Women with breast asymmetry have a size discrepancy between their breasts. Although everyone has some degree of asymmetry, for some women it is more severe. For some, there may be at least one cup-size difference or more, making it impossible to find a bra that fits. It will either be too big on one side or too small on one side.
"I can’t tell you what a pleasure it was to go prom dress shopping with my girl and not have her stand there looking in the mirror in tears. She put on a fitted, little number and twirled in the mirror beaming. You are the best team ever."
(mother of teenager with breast asymmetry)
This condition may also be very embarrassing. Before surgery, some of our patients (who are often relatively young) report situations like the following:
- Wearing oversized clothing to camouflage the size discrepancy
- Avoidance of situations that necessitate the wearing of bathing suits
- Feeling self-conscious and uncomfortable in intimate situations
Who can benefit from surgery?
Anyone with breast asymmetry can benefit from surgical correction; it is a congenital anomaly and the patient should understand that it is easily corrected. The degree of asymmetry does not matter; if it causes the patient psychological distress, she should consider correction.
Another group of patients who have breast asymmetry are those who have rib abnormalities. In this case, the ribs are deficient or very prominent; this in turn affects the size of the breast. A young woman with a prominent rib on one side will have a breast that appears larger on that side. This situation is common. Often the patient will come in for breast augmentation on both sides and not be aware of her rib asymmetry. This has to pointed out to the patient and the solution is to use a slightly larger implant on the unaffected side.
How is breast asymmetry corrected?
Breast asymmetry can be corrected by either making the large breast smaller, or the smaller breast larger. Often the patient has a preference as to which breast they prefer and the surgeon tailors the operation to match that breast. A small breast can be made larger with an implant, in either saline or silicone. Although there's no rational scientific reason for it, patients must be at least 22 years old to receive a silicone implant, per FDA regulations. A larger breast often needs a reduction and a breast lift to match the opposite breast. In addition, the larger breast often has a larger areola which also needs to be reduced in size the match the opposite side.
After correction of breast asymmetry
The patient should expect very good symmetry. The recovery is usually about 1 week. If the patient has an implant under the muscle, she may need 2 weeks to recover. All of our patients wear a sports bra for support 24/7 for the first 2 weeks. They wear paper tape for 3 months to promote a fine scar. They can shower the day after surgery. No heavy lifting or vigorous exercise for 2 weeks. Discomfort is usually easily controlled with muscle relaxors, anti-inflammatory meds, and mild narcotics if necessary.
Some patients with asymmetry have a condition called Poland’s Syndrome. This syndrome is characterized by deficiency or absence of the pectoralis major muscle; however, the ribs, sternum, breast and nipple can also be deficient. Patients with Poland’s syndrome will come in because of the obvious asymmetry of their chest wall. The deficiency can be mild to very severe. Mild cases can be treated with an implant alone. Sometimes a custom breast implant must be made to adequately camouflage the deficiency. In more severe cases, extensive reconstruction is necessary. The options include tissue expander with implant, latissimus muscle reconstruction or transverse rectus myocutaneous (TRAM) flap reconstruction.