Tailoring the Breast Shape with Breast Augmentation

When patients come in for breast augmentation, one of the key things we try and learn from them is what shape they desire for their breasts. We like to categorize this as a breast that appears very natural, or a breast that appears very round.

Here is what we mean. If you were to look straight on at the breast and draw it as a line drawing, you would draw a shape that looks like the letter U. Breasts of course vary in their shape and the U can be drawn as large U’s, small U’s, wide U’s and short U’s and long U’s. However the basic shape is a U. The top open part of the U we call the upper pole of the breast and the curved bottom of part of the U we call the lower poll. The upper pole of the breast may have some fullness or it may be flat with the chest wall. The bottom part of the U is where the breast is most full.

When you look at the breast from the side a line can be drawn from the upper pole to the lower pole. This line is called the breast slope. In a natural appearing breast, the slope is either straight or it might be concave with a curve like a ski slope. In general, when a breast implant is placed, the plastic surgeon can either maintain a natural straight slope, though at a different angle, or a rounder projecting curve can be created in the upper pole of the slope. What the surgeon does to create the pocket for the implant and what type of implant is inserted, will determine this shape.

Breast implants have a flat base and a curved outer surface. When the implants are laying on a flat surface, the amount of height that the outer curved surface has is called the implants projection. Round implants come in four basic types of projection or profile: low, moderate, high, and very high. The different implant companies give their profiles different names, but for simplicity sake, we describe them as low profile, moderate profile, high profile or very high profile.

When the patient and implant are upright, the volume of the implant flows to the bottom of the implant. This makes the implant have a more teardrop appearance. This varies somewhat with the different profiles. Low profile implants tend to produce the most natural teardrop appearance. Moderate profile implants can also produce a natural appearance with more projection to the breast. High profile and very high profile implants produce less of a teardropped shape and more of a round shape with more fullness in the upper pole of the breast.

There are a few other considerations in determining breast shape. The first is implant position, and the second is “overfill”, a term used when using saline implants. When an implant is properly positioned, the greatest amount of projection (P’) in the implant should be centered behind the nipple. If P’ is not centered behind the nipple, it can adversely affect the shape of the breast. For example, if P’ is located above the nipple, it can actually create the appearance of the nipple pointing downwards. If P’ is located too far towards the cleavage, it can make the nipple appear that it is pointing too far to the side. It is very important that the implant and P’ be appropriately positioned in each breast or significant differences in the appearance of the breasts will result.

When saline implants are used, the surgeon can either fill the implant to its stated volume or more than the prescribed volume can be inserted. For example, if we use a 400cc implant, the surgeon can overfill the implant with 425cc’s of saline. When the saline implant is overfilled, the implants shell is stretched more and the implant takes on a rounder and less teardrop shape.

Thus the surgeon can produce a natural appearance to the breast, a round appearance to the breast or something in between based on implant choice and surgical technique.

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