Breast Anatomy
The breasts are often an object of much adoration, scrutiny and obsession. Some will argue that we should be comfortable with our breasts as they are. In a perfect world all of us would have erect, firm, perky breasts in the size that we desire but since this isn't the case, breast augmentation is used to achieve this desire. Most of us really don't care to know what our insides look like, how they are formed and what muscle is named what. All we know is we want larger, firmer, better looking breasts. Period. Regardless, I have provided the below information so that if you so desire, it's here. The breasts are considered to be the mammae, an organ of lactation (to form milk) used to provide sustenance to our children. Granted we don't walk around pregnant or nursing most of our lives so what about the rest of the 90% of the time? We want them to look good no matter what stage we are in, don't we? The breasts begin to developing in utero at around 6-7 weeks post conception. It begins as a ridge of breast tissue running from the axillae (armpits) to the groin--called the milk ridge. At about the 8 or 9th week. the milk ridge subsides in all areas (usually) except above the pectoral muscle. At about 16 weeks the cells begin grouping for the lactation glands of the breasts (called lobules). Although they are not yet formed they are at the beginning stage of organizing into the intricate ductwork that will once perhaps feed the embryo's own, future child. The underlying myology (muscle) structure of the areolae complex (nipple and its surrounding disc of pigmented skin) will begin to form as well. Over the next several months the inner workings of the fetal breast will develop and define. During the last 2 months the lobules (lactation glands) will begin to produce and fill with a yellowish-clear or sometimes oily, milky substance called colostrum. This is a result of the mother's hormones crossing the placenta during the last trimester of the pregnancy. After the child is born the colostrum will resorb or leach out of the child's breast through the nipple. Both genders develop colostrum and have identical breast structure until puberty. The mother's breast will also produce this colostrum for the first week or so which is usually yellowish in color and is considered very beneficial for the child to consume soon after birth. The colostrum contains antibodies which destroy potentially dangerous organisms in the newborn child and hinders disease as well as has a laxative effect which helps the newborn pass the meconium, which is often a thick and tarry first bowel movement. Up until pre-pubescence, both gender's breasts are the same. At this time, the female body produces estrogen and then progesterone which stimulates the sexual maturation process. While the ovaries are maturing the breasts undergo significant changes themselves. The breasts will enlarge and develop more fully for a time period anywhere from 3 to 4 years. Menstruation usually begins within 2 years of breast development. After functional maturation the teen is able to produce a milk supply in the event of a pregnancy and subsequent childbirth. Even though during this time the breasts are still not truly developed in size, they are able to sustain life if need be. The breasts continue to further develop and reach their adult size anywhere from age 18-23 . Further breast changes develop as the years go by and estrogen/progesterone levels increase. This can happen quite naturally or with the interference of synthetic and natural supplemental hormones. Such outside hormonal influences may be from birth control pills, shots or implants, human growth hormone (HGH), and even herbal remedies thought to increase breast growth such as wild yam. Below you can see the breast, its lobules which group further into lobes, adipose (fatty tissue), milk ducts, connective tissue and the nipple/areola complex, as well as the underlying pectoralis major and ribs. The Chest wall itself is covered by muscle and muscle fascia which is sometimes dissected to make way for a sub-pectoral or full sub-muscular implant placement. Almost all women will have the mammae attributes depicted at the right, only more or less of them. There may be as many as 20 lobes in each breast, plus a collection of about about 5 to 10 larger milk ducts called collecting ducts. This is where a surplus of milk is emptied into awaiting removal by the nursing infant. There is also glandular tissue. Glandular tissue usually resides in the outer upper quadrant of the breast and feels like lumps or nodules of tissue. Many women who are not familiar with their breasts during a self breast exam may believe this to be a cyst or tumor. Many times it is only a gland although if you ever have any doubt or suspicion, please alert your gynecologist or primary care physician. You may also notice breast tenderness in this area if you are prone to such during both ovulation and menstruation. More often you will notice this right before menstruation.
1. Cooper's Ligament: a strong ligamentous band extending upward and backward from the base of Gimbernat's ligament along the iliopectineal line to which it is attached--called also ligament of Cooper. In 1829 he published a work on the anatomy and diseases of the breast in which he described those ligaments which are the connective tissue attachments of the mammary gland to the overlying skin. The ligaments have since been named in his honor. 2. pectoralis major: a larger chest muscle that arises from the clavicle, the sternum, the cartilages of most or all of the ribs, and the aponeurosis of the external oblique muscle and is inserted by a strong flat tendon into the posterior bicipital ridge of the humerus--called also pectoralis major 3. pectoralis minor: a smaller chest muscle that lies beneath the larger, arises from the third, fourth, and fifth ribs, and is inserted by a flat tendon into the coracoid process of the scapula--called also pectoralis minor 4. connective tissue: a tissue of mesodermal origin rich in intercellular substance or interlacing processes with little tendency for the cells to come together in sheets or masses ; specifically : connective tissue of stellate or spindle-shaped cells with interlacing processes that pervades, supports, and binds together other tissues and forms ligaments, tendons, and aponeuroses 5. blood vessels: any of the vessels through which blood circulates in the body 6. ribs: any of the paired curved bony or partly cartilaginous rods that stiffen the lateral walls of the body of most vertebrates and protect the viscera, that occur in mammals exclusively or almost exclusively in the thoracic region, and that in humans normally include 12 pairs of which all are articulated with the spinal column at the dorsal end and the first 10 are connected also at the ventral end with the sternum by costal cartilages 7. subcutaneous fat: fat cells being, living, used, or made under the skin 8. infra-mammary crease: infra- meaning below, mammary meaning breast. The fold or crease under the breast where the breast lobe meets the torso. 9. breast fat: fatty tissue found above the glandular tissue of the breast. The breast is mostly made up of lobules, milk ducts, fat, and glandular tissue. 10. ducts: a bodily tube or vessel especially when carrying the secretion of a gland, specifically breast milk. esp. lactiferous ducts, milk ducts 11. glandular tissue: of, relating to, or involving glands, gland cells, or their products; specifically breast milk production. esp. lobules 12. nipple: the protuberance of a mammary gland upon which in the female the lactiferous ducts open and from which milk is drawn 13. lobules: The glandular part of the breast where milk is produced 14. breast envelope: the skin which surrounds the structure of the breast. Risks of Breast Augmentation Surgery: Scars * Hypertrophic Scars: Thin red scars that become raised and firm from Breast Augmentation Surgery. These usually fade, but sometimes become permanent. * Keloid Scars: A scar that becomes enlarged, does not fade with time and may have to be removed surgically. Incidence of scarring is between 2% and 6% after 3 years. Capsular Contraction from Breast Augmentation Surgery This occurs when scar tissue forms around the implant and tightens. This causes the implant to change from a teardrop to a spherical shape. Further surgery is required to correct it by 'scoring' the scar tissue from Breast Augmentation Surgery; this is usually successful although implant removal is sometimes necessary. It is difficult to predict which patients might suffer from this problem although it is more common with subglandular insertion. Incidence is usually quoted at 9% over 3 years depending on implant type and procedure. Infection from Breast Augmentation SurgeryInfection can occur at the incision site, around the implant or, very rarely, inside the implant. If infection occurs it is sometimes necessary to remove the implant until the infection has been clear for several months, and then a new implant is inserted. Risk is between 2% and less than 1% over 3 years. Change in Nipple Sensation-- from Breast Augmentation Surgery This is generally caused by stretching of the skin by the implant, and not the incision site. Temporary changes are fairly common and usually resolve after six months. 70% experience no change. Sometimes it is permanent, with 20% experiencing diminished sensitivity/numbness, and 10% found sensation was enhanced. This may affect breast feeding or sexual arousal. Implant Deflation, Leakage or Rupture from Breast Augmentation SurgeryOccasionally the implant leaks via the valve or a rupture in the silicon elastomer. Saline is absorbed by the body and excreted via urination. Figures vary around 5% over ten years. Tissue Necrosis from Breast Augmentation SurgeryTissue around the implant can die; this may cause infection and will delay healing. There might be a need to remove the tissue, or even the implant. This is more likely in smokers and patients taking steroids. Tissue necrosis is very rare. Implant Extrusion from Breast Augmentation SurgeryThe device can break through if the skin covering the implant is very thin. Surgery will be required to remove the implant and repair the area. This can result in tissue loss and scarring. Skin Wrinkling and Rippling from Breast Augmentation SurgerySometimes the implant pulls on overlying tissues causing wrinkling or rippling. Occasionally the natural folds of the implant can be seen through the skin. The incidence of this happening is 11% to 21%. Removal/Revision of the Breast Augmentation Surgery results-Breast implants, like any other implant from Breast Augmentation Surgery, such as a hip replacement, are not permanent and will need replacing or complete removal at some stage. This will incur further surgical costs. Between 20% and 30% of breast augmentations will require re-operation within five years. Calcification from Breast Augmentation SurgeryCalcium deposits may form in the scar tissue, causing pain and hardness. These deposits sometimes interfere with mammography and need to be investigated. Investigation may damage the implant. Incidence of calcification is 1% over 3 years. Chest Wall Deformity from Breast Augmentation SurgeryThis has been reported rarely following removal of implants or use of tissue expanders. It is of unknown significance. Malposition from Breast Augmentation SurgeryThe implants can be misaligned, rotate, or slide. This can cause distortion, asymmetry, and/or discomfort and may require additional surgery to correct. The occurrence of asymmetry is between 7% and 10%. Ptosis-- from Breast Augmentation SurgeryPtosis or 'drooping' occurs when the natural breast tissue begins to sag whereas the implant does not. This happens over time and causes a double bulge similar in appearance to the effect of wearing a bra that is too small. Sometimes known as a 'snoopy' breast because of the shape in profile. Further surgery will be required to correct this. Incidence of ptosis is around 2% over 3 years. Connective Tissue and Autoimmune DisordersThere are anecdotal reports of silicone implants causing complaints such as arthritis and Lupus. At the time of writing there is no clinical evidence supporting this. Breast Cancer DiagnosisMammography and lump detection can prove more difficult to perform on patients with breast implants than those without. No evidence has been found for implants causing cancer. Seroma and HematomaSerum or blood can collect aroud the implant and potentially cause capsular contracture, infection or other problems. Seratoma can occur following surgery, after vigorous exercise or trauma. One or both breasts will appear to increase in size. It this happens it should be investigated and may result in further surgery. The cost of this corrective surgery may be more than that for the original augmentation. Hematoma occurs in about 2% of cases over 3 years. Anesthesia from Breast Augmentation SurgeryThere are risks associated with any anesthetic procedure; for example an allergy to the drugs used to induce general anesthesia. Sources: 1. Learn about Procedures, Quick Facts (2002) American Society of Plastic Surgeons http://www.plasticsurgery.org/public_education/2002statistics.cfm 2. Saline Filled Breast Implant Surgery: Making an informed decision (January 2004 Update) Mentor Corporation http://www.mentorcorp.com/pdf/FinalInformedConsent.pdf 3. Making an Informed Decision: Saline-filled breast implant surgery (2002 Update) Inamed Aesthetics http://www.inamed.com/pdf/us_aesthetics/M713D_Informed_Decision.pdf 4. Surgical Procedure: Breast augmentation (2002) Plast Surgery, Your Practice Online and Sydney Institute of Plastic Surgery http://www.plastsurgery.com/5
FDA GUIDE Breast Augmentation Surgery
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