Breast are specialized accessory glands of the skin capable of secreting milk. They are present in both men and women. In men and young woman, they are similar in structure. The nipples are small elevation located on the breast tissue & surrounded by colored aread of skin called areola.
In young woman after the periods commence, the breast glands gradually enlarge and assume hemi-spherical shape under the influence of female hormones.
The increase in size is due to deposition of fat mainly. The breast tissue lies in the superficial fasicia, above the rib cage and therefore surgeries of the breast is performed only superficially in the skin and deeper structured are not touched and hence the safety of the breast surgery. The breast gland is separated by fibrous septa that extend from deep fascia over the chest muscle to the skin and they act as suspensory ligaments with growth, these suspensory ligaments looser up leading to sagging breasts. In young woman, the breasts tend to protrude forward from a circular base, in older women they tend to be pendulous.
They reach their maximum size during lactation, problem of shape & size of breast causes great concern and these may be congenital ( present since birth) or developmental (happens during development due to either endogenous or external factors).
What are the types of abnormalities that can happen with breast in woman?
- Congenital or Abnormalities from birth –
These problems are due to genetic reasons and are corrected with right diagnosis & treatment (usually surgery)
- Amastia or absence of breast tissue – In this problem there’s no breast tissue present from birth that leads to flat chest in woman and even under influence of hormones breast fail to develop in such people as their no tissue present that respond to hormonal stimulation.
- Polymastia or more than me breast on one or both sides these multiple breasts lie on a -straight line usually 7-10 in number below the normal nipple. They may have rudimentary nipple or it may be confused with some other swelling or lipoma. Careful examination is a must for the right diagnosis and treatment.
- Polythelia or multiple nipple on the breast – This arises from faulty development of breast tissue since birth and signified by presence of multiple nipples on the breast tissue and not in a line as in polymastia. Treatment involves excision of extra nipples.
- Breast Developmental Abnormalities –
- Small size or undersized breasts – This is not a disease or any abnormality. The size of the breast differs depending upon various factors e.g. age of women, race and genetic factors. The ideal size and shape of breast is driven by internet and movies and fashion magazines. In young women, breast size is small and the size fluctuates according to the reproductive life cycles of the women as under influence of certain female hormones it increases of decreases in size depending upon the availabity of these hormones in the blood.
The hormones e.g.
Prolactin and progesterone increases during pregnancy and increases the breast size and their low levels in the blood after stopping breast feeding leads to decrease in the size of breasts.
Before considering breast augmentation, it is always wise to consult a specialist like Dr. Monisha Kapoor (Plastic Surgeon) to understand whether this is required or not.
Treatment for small Breasts –
- Non surgical options –
- Fillers – This employs injection of hyaluronic gel for augmentation but not a choice procedure for women looking for permanent augmentation.
It’s temporary solution and moreover large volume of gel cannot be pushed in the breasts because of safety issue, only small change may be expected with this technique and that too it may be repeated every year and the cost of this treatment may be more than the surgery as it is dependent upon the cost of injections.
- Fat grafting for breast augmentation – It is minimally invasive procedure for augmenting breast tissue by injecting body’s own fat into the breast. However the aesthetic result of fat transfer cannot be compared with breast Implant after one sitting. After fat transfer to the breast, 40% of injected fat gets absorbed leading to decrease in the size of the breast a minimum of three sittings are required for the desired augmentation. The cost of all three procedures is 3 times the cost of breast Implant surgery.
- Surgical Augmentation – Breast augmentation surgery or augmentation mammoplasty involves placement of breast implant in the breast to increase the size. This surgery involves a cut on the skin and fat layer. This is followed by making of a pocket under the breast tissue for placing the implant and then stitching the fat layer and skin. Depending upon the type of breast Implants (Saline or Silicone), the surgery cost is calculated in India.
Silicone breast implants are used for breast augmentation. These Implant come in different shapes. The implant and sizes & shape is chosen by the operating surgeon depending upon the requirement discussed with the client. The cost of the Breast Implant augmentation surgery depends upon the quality and price of silicone breast implant chosen for the procedure as well as addition of other procedure. If breast lift is also desired along with breast augmentation addition cost may be added to the whole procedure.
- Large breast or Gigantomastia or Breast Hypertrophy – Heavy, Pendulous breasts cause neck & back pain as well as grooves from the pressure of brassiere straps.
- Heavy & large breasts themselves may be chronically painful and the skin in the inframamary region is subject to maceration and dermatoses.
- Huge breasts may put weight on the shoulders & neck leading to neck and shoulder pain lasting for weeks & months not responsive to medication.
- From psychological point of view, excessively large breasts can be a troublesome focus of embarrassment for the teenager as well as the woman in her senior years.
- Unilateral or one side enlargement with asymmetry heightens embarrassment.
- Women seek to reduce the size of their breasts for reasons both physical & psychological.
Cause of Large breasts – The tremendous overgrowth of breast tissue is apparently due to an alteration in the normal sensitivity of the breast to female hormones (oestrogen) and therefore some success in treating it with anti-oestrogens has been reported but because of other side effects of anti-oestrogens like hair growth and acne, it is not the treatment of choice for breast enlargement.
The treatment for large breasts is reduction mammoplasty. In Breast reduction surgery, both skin and breast tissue (gland & fat) is removed to achieve smaller breast and depending upon the size of breast the surgeon may choose different technique for breast reduction mammoplasty.
For mild to moderate enlargement, vertical reduction mammoplasty with keyhole incision on skin may be preferred. In large breasts, inverted – T technique or anchor incision reduction mammoplasty may be performed.
In gigantomastia / very heavy breast tissue, breast amputation with free nipple graft may be undertaken for best results.
In young, unmarried women who doesn’t want the scar, suction assisted liposuction can be performed to decrease the size of breasts avoiding the scars.
- Sagging or Ptotic Breasts
The set of patients have adequate breast tissue or they are happy with the breast size but it is just that they are not happy with the saggy appearance. Breast ptosis is classified or divided as Minor or first degree- where nipple is at the same level of Breast fold.
- Moderate or Second degree – When nipple is below breast fold.
- Severe Ptosis or third degree breast sagging – When nipple is at the lowest breast contour and below the level of breast fold.
- Glandular Ptosis – It is characterized by nipple above the breast skin fold & gland or breast tissue hanging below the fold.
This clarification helps in determining the best treatment for particular breast type. It was originally described by Regault.
The treatment for saggy Ptotic breast is breast lift surgery or Mastopexy.