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 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.
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.