1. Aesthetic Breast Anatomy: Novel Insight for Improved Breast Implant Design

The female breast is an organ with dual functions of milk production and aesthetic appeal. Accordingly, the breast anatomy can be described in two different ways: functional breast anatomy, and aesthetic breast anatomy.

The functional anatomy of the breast consists of milk glands and ducts arranged like flower petals surrounding a nipple located at the 4thintercostal space. The important dimension of this description is the width of the breast footprint. 

The aesthetic anatomy, on the other hand, displays the nipple with the milk gland embedded in a compartmentalized subcutaneous fatty tissue that provides volume and shape to the breast. The important dimension in this description is vertical height of the breast footprint, that lies between the 2ndand 6thrib.

Current implants primarily augment the functional part of the breast, focusing on breast width while ignoring vertical height. Improved breast upper pole fullness requires an implant that augments the total of the aesthetic breast anatomy.

Anatomical Structure and physiology of Aesthetic Breast:

Sizes and shapes of breasts vary considerably. Some women have a large amount of breast fat and have larger breasts. Others have a smaller amount of tissue with little breast fat. The amount of breast fat is the result of genetic, ethnic, and dietary factors. In the published literatures there is a lack of research on breast fatty tissue, but there are articles related to the body fat in general, including some specific description of the breast fat.

The figure on the right demonstrates the structure of the breast fat compartments, which represent the largest portion of subcutaneous fat. Resembling orange segments, each section of subcutaneous fat is defined by a thin fibrous membrane consisting of sheets of fibrous tissue known as the Cooper’s ligaments. The path of blood vessels and nerves follows these fibrous partitions. The size and shape of these fat compartments are responsible for the natural shape of the breast. 

Aesthetic breast anatomy is related to the structure and configuration of the compartmentalized deep subcutaneous fat, which is considered part of the patient’s soft-tissue envelope and defines the borders of the breast footprint. Of particular interest is the upper border and the 3D shape of the breast sitting on this footprint, which receives minimum attention in literature because this border cannot be altered using round and teardrop breast implants. The upper border of the footprint is relatively mobile and is better visualized in supine position. Some patients have a high upper border and are described as “high-breasted, and others have a low upper border and are described as “low-breasted”. 

Natural breast mound may be hemispherical, conical, variably pendulous, pyriform, or thin and flattened. Each breast usually assumes a conical form with a base measuring 10–12 cm and a thickness of 5–7 cm. The main bulk of the breast tissue is usually localized to its upper outer quadrant. 

Anatomically, the upper border of the breast is located at the level of the 2ndrib at the level of the sternal angle. And according to the aesthetic breast anatomy it is the upper border of the compartmentalized subcutaneous fat.


Augmenting the Functional vs. Aesthetic Breasts:

Current breast implant devices augment the functional breast anatomy from the 3rdto the 6thrib. They have limited vertical height that restricts their upper reach. With the use of current round or teardrop shaped implants, surgeons cannot affect changes in the breast’s upper border. The implant’s upper edge ends within the pre-auxiliary fullness, much lower than the level of the breast’s upper border. Therefore, only limited changes in breast aesthetic can be made with current implants.

In order to augment the “whole” of the aesthetic breast, Dr. Al-Jasim has designed the DefyGravity breast implant that augments the breast from the 2ndto the 6thribs, reaching directly to augment the breast’s upper pole in the most natural way.

This description of the 3D geometric aesthetic breast anatomy serves as a template for the creation of a new breast implant design that is in demand for patients seeking additional upper pole volume, whether in an attempt to restore their lost volume or to augment an underdeveloped, flatter breast.

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