By Dr. Grant Stevens from About Plastic Surgery
Breast asymmetry is a very common cosmetic issue for patients seeking plastic surgery. A breast surgeon may suggest a number of ways to address this problem including a breast lift, reduction, and implants.
As any breast surgeon will tell you, almost all women have some degree of breast asymmetry. How bothersome this cosmetic issue is depends on the perspective of the patient. Some women feel that as long as the difference can be evened out and concealed with a properly padded bra, it’s not a problem. Others are very self-conscious about this issue and feel their body image would be improved by having breasts that are more symmetrical. About half of all women who see a breast surgeon for saline or silicone implants, breast reduction, or breast lift surgery request that asymmetry issues be addressed at the same time.
There are Many Types of Breast Asymmetry
The difference in volume between a woman’s breasts is usually a cup size or less. Extreme asymmetry is considered a difference of two or more cup sizes. For example, a woman might have one B cup and one D cup. This degree of asymmetry is difficult to conceal – even under clothing.
Shape & Position
For many women, a difference in size is linked to a difference in shape and position. Their smaller breast may be round or conical while the other breast may be pendulous. The larger breast is likely to droop down onto the rib cage.
Nipple & Areola
Nipples and areolas are often different sizes or shapes, making the breasts appear even more asymmetrical. The nipples may also point outward from the chest at different angles. For example, the nipple on the larger breast may point downward instead of forward. One areola may be larger than the other and they may have different shapes.
Causes of Asymmetry
Congenital anomalies causing severe breast asymmetry may be apparent at birth. This is true of Poland’s syndrome, a condition that is typified by partially missing chest muscles. This defect is very rare. A breast surgeon who specializes in reconstruction rather than just cosmetic procedures should be consulted in cases of congenital abnormalities.
Usually, breast asymmetry is acquired. Hormones stimulating breast growth may not affect both breasts equally causing differences in breast size and shape to become apparent at puberty. Once the breasts are fully developed, they are unlikely to become more symmetrical over time. Young women from the ages of 18 through their 30s are often candidates for correction of asymmetry that occurs during puberty. Breasts do continue to change throughout a woman’s life. Pregnancy, breastfeeding, weight gain, and aging can all cause breasts to diverge further from one another in appearance. For example, many women find that their baby nurses more from one breast than the other. This can affect the size, shape, and position of the breast, the nipple, and the areola.
Solutions to Reduce Naturally Occurring Asymmetry
The smaller breast may have a saline or silicone implant inserted to bring it up to the same cup size as the larger breast. If the larger breast is not sagging, it may be left as is. However, the larger breast usually has some degree of ptosis (drooping) that needs to be addressed. A breast lift is commonly performed to reposition the larger breast higher. A reduction may also be performed if the degree of size asymmetry is significant. One or both areolas and nipples may be revised if desired.
For women who prefer the size and shape of their smaller breast, the larger breast can simply by reduced to more closely match it. This option is attractive for women who don’t want the ongoing maintenance associated with having an implanted device in their body. In contrast, women who want to reshape both breasts may choose to have implants placed on both sides to create a completely new look.
Surgically Acquired Asymmetry
A lumpectomy or large biopsy can leave a depression in the breast or significantly decrease its size. Mastectomy is the most extreme form of acquired breast asymmetry. Severe capsular contracture around saline or silicone implants can also change the appearance of the affected breast. When a breast surgeon performs an overly aggressive capsulectomy to remove the scar tissue surrounding the implant, this may worsen asymmetry. In many cases of surgically acquired breast asymmetry, some type of reconstructive surgery might be required to correct the problem. This treatment can be complex and may entail multiple operations.