Nearly all women have a small degree of breast asymmetry (breasts that are not perfectly symmetrical ie the same) but when this is something that is noticed by the patient and causes upset and even problems finding clothing, then breast surgery may be worth considering. It is often said in surgical circles that “breasts are sisters and not twins” so it is best not to worry about very small differences as these are quite normal and it is something that a good Surgeon will have to point out to you if you are, for example, having a breast augmentation as sometimes patients will only notice these differences after and believe they have been caused by their recent breast surgery.
Difference in a cup size of more
However, a cup size or more difference between the two can be problematic and the first decision to make is whether you prefer the smaller or the larger breast. In general it is easier to reduce the size of a large breast to match a small one. The benefits of this choice are that it avoids the need for any implants but does come at the cost of some scarring.
It may be that the larger breast is the preferred one and in some cases there can be a large difference between the two sides. Small differences can be corrected with an implant on one side or sometimes patients prefer to have implants in both but just using different sizes to rebalance the discrepancy.
Staged Breast Surgery
There are, however, some conditions that affect the breasts which need more than one operation. Conditions like tuberous breasts in which there is restricted growth at the base of the breast and sometimes unusual prominence of the nipple can be challenging to do all at once and may require a staged approach with expansion before final surgery. If differences are small and perhaps a patient does not want to have breast implants or a breast reduction, fat transfer can be a good solution and in some cases is the only good way of correcting differences in shape as the fat can be used to sculpt the shape and add to deficient areas like the cleavage or upper pole (top half of the breast).
Reconstructions after Breast Cancer
Many of the techniques used above have been developed in my breast reconstruction practice and sometimes I see second opinion cases of ladies who have undergone breast reconstructions after breast cancer and who have some asymmetry. This can sometimes be quite challenging but it is always very gratifying to see the difference it can make to a patient when they have a good result after revisional surgery.
As you can see there are a number of different decisions to make in regards to procedures and their timing as well as weighing up the various pros and cons of each operation and for this reason I will usually see you for 2 consultations in order that you have time to weigh up and process all of the information before making your final decision on which type of surgery to have and when to book in.
Mr Gerard Lambe MD, FRCS (Plast)
Consultant Plastic and Reconstructive Breast Surgeon