During your consultation, the doctor will examine your breasts, take measurements and explain the breast augmentation procedure to you. It will be beneficial to you to understand some of the terminology regarding breast anatomy and function.
A girl’s breast begins developing as early as age 9 and is usually complete by the age of 18. The shape changes with age and that shape is determined by the anatomy of the chest wall, the amount and quality of skin, the volume of fat and glandular tissues, as well as the effects of gravity, aging, hormonal, and environmental influences. The ideal shape is generally conical with breast volume in proportion to the woman’s frame. On front view the nipple sits an inch or more above the crease at the bottom of the breast. One third of the volume sits above the nipple and two thirds sits below the nipple. On side view the upper portion of the breast may be slightly convex, flat, or concave.
The breast has a vast network of blood vessels and nerves that essentially enter the breast from all sides. The circulation allows the breast to heal from the wide variety of successful operations that have been described for it. The nerves enable the breast to maintain variable degrees of sensitivity after surgery. The location of these at the periphery of the breast becomes an important consideration if one is choosing an implant that is wider than the patient’s breast. As the dissection nears the periphery of the breast it is more likely to disrupt the blood vessels that can result in excessive bleeding, or injure nerves causing a decrease in sensation.
The quality and quantity of skin is an important factor in determining the final result after breast augmentation. Younger patients tend to have thicker, tighter skin with greater amounts of collagen and elastic fibers. As a woman ages the skin becomes thinner and less elastic. This is due to ageing, genetics, pregnancy, and environmental factors such as sun damage and smoking. As the amount of skin increases and the volume of the breast decreases the breast tends to sag more.
Underneath the breast skin is the glandular tissue and fat. In younger women there is typically more gland and less fat and the breast is firmer. With age the amount fat relative to breast gland increases and the breast becomes softer. Anatomy drawings typically show a solid cone of breast gland covered by a layer of fat. However in a real breast the glandular tissue is interspersed among the fat. An analogy is a chocolate chip cookie where the gland is the chip and the fat is the dough. Exiting from the glands are the lactiferous (milk) ducts that eventually converge and arrive at the nipple via multiple tiny openings. Because these ducts communicate to the outside they are also an entry point for bacteria. This is an important consideration in the development of infection and capsular contracture after breast augmentation.
The nipple areola complex is the area of skin and specialized structures at the center of the breast. The areola is the larger pigmented portion. The nipple is the raised central portion.
The inframammary fold or crease is the lower perimeter of the breast where it meets the chest wall. This is the fixed portion of the breast where it is attached to the chest wall. It can be moved very little surgically.
Several muscles make up the chest wall in the area of the breast. The most important one in breast augmentation surgery is the Pectoralis Major muscle. When a surgeon mentions putting implants “under the muscle” this is the one he is referring to. One end of this muscle attaches to the collarbone, breastbone, and ribs. The other end attaches to the upper arm. The free edge of this muscle can be felt just in front of the armpit.