction in which the patients will likely experience muscle weakness in the donor site, most patients had reported weakened abdominal wall three months after surgery.  However, the symptom is usually tolerated well by many.

While muscle weakness is one of the tradeoffs of breast reconstruction via tissue-based technique, plastic surgeons can prevent this by placing surgical mesh or support over the donor site.

Apart from using a person’s own tissue, plastic surgeons also use breast implants, either filled with silicone gel or saline solution.  But in case that there is little tissue left after mastectomy, they will first insert temporary implants that is inflated with saline solution every two weeks; once there is enough room, they remove the tissue expander and replace this with a permanent implant.

The appropriate breast reconstruction technique largely depends on the amount of tissue left—or the lack of it.  And in general, patients who had invasive cancer surgery will likely need tissue-based surgeries.

On the other hand, women who are left with more amounts of glandular tissue and skin after their cancer surgery will often have the opportunity to choose breast implant surgery, which is less invasive and results to less scarring than the tissue-based reconstruction.