A Discussion about Breast Asymmetry

As you know, no two breasts are perfectly symmetrical on any woman, but at times, the asymmetry is significant enough to warrant surgery.  Interestingly, breast asymmetry deformity tends to be fairly consistent in its appearance.  Usually the smaller breast is narrower, has a smaller areola (nipple/areolar complex) and minimal ptosis (droop), and often the inframammary fold (the fold under the breast) on that side is higher.  By comparison, the larger breast tends to have a larger areola, may have a lower inframammary fold, and tends to be somewhat droopy or ptotic, as well as wider.

The treatment for this deformity is somewhat variable but usually involves an implant and/or fat grafting on the smaller side and a lift or reduction on the larger side.  Sometimes an implant is placed on both sides and only one side has a lift (mastopexy).  Unfortunately, the most important thing you need to understand about this operation is that although I can get the volume of both of your breasts much more symmetrical, long term you will not have perfect symmetry.  This is because the small breast with the implant tends not to change shape very much whereas the large breast, whether the treatment is lift alone, reduction alone, or lift plus implant alone, does often change shape, especially if a woman gains weight over time.  As she goes through the cycles of pregnancy and breast feeding, this will change the shape of the larger breast more than it impacts the smaller breast.  Of the options, the best option over time tends to involve an implant on both sides, but not all body shapes are ideal for this procedure.  In addition, the smaller side because of its tight, high inframammary fold, tends to have a band of tissue that holds the implant up, or the fold can stay faintly visible, whereas the ptotic breast (the larger breast on the other side) does not.  Sometimes I will liposuction the larger breast so that both augmented breasts will tend to change in the same way over time.  Fat grafting to the smaller side can help modify both the size and the shape of that breast.

I will refer you to the augment discussion which summarizes the procedure and risks for an augment, but basically these are bleeding, infection, deflation and encapsulation, although most of these are rare.  The complications for the lift or reduction are also summarized by separate letters, but would be wide scars, possible change in nipple sensation (although rare), and recurrent droopiness to a greater or lesser degree.

Smokers heal poorly in terms of infection and wound breakdown, and you are advised not to smoke for at least one month before and after surgery.  Nicotine screening may be necessary the day of your surgery.  IF THE TEST IS POSITIVE, YOUR SURGERY WILL BE CANCELLED.

For most patients, feeling better about one’s appearance and not having to wear a prosthesis to feel balanced in clothing or a bathing suit makes the surgery worth it, despite the drawbacks.  Please do not hesitate to contact me if I can be of further assistance (804-320-8545).