Background: Despite the breasts being a paired chest structure, they rarely are perfectly symmetric. These asymmetries may be slight and often are completely unrecognized by many women until they are pointed out. Larger breast asymmetries are more well known to the patient and may have been caused by natural breast development, pregnancies, breast feeding or tumor removals.
For those women considering breast augmentation recognition of any size or shape differences between the breasts is critical. Since most breast implants are usually similar in size and projection, any breast asymmetry issues are unlikely to be improved. In fact in many cases the breast asymmetry may become greater and more noticeable. This is particularly true when the asymmetries are in the level of the inframammary folds, horizontal position of the nipples or sagging of the breasts.
Case Study: This 28 year-old female presented for breast augmentation after having two children and losing much of her natural breast tissue. Her breasts were deflated with some sagging but with nipples that were still above the inframammary folds. Of note was the asymmetry between the breasts with the right breast lower than the left. Both breast sat fairly low on the chest wall.
Under general anesthesia 350cc high profile silicone gel breast implants were placed in a dual plane position through inframammary incisions. While the existing inframammary folds were slightly lowered on both breasts, perfect symmetry between the fold levels was not attempted given the position of the overlying sagging breast mounds.
Her postoperative results showed good breast mound size increases but persistent asymmetry in the position of the inframammary folds, horizontal nipple levels and mound positions. She was well aware of the asymmetry but understood that it existed before surgery and that it would be so after surgery. She had no displeasure of the result despite the persistent asymmetry.
It is often said that all implants do is take the existing breast mounds and just make them bigger. Whatever asymmetry exists before surgery will persist afterwards. While this is not always completely true, it is more true than not. Asymmetries in the breast mounds may sometimes get better with differences in breast implant sizes. But the horizontal level of the nipples and the position of the inframammary folds, which make major contributions as to how the symmetry of the breasts are perceived, will often not be improved by implants. Preoperative appreciation of breast asymmetries is important for both patient and plastic surgeon alike so postoperative expectations can be realistic.
Highlights:
1) Breast implants increase breast size but may only magnify existing breast shape or asymmetry issues.
2) Asymmetry is extremely important to diagnose before undergoing breast augmentation surgery.
3) Breast augmentation results almost always have some degree of asymmetry which is assured in the preoperative breast asymmetry patient.
Dr. Barry Eppley
Indianapolis, Indiana