When having breast augmentation, it is important to have realistic expectations. This starts from understanding what the surgery can and cannot do. First of all, your body’s natural shape will determine much of the outcome. The plastic surgeon will take this into account during the initial exam.
Here are some basics on breast structure and body shape. Understanding this will help explain how the breast augmentation result will vary from woman to woman.
Breast Anatomy
General breast structure, shape, and size
The breast is mostly made up of glands and fatty tissue. The glandular tissue is what produces milk for newborns. This tissue may be referred to as lobes. Within the breast are around 15-20 lobes, each of which contains smaller lobules. These all end in bulbs and it is all connected by thin tubes called ducts. This glandular structure is what actually produces milk. The ducts are attached to the nipple for breastfeeding. There are also nerves, blood vessels, and lymphatic vessels within the breast. (Lymph nodes are found under the arms).
Fat fills the space between all of the lobes. The amount of fat is what creates the final size of the breast. Breast size can change often. It changes in response to hormones or changes in weight. This can be from puberty, menopause, pregnancy, breastfeeding, and hormonal changes during the monthly cycle.
The ratio of glandular tissue and fat will vary from woman to woman. It will also vary over a woman’s lifetime. For example, a woman will typically have more glandular tissue than fat during her child-bearing years. This ratio will be the highest during breastfeeding. The ratio will reverse after menopause (more fatty tissue, less glandular tissue). Glandular tissue can feel firmer to the touch than fatty tissue. This can mean that the firmness of the breast changes over time. As the glandular tissue decreases, the size will also decrease. The exception is when more fat is added to replace the lost glandular tissue; this typically only happens during weight gain. Some women will maintain the heavy breast look yet still desire breast augmentation.
There are many different breast shapes as well. For example, they may be swooped. This results in a nipple that points slightly upward. They may be tubular. This results in a narrow shape projecting outward. They may be quite large or quite small. They could droop or point downward. In addition to breast shape asymmetries, there can also be nipple position asymmetry after breast augmentation. There may be nipples too low after breast augmentation. The nipples may also become outpointing nipples after breast augmentation. The important thing to remember is that the nipple positions were actually asymmetric before the surgery. The breast implants only magnified the result.
Breast Position
The breast mounds sit on the chest wall above the pectoral muscle. This muscle sits atop the rib cage. This is the muscle that an implant may be placed above or below. There are no muscles within the breast itself. The breast mound is positioned over the 2nd through 6th rib in most women. The nipple usually resides above the crease and sits over the 4th rib. It is connected with ligaments between the muscle and the skin. The ligaments relax over time, which allows the breasts to sag.
Skin Layer of Breast
The skin covering the breast, just like skin on the rest of the body, has an outer layer and a dermis. The dermis is the thicker inner layer that provides structure and strength. Elastin is also found within the skin. It affects how much the skin can stretch. It also affects how well the skin and tissue will return to its original position after it has stretched. This can be especially noticeable after major breast changes. For example, pregnancy and breastfeeding can make the breasts larger. This can in turn make the skin thinner. The elastin may not be able to return the breast to its original shape after breastfeeding stops. The result can be breasts that now sit lower than they did before pregnancy. The skin can also contain stretch marks if it stretches quickly. The mark itself is actually a tear in the dermal layer. This tear is seen at the surface as the stretch mark. Stretch marks after breast augmentation may become irritated and red again. Over time they will fade to their pre-existing condition.
The breast skin also has an areola and nipple. This is a darker section of skin that is connected to the glandular tissue below. The areola can be many different shapes and sizes. The tissue of the nipple and areola is usually darker than the skin around it, but the color may vary from pink to brown. The shape of the areola may or may not be circular. It may be more elliptical. The skin of the nipple and areola is also thinner than the surrounding skin. It will stretch more easily. As the skin stretches, the breast implant settling will be impacted.
At the bottom of the breast is the inframammary fold, also called the breast crease. Regardless of breast size, this structure still exists. This structure is very important when considering breast augmentation. This is because the breast implant will sit just above this fold. The strength of the tissues in the inframammary fold can vary. If the tissue is weak, an implant may cause the fold position to lower. The breast folds can also be a different positions on the two sides of the chest. This will result in inframammary fold asymmetry after breast augmentation. If the breast implants settle below the fold this can also cause a problem. When the breast implant settles below the breast fold, a double bubble complication after breast augmentation will occur.
Body Shape
The ribs, chest, and spine all influence results
You may not think of the ribs and spine when considering breast shape. However, these are very important. Since the breast tissue sits atop the rib cage, the curvature of the rib cage matters a great deal. It will affect how the breast mound sits on the chest.
The ribs curve around the chest area; they protect the organs. The degree of curvature also affects how the breasts sit atop them. Rib curvature will influence breast augmentation. The ribs themselves can be flat or curved outward at the front of the body. The two sides could also differ. If the rib cage lies relatively flat in the front, this will create a flat base for the breast. Alternatively, if the rib cage is more curved along the front, this means the breasts will sit further out. This will cause a wide gap breast augmentation result. A difference in the curvature of the ribs can also mean that the breasts may point in different directions. The ribs can also bow inward in the center and this will cause the breasts to have a fuller cleavage look after breast augmentation.
Where the ribs come together at the front is called the breast bone. It’s also called the sternum. Like the ribs, the breast bone can be flat or curved. It can be level with the ribs or it might stick out further than the ribs. It could also sit lower than the ribs. Each of these variations will have an effect on the way the breasts sit on the chest. The breasts typically sit next to the breast bone. So its shape and position makes a big difference in the position of the breasts.
Since the ribs connect to the spine, any curvature of the spine will also affect how the breasts sit. A spine curvature may result in one breast sitting lower than the other. It could also result in ribs that sit at a different angle; this may mean one breast seems to be further back (toward the chest wall) than the other. A spine curvature could also change the alignment of the hip and shoulder. This could cause a shift that makes one breast appear higher than the other as well. So spine curvature and breast augmentation go hand in hand and should be identified before the surgery.
The body shape is also very important women of the same height but different frames will get different breast augmentation results. A thin or skinny woman breast augmentation will look completely different from a full framed breast augmentation. A long torso woman with breast augmentation will different from a muscular woman with breast implants.
It is important for the plastic surgeon to go over the overall shape of your body when preparing for breast augmentation. The shape of the ribs, spine, and body can affect the breasts dramatically. Each of these items has a direct influence on how the breast sits. As such, each needs to be considered. If they are not noted, asymmetry is more likely to result after the augmentation. Any subtle change that exists naturally can be even more noticeable after the breasts are enhanced.