Determining Shape In Breast Augmentation

• Factors in Determining Your Final Shape
• Determining Cleavage
• Preventing Capsular Contracture
• Tubular, Tuberous, and Constricted Breast Shape

Factors in Determining Your Final Shape

Your final shape after breast augmentation surgery is in large part determined by your breast shape before surgery. In general you can expect your post-operative appearance of your newly augmented breast to be an enlarged, amplified form your original shape.

There are many factors the influence the shape of your preoperative appearance and your final shape. Some of these variables can be modified during surgery while others are permanent. Your final shape will be determined by:

• The amount of breast tissue before surgery
• Your skin elasticity and the presence of stretch marks
• The position and height of the nipple and areola on the breast and in relation to
  your chest wall
• The diameter of the nipple and areola
• The width of your breast bone
• The thickness of your pectoralis muscle
• The shape of you ribs and width of your rib cage
• Any curvature of your spine
• Level of the inframammary fold
• Any preexisting asymmetry between breasts

Asymmetry occurs when each breast has a different shape. Some asymmetry between breasts is normal. In fact greater than 95% of woman have measurable asymmetry between breasts. Asymmetry may occur due the following factors:

• Breast volume
• Breast width and height
• Level of the inframammary fold
• Skin elasticity
• Size and shape of the nipple and areola
• Differences in the shape of the left and right rib cage
• Presence of scoliosis (curvature of the spine)
• Thickness and shape of the pectoralis muscle

Some of these variables can be altered with surgery, while some are permanent. Breast volume, width, and height as well and the level of the inframammary fold can often be modified. Factors such as width of the breast bone, which effects cleavage, curvature of the spine and the shape of the ribs cannot be modified.

The level of the inframammary fold (the crease where the lower portion of the breast meets the chest wall) and location of the nipples have a tremendous impact on the shape of the final breast implant result. The size and shape of the nipple and areola, loosening of the breast skin, and breast sagging may be modified by a breast lift (mastopexy) if needed. Volume and size differences of the breasts can be often corrected by adjusting the size of each implant.

Determining Cleavage In Breast Augmentation

The depth and tightness of cleavage of the breasts postoperatively is not the same for each patient. As outlined above the width of the breastbone, thickness of skin and amount of breast tissue can also influence the curvature and rise of the cleavage from the rib cage. The width of the breastbone is fixed and cannot be altered. This factor is the major variable influencing the width of the cleavage.

These anatomical factors vary greatly from patient to patient, and our breast surgeon, Dr. Neil J. Zemmel, will go over these issues in detail during your consultation.

Preventing Capsular Contracture

As noted above, one of the most common complications of breast augmentation is the development of capsular contracture. This is a thickening and hardening of the thin capsule that forms around any permanent implant, including breast implants. The thickened capsule tries to contract the implant into the smallest volume possible (thereby minimizing surface tension). In greater than 95% of patients, the capsule remains thin and soft and undetectable by the patient. In a small minority of patients the reaction is more vigorous and the capsular thickens. Dr. Zemmel uses several ways to limit the amount of scar production before, during, and after surgery.

Your surgeon will advise you on several methods to optimize your wound healing. If you are smoker you will quit smoking 4 to 6 weeks before surgery. Smoking reduces the amount of oxygen and nutrients delivered to the wound bed and severely inhibits wound healing.

Capsular contracture also may be influenced by the amount of contamination during surgery. This contamination is not significant enough to cause a robust infection, but serves as an irritant to the breast pocket causing contracture. Dr. Zemmel maintains the highest level of sterile technique in the operating room to reduce the amount of bacteria around the implant. It is also important to limit potential germ contamination during surgery by proper hygiene in the days before surgery. Your surgeon will instruct you to take a thorough shower the evening before and morning of surgery using an antibacterial soap such as Dial. A betadine prep is done while you are prepared for breast augmentation surgery.

Finally, Dr. Zemmel instructs all patients to begin early, vigorous post-operative massage of the implants. He will instruct you on the time and course and technique of breast massage. Most patients begin breast massage 7 to 10 days after surgery as tolerated.

Tubular, Tuberous, and Constricted Breast Shape

As discussed above, the original breast shape largely influences the final outcome in breast augmentation surgery. The volume, height, width, breast tissue and skin thickness, and position of the nipple and inframammary fold all influence final shape. Some women develop breasts that have a smaller, constricted lower pole (bottom half) of the breast called tubular breasts, tuberous breast or constricted breast deformity. These three names all denote the same condition.

Women with tubular breasts have many variations, but all share some common features:

• Smaller breasts with a large nipple and areola
• A higher and tighter inframammary fold
• Narrowing of the breast base width
• Abnormal widening of the areola with a central herniation of the breast tissue
  through the areola.
• Lengthening and enlargement of the nipples.
• The breast tissue falls forward over the high, tighter inframammary fold causing significant sagging and shape changes.

The treatment for tuberous breasts consists of breast augmentation to increase the size of the breast and to provide a much-improved shape. The inframammary fold is lowered. Radially scoring of the breast tissue is typically necessary to allow the breast tissue to “unfurl” like an umbrella. This allows of the breast tissue to redrape over the implant. Finally, a periareolar mastopexy is necessary to narrow the diameter of the areolar and treat the areolar herniation.

If you believe you have tuberous breasts, our surgeon will be happy to see you for a consultation.