Breast Asymmetry

It is normal for women to have differences in size and shape between their breasts. However, for some women, these differences are more marked than others. This can be due to differences in breast development that has occurred in utero. The difference may not be noticeable until the pubertal years as the breasts begin to develop. One breast may not grow at the same rate, or at all, and it can have a different shape to the other breast. Sometimes the abnormalities are in both breasts and to different extents. This can be extremely distressing for young women progressing through adolescence and into young adulthood, and it is important to know that it is common and manageable. It is also often possible to start symmetrisation procedures during these years.

Tuberous breasts are one condition that commonly presents as a breast asymmetry. In this condition, the breast can have one or a number of the following: volume deficit, narrow base, enlarged or herniated nipple-areola complex, decreased nipple to IMF (inframammary fold). This condition can be associated with other abnormalities of the chest and shoulder girdle.

Breast asymmetry can be due to Poland’s Syndrome, a condition in which an abnormality of chest wall development results in failure to develop breast tissue on the affected side, and can involve other muscles and bone of the chest wall.  This condition can affect boys as well, presenting as contour abnormalities due to the absence of chest wall muscles.

A variety of surgical techniques are used, and both breasts may require surgery to best achieve symmetry.

 

Consultation

During the preoperative consultation with Dr Taylor, a medical and development history is taken and a thorough physical examination is performed. This will identify the characteristics of the deformity. Based on these factors which include analysis of the breasts, chest and body shape and surgical strategy can be discussed. Your specific situation, needs, and desired outcome will be discussed. Measurements and clinical photographs will be taken and a 3D Crisalix simulation will be performed to aid in visualising and discussing potential outcomes.

Surgery

Surgery to correct breast asymmetry and congenital breast deformity often involves multiple, staged procedures and employs a variety of surgical techniques. Surgery for the affected breast may involve, lipofilling (fat grafting), breast lift (mastopexy), breast reduction and breast implants. The other breast may require a breast lift, breast reduction and lipofilling (fat grafting) to achieve symmetry. For tuberous breasts, the breast tissue, nipple and areola complex are reshaped.

Surgical management of Poland’s syndrome includes a variety of techniques such as muscle transfer, custom-made implants or lipofilling.

All procedures are performed in an accredited hospital facility under general anaesthetic. The length of surgery varies but is approximately 3-5 hours and usually involves an overnight stay.

Side Effects, Risks and Complications

All surgery causes bruising, swelling, some oozing or bleeding from wounds, and new scars and carries a risk of wound infection and wound healing problems. There are risks associated with general anaesthesia risks including cardiac/respiratory issues and DVT.

Some risks and complications specific to surgery to correct breast asymmetry and congenital breast deformity:

• Postoperative bleeding requiring a return to theatre
• Nipple-areola complex changes – changes in sensation which may be temporary or permanent, rarely poor healing or loss of part or all of the nipple
• Seroma – accumulation of fluid within the breast which may become infected
• Asymmetry
• Small lumps due to fat necrosis
• Fat cysts can be aspirated easily in the office
• Decrease in volume post lipofilling due to graft “take”
• Changes in appearance with weight gain or loss
• Wound infection, which may require antibiotics, ongoing dressings and occasionally surgical management
• Poor scarring, including hypertrophic and keloid scars