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Breasts Asymmetry Correction;
Breasts Asymmetry is prevalent amongst both sexes; however, with a variable degree of presentation. In the majority of cases it is congenital, i.e. from birth. Men do not normally present for surgical correction.
The majority of women with breasts asymmetry do not normally warrant surgical intervention as it does not affect them or they may not be aware of its presence, as they have become accustomed to its presence, especially when it is mild.
In some patients breasts’ asymmetry is such that it may impact on the patient’s ability to fit a bra, wear a dress; or they may feel self-conscious. In the case of teenage females, there may be peer pressure at school with potential psychological implications in the long-term.
As a consultant Plastic Surgeon of nearly 20 years experience including in breasts asymmetry correction I have learnt it is important to ascertain what the patient is aspiring to achieve; and what their expectations are. It is also important to keep in mind that perfect breasts’ symmetry is a rarity prior to surgery and is not achievable following surgery. Beauty in my opinion is in the subtle differences in the human form. I remember when training one of my consultant colleague used to say, following surgery the breasts will become sisters, not identical twins. I would go on to add that even in identical twins there are subtle differences, when looked for.
During the consultation/s process it is important to establish the information relevant to the patient presentation. The next step would be to discuss the options available, doing nothing being one such option. The surgical options may include a one or a two-stage surgery.
In my opinion, seeing a patient for one pre-surgical visit is not adequate enough when undergoing a cosmetic procedure. This surgery is a life event that will affect the patient for the rest of their life and as such must be dealt with utmost care, with attention to details at all fronts.
The one-stage technique may involve a breast reduction on the bigger breast, this in my near 20 years experience as a consultant Plastic Surgeon is more desirable to females in the age group 30 years or more, and following having had children. I find the majority of females less than age 30 years; tend to favour the larger breast; and wish to either match it or enlarge it further.
Breast reduction of both breasts is also a possibility; albeit not that common a route to take in the majority of significantly asymmetrical breast patients. The other treatment pathway may also involve the enlargement of the asymmetrical breasts, with or without a Mastopexy (breast uplift).
The two-stage surgery, in my opinion could be a more dynamic pathway to achieve results, and is likely to be more suited to those of younger age, i.e. prior to the breasts having concluded their growth, up to age 21-23 years, however, it is a longer route and may not be suited to all patients.
The first stage would involve the insertion of expandable breast prosthesis, in either or both breasts. This may be replaced with silicone breast implants, with or without mastopexy (breast uplift) in the second stage. The second stage timing can be between 6-12 months following the first operation, however, it is variable between patients.
Fat transfer (Lipo-filling, Lipo-modelling), is another technique offered to correct breast asymmetry. The benefit of this technique is the use of your own fat, if available, in building the smaller breast, and refining the larger breast contour.
The stages to achieve the desired outcome could vary between1 to 3. The fat donor sites include tummy, flanks (“love handles”), and thighs. The more desirable donor sites are the tummy and flanks.
Lipo-filling can also be used as an adjunctive procedure to supplement breast implants surgery to add more volume and also to refine the upper poles of both breasts. In some patients, and in order to create more space for the fat to be transferred an external suction device is used for 3 weeks; however, the compliance with this tends to be poor. When combining options of treatment e.g. fat transfer and implants with or without mastopexies, this is called a hybrid approach.
Following many years of experience in performing balancing surgery for breast asymmetry, I find that it is rewarding both to me as a Plastic surgeon and most importantly also the patient. It gives, in the majority of patients the confidence they may have lost; which is apparent from their first post-operative visit. In the case of the tissue expansion building the breasts over a period of time also allows for the psychological adjustment the patient goes through whilst experiencing body form changes.
The philosophy presented in this short article is based on my own experience and can vary between patients and also between consultant colleagues, which is part of the beauty of our specialty.
What To Expect After The Surgery:
The surgery is carried out under a general anaesthetic; the hospital stay is 1 night. I personally use drains (tubes used to drain excess fluid following surgery), and have done so for many years. The scars vary on the surgery performed and could be under the breast, a “lolly pop” pattern or anchor-shaped. The dressings are removed and the dissolvable stitches are trimmed after 10-12 days. I do not advocate the patient wearing a bra until the dressings are removed. The bra will have no underwire fro a period of 4-6 weeks.
The anticipated recovery time following surgery in most patients is 3-4 weeks. In the case of tissue expansion, an injection of normal saline (sterile salt and water) is performed in outpatients’ clinic in order to inflate the breast/s to the desired volume prior to the next stage. Numbing cream is used to numb the skin prior to injecting the fluid into the expandable device. In the case of fat transfer, a liposuction garment is worn for a period of 4-6 weeks.
Pain relief requirements vary between individuals; hence we tailor the individual patient’s pain relief requirements in order to make their post surgery journey as pain free as possible.
In most patients they find the pain is limited as we use pain controlling local anaesthetic injections during surgery to minimise the pain. As a team we work together and aspire to achieve excellent and pain free outcomes following surgery.
