Background: Breast augmentation is completely successful at enlarging the breast mounds. While it is not without its potential complications due to being an implant placed in the body through surgery, by far its most common postoperative concerns are aesthetic in nature. Are the breasts the desired size and shape and how well do they match are the critical aesthetic judgments that determine a woman’s satisfaction with their cosmetic result.
While women understandably spend considerable time before surgery focused on the desired size of the breasts they want and what implant is needed to get there, they often overlook the importance of breast symmetry. Not that women don’t want or care less about symmetry than breast size, it is just an issue that they assume will happen from the surgery…because a paired set of breast implants are identical/symmetric regardless of their size.
But the risks of asymmetry are major concerns to plastic surgeons and often one of the most important issues that are being evaluated during breast augmentation surgery. This is because plastic surgeons know full well that few women have symmetric breasts and implant enlargement usually goes on to reveal the significance of those asymmetries. In other words, when one has small breasts those asymmetries may be barely perceptible or often not known at all by the patient. But when the breast mounds are significantly increased, so to may be these asymmetries.
Case Study: This 24 year-old Asian female wanted breast implant enlargement to have breasts that better matched her body. She didn’t want very large breasts, just enough that would change her cup size from a B to a C. She had very visible breast asymmetry with a smaller mound on her left side that was more highly positioned as judged by the horizontal position of the nipple-areolar complex compared to the opposite side. She opted for silicone implants as she did not want to risk the issue of spontaneous deflation from saline implants. It was discussed with her thoroughly before to expect that she would have breast asymmetry after surgery and that this could not be avoided due to her pre-existing differences.
Her breast augmentation surgery was done through a lower breast fold incision. Breast implants of 325cc silicone gel were placed in a submuscular position in the right breast and 350cc in the left breast. The implants were put into position based on the level of the existing inframammary folds. No attempt was made to make the pocket on the higher breast side lower. By doing so the fear was that it could even make the nipple look higher than before if the breast mound dropped with size enlargement.
After surgery it was surprising to see that her breast asymmetry had not significantly worsened. The differences in the horizontal levels of the nipple-areolar complexes remained different but not worse. Almost always such cases of breast differences persist or even look more asymmetric once implants are placed. Such results speak to the important patient understanding that surgical outcomes from any procedure are not always completely predictable. Fortunately in this case and for her this unpredictably became a favorable outcome. This is not usually the case most of the time.
Case Highlights:
1) Breast asymmetry is very common in women who undergo breast augmentation.
2) It is a common misconception that the placement of breast implants will somehow improve breast asymmetry…but it usually will not and may even make it worse.
3) Breast implants may occasionally improve breast asymmetry if the mound difference is the main cause of the breast differences. But the differences in the horizontal level of the nipple-areolar complexes will remain unless a concurrent or delayed superior nipple lift is done.
Dr. Barry Eppley
Indianapolis, Indiana