Breast
The glamor of the breast is brought down to earth with a bump by the anatomists who define it as a “modified sweat gland.”
The normal location of the breast (mammary gland) is lateral to the midline, with its central point, the nipple, at the level of the 4th intercostal space, and in post-menarche youth extends in the female between the 2nd and 6th intercostal spaces, lying on the surface of the deep fascia that covers the pectoral muscles. With age and pregnancy the breast may become pendulous, but its base does not move.
The milk line from the axilla to the groin is a potential for nipples or vestigial breaststo be located elsewhere.
The center of the breast is marked by the colored conical nipple and its surrounding areola; elsewhere the breast is smooth, and usually in the female bears few hairs. The outer coat is normal skin, with a varying degree of fatty tissue in the subcutaneous layer.
The gland tissue is constructed rather like a grape vine; there are ovoid lobules which in lactation produce the milk; these empty into small ducts which are joined by others until the main stem duct, the ductus lactiferi is formed and leads to the nipple, with an opening much narrower than the duct itself, and usually with a distended lactiferous sinus immediately proximal to the opening. The gland tissue is structured into recognizable divisions, into lobules and lobes by fibrous septa connected to the subcutaneous fascia.
The space between the glandular tissue is filled with fiber and fat. The fibers are organised as supporting ligaments for the breast tissue, named after the anatomist and surgeon, Sir Astley Cooper, and giving cause for the vulgar medical student to refer to the pendulous breast as Cooper’s droop.


This 25 year old woman with a preoperative BMI of 31.8 underwent abdominoplasty along with circumferential liposuction. This procedure treats the trunk or mid-section of the body as one unit all the way around. I believe that this method results in a more harmonious result than treating just the front with an abdominoplasty or just the back with liposuction.


This 31 year old woman underwent breast reduction in which approximately one and one third pounds of tissue was removed from the right breast and almost two pounds of tissue was removed from the left breast.
In this individual’s case, the incisions used to perform the breast reduction were of the “lollipop” or short scar type. This method of breast reduction avoids any incisions in the cleavage and in most instances along the lower fold of the breast.


This 24 year old woman underwent breast reduction in which approximately two pounds of tissue was removed from each breast.
In this individual’s case, the incisions used to perform the breast reduction were of the “lollipop” or short scar type. This method of breast reduction avoids any incisions in the cleavage and in most instances along the lower fold of the breast.


This 40 year old woman underwent breast reduction in which approximately one and a half pounds of tissue was removed from each breast. The remaining breast tissue was then rearranged to form a new breast shape that is shorter and rounder. This "rearrangement" process is very similar to what is done in a breast lift and in fact, each breast reduction I perform includes a breast lift.


This 39 year old woman underwent breast reduction in which approximately one and a half pounds of tissue was removed from each breast.
I view breast reduction as a two part process: first, tissue is removed to decrease the size and weight of the breasts; second, the remaining tissue is rearranged to create a new breast that has an aesthetically appropriate appearance. This rearranging process is very similar to what is done in a breast lift.


This 22 year old woman underwent bilateral augmentation mammaplasty using saline filled breast implants inflated to a volume of 320 cc’s place partially beneath the pectoralis muscle.
This individual wished to have the largest possible cup size while still appearing to have relatively natural breasts.
In my opinion, this implant size was the largest round implant that could be inserted, while still maintaining a natural appearing breast shape.


This 32 year old woman underwent breast augmentation using saline filled breast inflated to a volume of 195 cc’s and placed partially beneath the pectoralis muscle.
The individual has a mild pectus excavatum, a condition in which a person's breastbone is sunken into the chest. She also has a tendency to stand in a slightly kyphotic position, which means that her upper back is rounded and her head is relatively forward.


This 30 year old woman underwent breast augmentation using 180 cc silicone filled breast implants placed partially beneath the pectoralis muscle through an incision along the lower fold of the breast that measured 3 centimeters in length.
Implants can also be inserted through an incision on the edge of the areola, which is the dark colored skin surrounding the nipple. However, when an individual has very small areolas, such as this patient has, this is not possible.


This 49 year old woman reached her plateau weight after losing 100 pounds following bariatric surgery. She is an excellent example of an individual whose breast tissue had been largely replaced with fat and as such, after massive weight loss, there was not enough breast tissue remaining to rearrange into a new breast shape that appeared typical of what one might expect after a breast lift or mastopexy.
Questions Related to Breast
Breast Reduction Ideals
Once I have removed enough tissue to achieve an appropriate breast size, the nipple and areola are repositioned, which means that the new, smaller breast also has a “lifted” appearance. While this is not the primary goal of this procedure, it is a fantastic secondary benefit of it. I strive to achieve the same aesthetic standards when I perform medically necessary breast reduction as I do for cosmetic breast lift or mastopexy. Since stretching of the areola is a common problem in patients with very large breasts, I typically reduce the size of the areola during breast reduction.
More >>Dr. Belsley's Philosophy of Breast Revision
I apply the same criteria to patients who have had their surgery elsewhere as I do to my own patients. I am typically reluctant to re-operate on a breast augmentation patient for minor issues, because each time one undergoes revision, many of the risks of surgery tend to be multiplied. This is why I spend a great deal of time discussing size preferences and the likely outcome of surgery with my patients pre-operatively. It is said frequently that the most common reason for re-operation of the breasts in women who have had breast augmentation surgery is that they wish to “go bigger.” Ultimately, I feel that this is a poor reason to undergo repeated surgical procedures that can only result in more scar tissue, which is unpredictable, and thinning of the native tissues, which are necessary to cover the implant and provide a natural looking result. I encourage patients to think carefully about the risks of revision in cases where there is not a major problem.
More >>Dr. Belsley's Philosophy of Male Breast Reduction
Treatment for gynecomastia can be approached in several ways and is largely dependent upon the “type” of tissue in the chest that needs to be reduced. A physical examination is necessary to create a plan for treatment. Most of the time, I treat these individuals with a combination of ultrasonic liposuction and removal of glandular and breast tissue through a small incision on the border of the areola. Some individuals will be able to achieve excellent results with ultrasonic liposuction alone. Others, may require more extensive incisions. My goal is to give you a natural looking masculine shape that is well proportioned with the rest of your body using the shortest incision possible.
More >>Dr. Belsley's Philosophy of Breast Lift (Mastopexy)
In my practice, I perform breast lifts using incisions that result in a “lollipop” shaped scars. With good care and a bit of luck, these incisions heal well and the scars are difficult to see from a distance. Nevertheless, a woman who undergoes a cosmetic breast lift must be prepared for scars that are visible. This is one example of a “trade-off” in plastic surgery and of course, there are many others. This is one, however, that I feel is more than worthwhile in appropriate candidates.
More >>Dr. Belsley's Philosophy of Breast Augmentation
When it comes to deciding what approximate breast size you wish to achieve, the best advice I can give you is that you should be guided by your physical frame. Indeed, you may in fact be limited by it. In my practice, I select implants based upon your chest measurements, the quality of your breast skin and the size of your breasts prior to surgery.
I perform breast augmentation through a peri-areolar or inframammary approach and I place that vast majority of implants at least partially beneath the pectoralis muscle. My patients are welcome to select either saline or silicone filled breast implants. Silicone filled implants can in some cases achieve a more natural feel and may be a particularly attractive option for women with less breast tissue prior to surgery.
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