What We Treat: Breast Asymmetry
While some degree of breast asymmetry, or difference in size and shape between the two sides, is present in most women, breasts can occasionally develop significantly differently. When this difference reaches the point at which it is difficult to find underwear that fits, if there is neck, shoulder or back pain due to the difference in weight between the two sides or when the woman has psychosocial consequences from the difference between the two sides, then women may choose to seek treatment for breast asymmetry.
When treating breast asymmetry in children and young women, it is important to realise that, even in the same person, breasts can develop at different ages, so it is important to wait until the natural breasts have developed prior to planning surgery to correct any breast asymmetry. We offer a personalised treatment to take into account not only the extent of the condition and how the individual patient is affected, but also to look ahead to how that young woman will grow and develop over time.
In-depth look into Breast Asymmetry
Almost all women have a degree of asymmetry of their breasts, either in size, shape or ptosis, which is the degree of droopiness of the breast. Breast asymmetry that is more than a cup size difference can cause physical problems including poor posture, pain in the back, shoulders or neck and psychosocial problems such as poor self esteem, unwillingness to undress in front of others, being teased by peers, difficulty finding underwear that fits comfortably, and difficulty with relationships.
When assessing a patient for breast asymmetry it is important to look for other conditions that can affect breast development on one side, such as Poland’s Syndrome [attach link] and to assess for an asymmetry of the underlying chest wall. It is important to ensure that the breasts have reached their final developmental size, as any surgery undertaken while the breasts are still developing can result in good initial symmetry but any further breast development can make the breasts, once again, asymmetrical.
Overall weight is also important. If you gain weight, it will alter the size and shape of your breasts, and these changes may not be the same on both sides so, gaining or losing weight after any surgery to correct asymmetry is likely to change the outcome from your procedure.
It is also important to appreciate that breasts change during your whole life, especially during and after pregnancy, and any technique to correct breast asymmetry can give good results to start with, but these results can worsen as your breasts change naturally. There are, however, certain techniques that are more resistant to this than others. In addition, any young woman undergoing insertion of breast implants is likely to outlive those implants and so should expect further surgery to replace her breast implants or to correct any complications from implants over the years.
There are many types of breast asymmetry but these are best thought of as how the breasts are compared to what the woman would, ideally, like. Out of the two, some women prefer the larger breast and would like the smaller one made larger to match; others prefer the smaller and would like the larger breast reduced to match; others would like a middle ground between the two; and others who have a difference in the ptosis of their breasts, would like a breast lift on the more ptotic side together with enlargement or reduction of one or both.
Signs & Test
There is no lab test for breast asymmetry and diagnosis is made usually by the patient herself and confirmed by clinical examination. More important than the diagnosis is the assessment of how the breasts are different and which operation or sequence of operations is the best way to treat the condition for the individual patient.
Treatment & Care
Treatment varies and depends very much on the nature of the difference between the two breasts, the size of the breasts, their shape and the woman’s wishes and expectations. Any surgery to the breasts should be carefully considered, especially at a young age, as changes should be expected over time but especially during and after pregnancy, and some operations can have implications for a woman’s ability to breast feed and risk significant complications to the breast. The main options for surgery to correct breast asymmetry are augmentation, differential augmentation, aumentation mastopexy, unilateral reduction and differential reduction / mastopexy.
Augmentation is an operation to increase the size of the breast and usually involves inserting a breast implant under the smaller breast to even out the size difference. The disadvantage of using a breast implant is that although the size of the breast can be matched well, the breast enlarged by the implant is often not a good shape match to a breast without an implant. The implanted breast tends to sit higher, doesn’t move as naturally to changes in position and can feel different. In addition, breast implants can cause complications even years after their insertion including a change in position of the implant, infection requiring removal of the implant to treat, a firm, visible or even painful capsule that forms around the implant and the implant rupturing causing a change in shape and size of the breast.
Differential Augmentation is a technique that aims to overcome the differences between a breast with and a breast without an implant by placing an implant into each breast, using a larger implant in the smaller breast and a smaller implant in the larger breast. This can give good results in the size and shape of breasts, although the ongoing risk of complications of implants remains.
Augmentation Mastopexy is a technique done in either one or two operations to both enlarge and correct ptosis of a breast. It is a combination of a breast lifting operation with a breast implant and can give good results in the right patient. It is not often used in pediatric patients.
An alternative to a breast implant is a relatively new technique, the Brava bra, which is a suction device that patients wear at least 10 hours per day for roughly three months. It can be effective in increasing breast size by one or two cup sizes but there are concerns that these results are temporary and that breasts treated this way lose their size when treatment stops. To reduce the chance of this, fat can be taken from other parts of the body and injected into the treated breast or breasts, which appears to improve the longevity of the technique. It does have the advantage of not requiring an implant and the ongoing consequences of having an implant but the disadvantage is that the lifelong outcome from the technique is not yet fully known. It is a technique that we can offer at Children’s.
Unilateral Reduction is an operation to reduce the size of a breast on one side. Breast reduction surgery involves reducing the amount of breast tissue itself, but also removing some skin, which would be loose if left behind on the smaller breast. It also involves repositioning the nipple areola complex, the nipple and the darker coloured skin around the nipple, to the best position on the smaller breast. Because of removing the excess skin and repositioning the nipple areolar complex, it does create scarring on the breast, both around the nipple areolar complex and from the bottom of that to the bottom of the breast. Depending on the amount of skin and tissue removed, there can also be scars in the fold under the breast. Although many women who have had breast reductions can breast feed, some are unable to and so that should be taken into account when deciding whether to have this operation.
Differential reduction / mastopexy
Differential reduction / mastopexy is the same procedure but performed on both breasts, taking a larger amount of tissue from the larger breast to correct the asymmetry. A mastopexy is a similar operation to a reduction to correct breast ptosis, in which excess skin is removed and the nipple areolar complex is repositioned but no breast tissue is removed. Sometimes a combination of a breast reduction on the larger side and a mastopexy on the smaller side will give the best overall long-term results.
Aftercare is important for breast asymmetry as the asymmetry can return through changes in weight, after pregnancy or just over time. If implants are used, aftercare is especially important as even many years after surgery, these can become infected, can shift position or rotate, can form a hard or painful capsule around them, can rupture or can even come through the skin. In these cases, further surgery is likely to be required. The chest is an area that changes dramatically during early adulthood so it is important that any treatment for breast asymmetry is planned to give the best long-term result into adulthood.