A Plastic Surgeon’s-Eye View of the Breast

Ever wondered what a plastic surgeon thinks when examining a patient’s breasts? The truth is, they are considering a myriad of physical factors. The female breast is a complex body part, as its purpose goes far beyond aesthetics.

In this post, Dr. Schlesinger provides an overview of breast anatomy, as well as a rundown of why your plastic surgeon must assess these qualities in the breast surgery consultation and planning process.

The basic anatomy of the breast

The breast is an organ whose primary purpose is to produce milk for lactation. It extends horizontally from the sternum to the center of the axilla (the armpit), and vertically from the collarbone to the middle of the rib cage.

The basic anatomy of the breast.

The breast contains three types of tissue:

• Glandular tissue includes the lobes, lobules, and ducts, which produce and transport milk when a woman is breastfeeding.
• Fibrous tissue, also referred to as connective tissue, provides structural support to the breast.
• Fatty tissue fills in the breast. Breast size and shape are primarily determined by fat volume.

Within these tissues are muscles, ligaments, glands, and vessels:

• Areola. This is the skin surrounding your nipple. The areola contains small bumps that can be either Montgomery’s glands (these lubricate the nipple during breastfeeding) or hair follicles. The areola is typically darker than the skin of the breast because the mammary gland lies beneath it, and can become even darker during pregnancy.

• Blood vessels. These provide oxygen and nutrients to the breast tissue and remove waste.

• Ducts. These are a network of tiny tubes that transport milk from the lobes and lobules to the nipple.

• Ligaments. Also known as “Cooper ligaments,” these connect the pectoral muscle to the breast tissues. Ligaments are flexible and allow the breast to move with the body. Ligaments can become stretched over time, resulting in breast ptosis (sagging).

• Lobes. Each woman has 15-20 lobes. These lobes contain lobules, which produce milk.

• Lobules. These are glands within the lobes that produce milk.

• Lymphatic system. The part of the circulatory system that is responsible for disposing of cellular debris and bacteria in the body.

• Lymph nodes. Lymph nodes are tiny masses of lymphoid tissue found throughout the body that filter blood. They are part of the lymphatic system. Lymph nodes are essential for proper immune function because they help fight infection and filter out cancerous cells.

• Lymph vessels. These are tubes that carry lymph fluid away from the breast.

• Nipple. Producing milk is the breast’s ultimate function, and the nipple is the part of the breast where milk exits. The nipple contains approximately 8-15 milk duct orifices, small holes that allow milk to flow through.

• Pectoral muscle. Situated directly on top of the ribs, the pectoralis major muscle forms the foundation of the breast.

• Ribs. Though not technically part of the breast, the ribs provide structural support for the breast.

• Stroma. These are connective and fatty tissues that make up the breast. Stroma encompass the ducts, lobes, blood vessels, and lymphatic vessels.

• Tail of Spence. This is an extension of breast tissue that extends into the armpit. It is noteworthy because it extends beyond what most people would consider the breast’s edge; this “tail” of the breast should be included in breast self exams.

How a plastic surgeon assesses your breasts

During your breast surgery consultation, your plastic surgeon takes all elements of your breast anatomy into consideration. Your surgical plan and implant selection are even influenced by your anatomy around the breasts, especially the space between your breasts and the shape of your torso. Here are some of the major anatomical elements your surgeon is looking for, and why understanding them is key to giving you good results.

1. Quality of your breast skin and supporting tissue

Your surgeon needs to assess your skin’s elasticity as well as the qualities of the internal connective and fatty tissues that provide your breasts with structural support. This is critical to making a surgical plan, as some augmentation patients may also require a surgical lift to achieve ideal results.

2. The volume of breast tissue in each breast

The amount of breast tissue you have will influence many of your surgeon’s recommendations, including implant placement, implant type, and—of course—sizing. Plastic surgeons also need to carefully consider any size differences between the breasts and work to improve symmetry with their surgical plan.

3. Spacing of your breasts

The space between your breasts can influence your results quite a bit, and widely spaced breasts should be approached differently than more close-set breasts. Either way, your plastic surgeon will need to take your breast spacing into account and plan carefully to achieve natural-looking cleavage.

4. Width and shape of your chest wall

Chest wall characteristics can heavily influence surgical choices: for example, the treatment plan for a patient with a sunken chest shape (pectus excavatum) will be very different from that of a patient with a protruding chest wall (pectus carinatum).

5. Width and shape of each breast

Implant sizing is a precise business that goes well beyond choosing the right number of CCs. The correct width of implant, matched to each individual breast, is important to delivering attractive and stable results.

6. Overall shape of your torso and body

Plastic surgeons need to look beyond the breasts to the surrounding features: your breast implants should create a harmonious overall look that includes your whole body.

7. Consideration of any special breast issues

Some women’s breasts need additional special consideration. For example, some patients have tuberous breasts, colloquially known as “snoopy boobs” because of their downward-facing conical shape. (A standard breast augmentation will not adequately fix tuberous breasts, since the breasts need to be fully reshaped rather than simply resized; read more about corrective surgery for tuberous breasts here.) Fibrocystic breasts also require special attention when it comes to breast augmentation. Women who are aware of any special breast condition should be sure to choose a board certified plastic surgeon with particular expertise in the issue.

Schedule your Honolulu breast consultation with Dr. Schlesinger

Board-certified plastic surgeon Dr. Larry S. Schlesinger has over 30 years of plastic surgery experience and has performed thousands of breast surgeries during his career. Dr. Schlesinger has also been named a RealSelf Top Doctor for 6 consecutive years for his high patient satisfaction rate, willingness to answer questions, and exceptional patient feedback. Contact his practice online or call (808) 597-8835 to schedule your breast consultation today.