The Aesthetic Surgery Journal March 2016 was full of good articles. I do a lot of breast augmentations, and I spend a lot of time looking at the anatomy. Are your nipples symmetric? lateral? droopy? How is your inframammary fold (where your underwire is)? Is it symmetric? What about the volume, and the skin tone, and your ribcage? Many women come in without really looking at their breasts closely. They may not notice one is larger or lower. It is important for your surgeon to see it. All things magnify when your breasts get larger.
So. This article was called “Challenging Breast Augmentations: The Influence of Preoperative Anatomical Features on the Final Result.” In it, they looked at 100 consecutive patients to see who had a suboptimal cosmetic result. They looked at issues on these patients:
- Breast
- Asymmetry of inframammary fold
- Severe underdevelopment of breast tissue
- Vertical nipple asymmetry
- Lateral nipples
- Volume asymmetry
- Constricted base (where your breast is too narrow for the chest wall, and tight in the lower pole)
- Pseudoptosis (looks droopy but is not actually drooping)
- one sided lateral nipple
- tuberous breast (where it is narrow, like a tube, usually with an areola which is too large)
- Poland syndrome (no development of breast and usually muscle on one side)
- Chest wall
- Flaming rib
- long thorax
- pectus excavatum (looks indented on your sternum)
- pectus carinatum (looks peaked on your sternum)
- Vertebra
- Scoliosis
What they wanted to see was are there certain things which will frequently lead to a “worse” result when doing a breast augmentation? They followed 100 patients age range 21-38, average age 26 (which tells me there likely weren’t as many women after breast feeding and babies).
Findings?
18% had suboptimal results. The average number of “deformities” was 1 per patient. The range was 0-5 deformities. 50% of patients had more than one deformity.
- Most common deformity was IMF asymmetry in 21%
- Lateral nipple position was found in 13%
- Asymmetry of height of the nipple was in 13%
- Suboptimal results were found when patients had 1 major or 4 minor factors
- MAJOR issues: tuberous breast, Poland syndrome, pectus, scoliosis
- MINOR: all others.
They discuss each in detail. I thought it was a good comprehensive review. As with all things, there are degrees of these issues. Some people have volume asymmetry which is 20cc, some have 200cc. They discuss we as surgeons must show the minor deformities and major deformities to the patients when doing surgical planning. They discussed the drawbacks of their study (retrospective, 100 patients, didn’t look at things like BMI). In their conclusion, they say 1 in 5 women have anatomic factors which may lead them to have a “suboptimal” result from breast augmentation.
What do I think?
I liked how they were looking at the anatomic factors, trying to figure out which ones are “major” vs. “minor”. I look at the anatomy with all of my patients, and point out differences — ribcage prominence, pectus, nipple and fold asymmetries, and volume asymmetries. I do this so they see where they are starting from. Breast augmentation can magnify differences, and we as surgeons make tweaks in surgery to try to minimize differences. But it isn’t magic. The goal is pretty breasts and as symmetric as we can get them, and your starting anatomy affects how hard or realistic it is to achieve that.