The age at which breasts start to develop and the time taken for breast development is very variable. In most girls, breast development will begin between the age of 7 and 14, and be complete between the age of 13 and 18, although there can be a further gradual change in size over the following few years. Breast development is driven by hormones, most importantly estrogens. Although, in most women with breast hypoplasia, hormone levels are normal, occasionally this condition can be caused by problems with hormone production, regulation or with the breast tissue’s response to the hormones. Identifying and treating this early can result in natural breast development without the need for surgery.
The extent of breast hypoplasia is also very variable. In some women, breasts do not develop at all, but in most women seeking treatment for breast hypoplasia, the problems faced by these women are psychosocial. Poor self esteem, unwillingness to undress in front of others, being teased by peers, difficulty with their identity as a woman and difficulty with relationships are commonly mentioned.
Surgery to correct breast hypoplasia has been attempted since the 1900s and most early attempts were unsuccessful. All sorts of materials, from wood, to wax and even ivory from elephant tusks were placed behind the breasts to improve their contour but most of these early attempts were unsuccessful. In the 1960s, breast implants made from silicone became popular and these are still used today, although they are much improved compared with the early designs. Today, surgery to correct breast hypoplasia is mainly undertaken either by placing a silicone implant behind the breast tissue or under the ‘pec’ muscle behind the breast, or by taking fat from elsewhere in the body and injecting it into the breast.
Tuberous or tubular breasts, are a rare condition in which breasts develop but, instead of developing fully, certain parts fail to develop. The cause for this is unknown and it can affect only one of the two breasts, with the other developing normally. The lower half of the breast tends to be underdeveloped compared with the upper with tight overlying skin, the width of the breast at the chest wall tends to be narrow, which means the breasts tend to be widely spaced apart and the breast grows forwards and droops downwards, with a lack of fullness to the breast. The fold under the breast tends to be at a higher position and the nipple areolar complex is widened and looks unnatural compared with the overall shape and size of the breast. Correction of tuberous breasts involves both increasing the overall size of the breast, and correcting the construction in the lower half to allow the breast to widen and develop a full and natural shape.
When considering any surgery for breast hypoplasia, it is important to appreciate that your breasts will change during your whole life, especially during and after pregnancy, and that especially any technique involving breast implants can give good results to start with, but these results can worsen as your breasts change naturally. 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.
The diagnosis of breast hypoplasia is made clinically by assessing the size and shape of the breasts together with their impact on the different aspects of your life. Depending on the age of the patient and the extent of breast development, testing for hormone levels and review with a Pediatric Endocrinologist may be recommended.
Signs to look for are that breast development has not started by the age of 13 or by the age of breast development in other women in your family, breasts that have developed into an unexpected shape and breasts that have not developed sufficiently for your expectations of what is adequate or desirable.