It is natural to have some degree of asymmetry between breasts. However, in some circumstances, excessive asymmetry can be present. This may be due to developmental issues (also known as 'congenital' - see below) or acquired conditions such as previous surgery, radiation treatment or trauma to one breast. Significant breast asymmetry can result in functional problems, such as postural imbalance, poor confidence, and clothing issues. Surgery can lessen the discrepancy between the breasts in these situations. There are a few methods which can be used by surgeons to restore better symmetry between the breasts.
- A breast augmentation can be performed on the smaller breast to match the size of the larger breast.
- The larger breast can be reduced via breast reduction surgery or alternatively breast liposuction to match the smaller breast
- The insertion of implants of different sizes in both breasts to lessen the discrepancy between the breasts.
- Performing a breast lift with or without implants for one or both breasts
Your surgery will need to be individualised according to the cause and degree of the problem. The pros and cons of each option will be discussed with you to determine your preference.
Causes of Congenital Breast Asymmetry
Breast Asymmetry is often congenital (present at birth) but may not be obvious until puberty and breast development. There are many causes for uneven breast development, some more common than others.
This is a descriptive term for total absence or deficiencies in breast development. Characteristically, the breast is either absent or small overall. This is the most common form of breast asymmetry and is usually corrected by implant augmentation of the affected side.
Tuberous Breast Deformity
This can occur on one side (unilateral) only or on both sides (bilateral). Tuberous breast deformity has the following characteristics:
- asymmetry in size
- deficiency of breast volume in the lower part of the breast
- large areola and nipple on the affected breast
- ‘tube’ like breast shape, with narrow base and long projection
- droopy breast with nipples sitting low or pointing downwards
Correction of tuberous breast deformity can be challenging, and various techniques can be used depending on the severity of each feature. Most commonly, augmentation with expander or implant, concurrent breast lift, areola reduction, or breast scoring is used to restore a more normal appearance to the breast. Often, multi-staged surgery is required to get the optimal result.
Children and adolescents with Poland’s Syndrome show a spectrum of abnormalities of the chest wall. However, characteristics associated with underdeveloped breast may include:
- absence of chest wall muscles - such as pectoralis major, latissimus dorsi and others
- high nipple position or even absence of nipple
- narrow chest width on the affected side
- absent bony structures of the chest wall
- finger and hand abnormalities on the affected side
Depending on the severity and number of underdeveloped structures, different techniques are used to correct the contour and shape of the chest wall. Latissimus dorsi flap and implants are the most common methods of reconstruction for these young girls.
It is not uncommon for children or adolescents with rib-cage abnormalities to present for correction of their breast shape and size. These abnormalities are often misdiagnosed as underdeveloped breasts when in actual fact, their breasts are normal, but appear small because of the sunken chest wall. Chest wall deformities can be unilateral or bilateral. Two main types are described:
- Pectus Carinatum - when the breastbone protrudes between the breasts
- Pectus Excavatum - when the breastbone and ribs sink deep towards the back
If these abnormalities are mild enough, simple breast augmentation with implants are adequate to correct the shape and volume. However, if the abnormalities are severe, a referral to the thoracic surgeon should be sought to discuss the options in correcting chest wall shape. Breast impants in the latter cases often result in disappointing cosmetic outcomes.
When is the right time for corrective surgery?
Young girls in their adolescence are often most affected by breast asymmetry. It is a fragile period during which self-esteem, self-confidence and self-identity is established. Even though most optimal result is achieved when full breast development has been reached, each case is assessed on individual basis. Early surgery can be done but staged surgical revisions as development continues should be expected.
Obviously future revisions during adulthood will be required as weight fluctuations, pregnancies, breast-feeding and aging change the appearance of the natural breast as well as the corrected breast. Life-long monitoring of the implant is also essential to ensure its integrity, position and capsule status (see All About Implants).
Cost of Breast Asymmetry Correction
Correction of breast asymmetry should be covered under private health insurance. However, check your policy carefully for any exclusion in plastic surgery, breast surgery, breast implants and pre-existing conditions. If you are covered, your health fund should cover majority of your hospital costs, as well as breast implants if they are required.
There is no such thing as a 'normal' breast size or a 'normal breast shape. Breasts come in all shapes and sizes. It is important, when undergoing corrective breast surgery that you have a realistic expectation of what can be achieved, in particular, with breast asymmetry. This includes:
- It is not possible to achieve perfect symmetry in shape and/or size
- You may require more than one procedure to correct the asymmetry. This may be performed at in sequence at different times, or even, at different stages of your life.
- It is likely that asymmetry can recur even after correction as you grow (if your correction is done before full development), or undergo other physiological changes such as weight gain, pregnancy, menopause etc.
- Breast surgery cannot correct some intrinsic features, such as underlying rib cage asymmetry, cleavage width, predominant shape, areolar colour, breast tissue texture/density etc.
It is important for you to specific to your surgeon what your expectations are. This will facilitate a frank and honest discussion so that you understand what can and cannot be achieved with surgery.
To read more about breast reduction, CLICK HERE.
To read more about breast augmentation, CLICK HERE.
To read more about breast implants, CLICK HERE.
To read more about breast reconstruction after cancer treatment, CLICK HERE.