All about breasts


Breasts are universally regarded as objects of feminine beauty. Just as there is a considerable range of variation in facial features between individuals and different ethnic backgrounds, there are many variations in the appearance of the breast.

What dictates our breast shape & size?

Breasts come in all sorts of shapes and sizes, and nipples too can vary immensely in size, form and colouration. Some women have more glandular tissue in their breasts, some have less, some have more connective tissue, some more fat. Most of the size differences between women’s breasts are due to fatty tissue.

The size and shape of women’s breasts can also change over time due to pregnancy, breastfeeding and menopause. The only muscles in the breast are those involved in the erectile function of the nipple. The supporting semi-elastic Cooper’s ligaments, like the skin of the breast, stretch over time due to gravity, creating a degree of droop.

Pregnancy and breastfeeding can contribute to stretching; breasts are also affected by loss or gain in weight.

Women’s breasts are rarely symmetrical. In most cases, one breast is usually slightly larger or smaller, higher or lower, or of different shape to the other. Sometimes the base is narrow at the breast wall, which affects development. Hypoplastic or tubular breasts don’t tend to have much glandular tissue and often have a large nipple complex.

Nipples can be flat or protruding and an areola can be confined to a small ring around the nipple or cover almost half of a small breast. Colour can range from pink to black and usually becomes larger and darker during pregnancy.

Sometimes the nipples are folded in on themselves. In most cases inverted nipples are functional for breastfeeding because the baby can suck them outwards. A very small percentage of people (less than six percent of men and women) have either additional nipples, which can occur along the foetal milk line (pre-birth area of breast development), or additional breast tissue that usually forms in the armpit.

What is breast augmentation?

Breast augmentation is a surgical procedure that increases the volume of the breasts through the insertion of prosthetic implants. Implants typically range in volume from 90 to 900 millilitres and also come in different shapes. They have either saline or silicone filling and smooth or textured silicone or textured polyurethane foam covered envelopes.

As every woman’s physiology and presenting conditions are different, a skilled surgeon chooses from a range of procedural options to suit the patient and her desired outcome. In some cases augmentation surgery is accompanied by a mastopexy, or lifting procedure, which involves more scarring but may be needed to ensure an aesthetic outcome in patients who have sagging breasts.

Is breast implant surgery right for you?

Breast implants are available to suit the needs and preferences of just about every patient. Some women seek implant surgery to correct congenital or developmental anatomical abnormalities, while others are striving to repair the toll of age or breastfeeding by restoring their breasts to a more youthful and upright position. Other women simply want to have a larger size bust, which is more proportionate to their overall body size. Implants may also be required to reconstruct a damaged or missing breast, which has sustained injury, illness or mastectomy. There are countless reasons women undergo breast augmentation and each one has unique importance to the individual.

The psychology behind the decision to have breast implants is one of the most important aspects of the procedure. A good candidate for breast augmentation is mentally and physically stable and understands the reality of what this surgery can achieve.

Often women seek cosmetic surgery as a means of fulfilling emotional needs or resolving problematic body image issues. Any cosmetic procedure affects the patient more on a psychological level than on a physical one and it is important to remember that if a woman with low self-esteem elects to undergo surgery in the hope she will feel better about herself, she is likely to feel disappointed with her surgery. While breast augmentation can help boost a woman’s confidence, she will not benefit from surgery if she thinks it is the cure for all that is wrong in her life.

Many women view their breasts as a vital component of their gender identity, as the female breast is one of the prime symbols of femininity, motherhood and sensuality. However, women are notoriously critical of their bodies and some may be especially so of their breasts. When contemplating breast augmentation, ensure it’s for the right reasons.

Which implant & why?

The patient considering breast augmentation has a number of choices to discuss with her surgeon, including the location of the incision, the type of breast implant and where it will be located.

Prior to the procedure decisions will be made about the size and type of implant, depending on the patient’s anatomy, body size, chest measurements and desired final result. Almost all patients who request a breast augmentation desire some degree of cleavage.

Cleavage is defined by the distance between the breasts and it can be enhanced by narrowing the gap between them breasts as well as increasing the fullness of the breast at the inner edge of the breast.

In most cases, the appropriate type, size and placement of the implant can enhance cleavage. However, in some women, particularly those who are extremely thin with minimal soft tissue and with widely separated breasts, a well-defined cleavage will not be possible without causing the risk of implant visibility and, worse, being able to feel the implant. In these patients, cleavage can only be further enhanced by a suitable bra.

Choosing the right implant is more complex than choosing a certain cup size or wanting to emulate a look from a celebrity or a friend who has previously undergone breast augmentation. It is important for the patient to choose a breast implant size that suits her individual body shape and size. This will help ensure natural-looking results that will enhance her existing shape.

The final outcome depends on the patient’s existing breast volume, the thickness of the soft tissue that covers the breast, the bulk of the muscle and the tightness of the skin envelope. While these factors should be considered case by case, there are some general characteristics of an attractive breast, including:

• A gentle slope from the shoulder to the peak of the breast at the nipple (roundness at the top of the breast is an implant giveaway)
• The nipple is located on the centre of the breast mound and tilted slightly outwards and upwards
• A gentle arc from the nipple to underneath the breast (not too big and full, which can make the breast appear saggy)
• A good cleavage
• A silhouette line so that when standing front-on, a gentle bulge is apparent on the side of the chest wall.

Careful discussion of the patient’s expectations and concerns, along with planning and assessment, can help to achieve a successful outcome and natural-looking results.

Patients should thoroughly discuss their goals and motivations with a surgeon they can trust and with whom they feel comfortable. Listening to the surgeon’s feedback and advice can help ensure expectations and motivations are realistic.

A woman’s satisfaction with breast augmentation results ultimately depend on her understanding of the capabilities and limitations of the procedure.