Asymmetry of the Breasts
Asymmetry of the breasts is a frequent problem. In many cases the asymmetry is slight and not more pronounced than the overall, natural asymmetry that normally exists between the two sides of the body, and therefore does not require interference. However, there are cases where the asymmetry is unusually pronounced and significant. Fortunately, treatment procedures are available whereby both the outward appearance of the woman and her inner self-conception are vastly improved.
Asymmetry problems can be divided into two categories, congenital and acquired:
Congenital asymmetry arise from malformation of the breast tissue, the outcome of which can be slight, when there is just a difference in size between the breasts, or serious (deformity of some part of the breast, protrusion of the breast through the areola, tubular formation, malformation of a pectoralis muscle adjacent to the breast and so on).
The appropriate surgical solution will correspond to the nature of the problem itself. The procedure will be timed according to the degree of severity of the problem and how much it bothers the patient. In severe cases, the surgery will be carried out already at puberty when the problem becomes evident and aggravating. The procedure involves insertion of a tissue expander into the underdeveloped breast, which is subsequently inflated gradually by the infusion of saline in parallel with the development of the corresponding breast. At maturity, an additional operation is performed, at which a permanent silicone implant replaces the expander and matches the size of both breasts. In general, the decision as to whether an operation will be performed rests with the diagnosis as to the cause of the asymmetry. For example, in the case of a tubular breast, the appropriate dimensions of the breast will be determined according to those of the second breast, following which the malformed breast is spread out by release of the fibrotic tissues. The breast tissue is subsequently filled with a silicone implant or with fat, according to the size and shape that are required. For optimal results, it is sometimes necessary to operate on the second breast as well. In cases where an implant is inserted into the underdeveloped breast, a silicone implant can, in certain cases, also be inserted into the second breast. In cases where one breast is underdeveloped, while the second one is large, one breast can be augmented and the second reduced, so that they will eventually correspond in size and shape (with or without the use of an implant), and so on.
Acquired Asymmetry: Problems causing asymmetry can be acquired by scarring (from surgeries, burns or other wounds), that cause misshaping or faulty development of the breast, or, in the case of a breast tumor, resection of a part or of the entire breast tissue. In such cases the decision regarding the surgical procedure will be made before any operative procedure is initiated, in collaboration with the breast surgeon, so that the breast reconstruction will take place immediately following the resection, and, if necessary, surgery of the second breast (mastopexy, reduction or augmentation) as well, in order to achieve optimal rehabilitation of both breasts so they will correspond in size and shape. If the reconstruction is not done immediately following the resection, or in cases where an additional procedure is necessary in order to match the two breasts, it is possible to reshape the partially resected breast by injection of autologous fat using a specially designed technique.
It is important to bear in mind that in the case of severe asymmetry, optimal results may in some cases depend on repeated operations, and there are instances where it is necessary to match the areola and the nipple as well.