Breast Augmentation Shape Determinants : Advanced Art of Cosmetic Surgery

Advanced Art of Cosmetic Surgery Thomas M. DeWire, Sr., MD, FACS Specializing in Cosmetic Plastic Surgery Richmond, Virginia, USA


	Breast Surgery Procedures
	*Breast Augmentation Shape Outcome Determinants*

Shape Determination of the result of Breast Augmentation:
	The shape of the breasts after implant enlargement or augmentation mammaplasty is mostly determined by the breast shape before surgery. Thus the post-op augmented breasts will generally appear as a larger version of the original breasts. This is true because there are certain factors, unrelated to the surgery, that have a significant effect on the final shape of the enlarged breast. While breast augmentation will reliably make the breasts larger, it will not change the underlying basic shape of the breasts, a factor that may vary significantly from patient to patient. Other factors determining the final breast appearance include the shape and symmetry of the ribcage and muscles, the shape and depth of the breast bone, the volume of the existing breasts, and the character of the existing breast skin. Position and symmetry of the existing breast folds, and the nipples also has a large bearing on the shape of the final implant result. While some degree of asymmetry is normal, often it is not possible to correct many of the asymmetries that are commonly seen, such as different heights of nipples or infra-mammary folds. Volume and size differences of the breasts often can be corrected by implant volume adjustments, as the sterile saline filler is added. Examples with before and after patient photos are displayed below

Photos Before and After Surgery:

Case 1: A 47 year old woman with round breasts and rounded lower breast folds underwent Trans-axillary Breast Augmentation Mammaplasty. Note the contrast of these rounded breasts and folds to the patient below (Case 2) who has obliquely oriented folds rapidly diverging from the region of the breastbone, as highlighted in the inset photos. The breast base has been enlarged by widening the breasts laterally, and lowering the inframammary folds. The superior point of origin of the breasts was also moved higher to allow this proportional increase in all breast base dimensions to match the increased height (projection) of the breast pyramid. See Breast Pyramid Concept below

Case 2: A healthy 23-year-old woman with divergent breasts, high breast folds, loose skin, and obliquely oriented folds extending from the breast bone laterally.

Post-operative result of Trans - Axillary Breast Augmentation shows lowering of the fold, filling of the loose skin which is pulled taut by the submuscular implant placement, and a relatively conical shape based on the relative conical shape seen pre-op in the side views below. Note also the persistence of the relatively divergent obliquely oriented folds beneath the breasts, as contrasted with the patient above who has a basic rounded breast shape with round folds beneath the breasts. Because of the pre-existing breast shape, this patient will not achieve a more rounded base shape like the patient above, and vice versa. Note also that the base dimension of the augmented breast has increased in all directions, with the enlarged breast base extending higher, lower, and wider than the original breast base dimensions. This allows maintenance of proper proportion of height versus width of the breast pyramid which maintains the beauty of the shape. If this pyramid, or cone shape is distorted by improper placement of the implants too high, too low, or too large, overall dimensional beauty of the augmented breast shape will thus be compromised. (See below)

The Pyramid Concept of Augmentation: When considering the mechanical and artistic principles of breast augmentation, I view the breast as a pyramid with certain height t o base width dimension proportions. Thus, the augmented breast should be enlarged in such a fashion as to maintain these proportions. If the pyramid is to be taller, it should have a wider base to maintain this aesthetic proportional beauty. Pictured below is a pyramid (blue), enlarged with a proportional base (green), containing a breast implant (yellow), and at right are photos of the two patients from above. This also explains why the crease must often be lowered in augmentation to maintain proper breast proportion, and to allow the nipple to be centered on the enlarged breast mound.