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Breast Asymmetry: What to do about it?

January 13th, 2015

breast asymmetry

Breast asymmetry is a very common concern among women, adolescents and adults alike. No one is born with perfectly symmetric breasts and mild to moderate differences in breast shape, size (1-2 cup size difference) and position in the developing adolescent are to be expected. Moreover, breast asymmetries that persist beyond puberty affect more than half of all women! In fact, one study in the Plastic and Reconstructive Surgery Journal, out of 100 women who wanted breast augmentation with implants found that 88 percent had natural asymmetries. At a time when our body and mind are changing rapidly, when is breast asymmetry a cause for concern? Having uneven breasts may impact a young woman’s body image. Let’s review the pros and cons of surgical intervention with an emphasis on newer techniques such as using liposuctioned fat to correct asymmetry, called fat transfer.

A recent study published in the December issue of the Plastic and Reconstructive Surgery Journal highlights the psychological impact of breast asymmetry on adolescents. The study suggests that patients with breast asymmetry have poorer emotional well-being and lower self esteem than their female peers. This is not a surprising revelation given that high rates of breast dissatisfaction have been reported within the adolescent female population, especially during early adolescence when there is greater variance among peers. Psychological issues are important in this group of young women, and these issues include social embarrassment, low self-esteem, depression and isolation from classmates. Problems that occur relate to sexual relationships and cultural beliefs. The majority of these patients are young, healthy individuals, and the psychological and social impact of these conditions is significant. Physicians and parents should be aware that seemingly small differences to an examiner’s eye might have a considerable impact on the sometimes fragile psyche of an adolescent.

Surgical options for correction exist. These include improving breast symmetry by combining different techniques using implants, autologous (your own) fat transfer, liposuction, breast reduction and/or myocutaneous flaps. Correction of breast asymmetry often involves multiple surgical procedures. The best policy is early intervention with education, support and counseling. The key steps in successful management are diagnosis, appropriate referral, counseling, optimal timing of surgery and avoiding unnecessary surgery in a developing young adult. In the rare instance that the asymmetry causes such distress that your doctor recommends surgery, please consult with an experienced plastic surgeon about your options for surgery.

Newer techniques such as autologous fat transfer, offer a less invasive way to correct breast asymmetry with more natural appearing results. Fat grafting is natural, flexible and versatile. It allows the plastic surgeon to gradually sculpt and reconstruct the breast to a natural looking shape and feel. Like other reconstructive techniques, fat grafting is a staged procedure with results achieved over time. Fat is harvested from the abdomen, flanks and thighs and then is injected into the breasts through small incisions. This is an outpatient procedure, with each stage carried out every 3 to 6 months. The number of stages required for completion varies on an individual basis. The results are long lasting and the patient also receives the added benefit of liposuction at the donor sites.

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Breast Cancer Part 4: Reconstruction with Implants

October 30th, 2014

Expander Implant

Choices in Reconstruction

Breast cancer is the most commonly diagnosed cancer in US women. Research has found that breast reconstruction contributes to a woman’s self-esteem and sense of wellbeing; however, over 70% of women eligible for breast reconstruction are not told about all of their options. Breast reconstruction generally falls into two categories: implant reconstruction or reconstruction using a person’s own tissue, also known as autologous reconstruction.

We discussed breast reconstruction with fat transfer and reconstruction with flap techniques in previous blogs. Today we will complete our educational series by discussing implant based reconstruction. No matter what your choice, breast reconstruction is inherently staged. This means it will involve multiple procedures, each being one of the stages, to achieve an optimal outcome.    

Implant Based

A temporary expander, placed under the pectoral muscle, creates a pocket, which will eventually accommodate a permanent silicone or saline implant. This procedure frequently requires an overnight stay in the hospital and has a recovery time of several weeks. Expansion starts a few weeks after the first surgery after the incisions have healed. The expansion process requires multiple office visits and may take anywhere from two months to one year based on the individual needs and desires of the patient. Once the expansion is complete, the expander is exchanged for an implant during an outpatient surgical procedure.  Additional procedures may be required to achieve the desired appearance, shape and symmetry.

Implants are manmade and will eventually fail. Rupture rates are similar for saline and silicone implants and average between 20-25% at 10 years. After 10 years, the rupture rate increases significantly. When a saline filled implant ruptures, your body safely reabsorbs the fluid and the reconstructed breast will flatten as a result. Silicone is a synthetic product and may go undetected when it ruptures. Instead, tissues may become inflamed, causing complications with scar tissue and calcification. When a silicone implant ruptures, it should be replaced promptly. Since silicone ruptures are often silent ruptures, the FDA recommends that women with silicone implants undergo an MRI test three years after having the implants placed and every two years thereafter. This maintenance is an additional personal and financial responsibility for the woman choosing silicone implants.

If you are diagnosed with breast cancer, you have many choices to make so take the time to make the right ones. Immediate reconstruction is safe, but you are not necessarily burning any bridges by delaying your reconstruction for personal reasons. Overcoming breast cancer is a journey and you are not alone. Speak with your primary care physician, breast surgeon and plastic surgeon about your options and help them make the decisions that will give you the best quality of life in the long run. Please click here if you missed Part 1, Part 2, Part 3 of our series.

Photo: Breast Reconstruction with Expander/Implant.

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