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Advanced Art of Cosmetic Surgery Thomas M. DeWire, Sr., MD, FACS Specializing in Cosmetic Plastic Surgery Richmond, Virginia, USA |
Body Contouring |
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| Breast Augmentation: Special Anatomical Considerations | |
| Prominence of the Upper Chest Wall |
| Prominence of the upper chestwall with downward inclination of breasts: | ||
| The average chestwall shape in most patients is a gradual taper that occurs from the widest portion at the lower chestwall, to the narrowest portion at the upper chestwall. In some patients, there is greater apparent prominence of the upper chest, with apparent narrowing in the mid-chest, and then flaring of the lowermost chestwall. This leads to a general downward point to the nipples, since the plane of the base of the breast pyramid is not flat on the chest, but | rather tilts somewhat downward, as well. Augmentation with broad diameter implants (standard profile) will lead to excessive upper chestwall fullness, and can cause a less natural shape in side view. High profile implants are very useful in this instance by limiting the implant base diameter, thus preventing the upper pole of the implant from riding up over the prominent upper chestwall, creating excess upper pole breast fullness from the side view. | |
| The photo at near right shows the normal thoracic cage from a lateral view, demonstrating the normal taper of the chestwall from bottom to top. An overlay of a normally oriented breast mound is seen, with nipple pointing slightly upward. An example of a patient with this type of chestwall is seen to the mid-right, along with her augmentation result at the far right. |
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The photo at near right shows an example of the upper chest prominence, and depression of mid- chest with normal taper of the lower ribcage. An overlay of the breast shows the reason for the downward point of the nipple. The base of the breast actually is not flat, on the chestwall, but slopes back at the lower aspect of the breast, causing the down-turned nipple. This patient is discussed in the photo set that is seen below.
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| Case 1: A 33 year old who came to Richmond for breast augmentation. On exam, upper chestwall protrusion and downward inclination of the nipples was identified, thus high profile saline implants were used to limit the overlap of the upper implant over the prominent ribs, preventing excessive upper pole breast fullness. Other views are seen both above and below. |  |
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Age:
33 Ht: 5'6" Wt: 130 lbs Implants: Mentor Type: High Profile Saline Volume: 290cc Size: 34AA to 34 C
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| The same patient is seen in lateral views here and above. Note the prominence of the upper pole mainly impacts the shape of the breast from the side view, and that in this instance the downward point of the nipples is more pronounced in the right lateral view seen above. This was due to chestwall asymmetry. |  |
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Note the more pronounced roundness of the Mentor High Profile implants. The high profile implant fills in the relatively depressed area of the mid chest, and allows for greater projection than a standard profile implant, while having a smaller diameter for any given volume when compared to a standard profile implant. |
| Tubular Breast Malformation Page | Special Considerations Page | ||
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| Advanced Art of Cosmetic Surgery | ||
| 3974 Springfield Road | ||
| Glen Allen (Richmond), VA 23060 | ||
| 804-290-0200 |
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| ©Copyright 1997-2007 Advanced Art of Cosmetic Surgery: Thomas M. DeWire, Sr, MD, FACS Revised October 29, 2007 04:06:00 PM |