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Breast Asymmetry
Breast asymmetry refers to a difference between the breasts of shape and/or size. It is generally accepted in the medical community that breast size differences are either genetic tendencies or random events in which paired organs like the breasts just grow differently with respect to starting and stopping. The breasts are naturally stimulated to grow under the influence of estrogen hormone in young girls. This period of growth begins with breast budding and about two years later the first menstrual period occurs. The breast continues to grow for about 2-4 more years and it is during this time that differences in size can develop.
Causes of Breast Asymmetry :
- A period of infection, breast trauma or surgery on the developing breast, which may ultimately cause a decrease in natural growth.
- An enlarging breast lump or mass may cause the breast to become larger.
- Hereditary or inherited tendencies from your family may also contribute to this condition.
- A congenital condition known as Polandís Syndrome also results in breast asymmetry. This condition consists of the underdevelopment of one breast and its underlying musculature along with disfigurement of the hand on the same side of the smaller breast.
What Gives the Breast its Shape?
The breast consists of milk ducts and glands, surrounded by fatty tissue that provides its shape and soft feel. (Fig. see graphic below)
Situated beneath the breast is the pectoralis major muscle. The skin envelope surrounds the breast mound and the nipple areola complex is connected to the underlying milk ducts.
Your Consultation
Before undergoing breast surgery, all patients will need a pre-operative consultation. At this time we review your medical history and perform an examination to ascertain if you are indeed a candidate for this restorative procedure. Also, during your initial consultation the procedure, the recovery and the expected outcome are discussed with each patient.
Dr. Rucker completed his Plastic Surgery Residency in 1984. Because of his desire to devote a large portion of his practice to Restorative Breast Surgery, he chose to attend a fellowship in Breast Surgery in Atlanta Georgia. He became board certified in Plastic and Reconstructive Surgery in 1986 and attained the position of a Fellow in the American College of Surgeons in 1989. During his 22 years of practice in west central Wisconsin Dr. Rucker has performed over 1,000 restorative breast procedures.
Surgery for Breast Asymmetry
The surgery is aimed at making your breasts look balanced when you are wearing a bra. The procedure may involve augmentation (enlargement) of one or both breasts; reduction mammoplasty of one or both breasts if breast enlargement is present; or even augmentation of one breast and reduction in size of the other. On occasion there is a sagging (ptosis) of one the asymmetrical breasts that needs to be corrected at the same time. The surgery to correct asymmetry is usually about 90% successful as far as women attaining their desired result. Most surgeons prefer not to perform this restorative breast surgery on patients younger than age 18. In general it is best not to operate within the first two years after the onset of menses.
The Procedure
The surgery is performed under a general anesthetic in a local hospital. If a reduction of one of the breasts is required, care is taken to make the breasts symmetrical, to preserve sensation to the nipple and hopefully the ability to breast feed in the younger patient. These goals are addressed by leaving the nipple areola attached to a pedicle of breast tissue. Through this pedicle run the nerves and vessels that help preserve sensation and a good blood supply to the nipple areola complex (See Fig. 1)
All incisions are closed under limited tension with a result in a smaller breast and areola and a more lifted breast contour (See fig 2 ). If an augmentation of one of the breasts is required, there are several ways to insert the required breast implant to enlarge the breast. Dr. Rucker prefers to make a small (2-inch) incision beneath the breast (See Fig. 3) . The implant is placed behind the chest wall muscle (pectoralis muscle) in the vast majority of patients. (See Fig. 4). This approach is preferred for several reasons:
- It is easier to develop the pocket to house the implant from this approach
- The nerve which gives sensation to the nipple is easier to avoid with this approach
- There is no nipple areola distortion, which may occur when placing the entrance incision around the nipple.
- The placement of the implant behind the chest wall muscle gives a more natural (not operated on) look.
Either procedure, augmentation or reduction, takes about two hours to perform. Following the procedure, a support bra is placed on each patient. If reduction of one of the breasts is required there is a hospital stay of 24 hours. If no reduction is required this can be an outpatient procedure.
The Recovery
Most patients rate the pain level as a 5 on a scale of 1 to 10. If an overnight stay is required, you will be evaluated prior to discharge home the next morning. There will be drains beneath each breast and they are usually removed prior to your discharge. You will be given detailed written postoperative instructions and prescriptions for an antibiotic and pain control. Light activity is tolerated well in the first week. Most patients are never so incapacitated to where they canít take care of their own basic needs. We see you one week after your procedure. All of your dressings are removed, your postoperative recovery and activity levels are again discussed and an anticipated date for your return to work is discussed. Light employment is tolerated after two weeks with heavy lifting and regular activity in 3 to 5 weeks. You are also given detailed instructions for care of your suture lines so as to help prevent excessive scarring. Your final consultation usually occurs 5 months after your procedure.
Q&A
Am I a candidate for the treatment of Breast Asymmetry?
This is a question that can only be answered after a full consultation with your plastic or reconstructive surgeon. Determining factors are your age and health.
Does insurance cover this type of Surgery?
In some instances, because of the extreme disparity in size, insurance may well consider coverage.
Does the condition of Breast Asymmetry have any correlation with breast cancer?
It has been suggested in recent studies that breast asymmetry is related to several of the known risk factors for breast cancer.
Closing
Dr. Rucker and his staff hope that this information will be of help to you if you are considering surgery to address asymmetrical breasts. The staff has gained a considerable amount of experience and knowledge in helping nearly 1000 patients during the preoperative, operative and postoperative periods of reconstructive breast surgeries. Please feel free to contact Dr. Ruckerís office with any concerns or questions that you might have.
Risks
There is a potential for complications in any operative procedure. The most common being infection, scarring and sensation changes. During your consultation a detailed discussion of these potential risks will be given to you.
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