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Breast Assymetry

A small degree of breast asymmetry is quite normal. Surgical intervention may be indicated when the differences in volume or shape lead to physical discomfort. Through breast augmentation or breast reduction, the appearance of full, balanced and even breasts with even nipples may be accomplished.

• How is a breast asymmetry procedure performed?
• How long does breast asymmetry procedure take?
• What type of anesthesia is used?
• Where is the procedure performed?
• When can I return home and resume normal activities?
• How do I prepare for a breast asymmetry procedure?
• What precautions are necessary during recovery?
• What are the possible complications after a breast asymmetry procedure?
• What results can I expect after a breast asymmetry procedure?
• Choosing the right surgeon

How is a breast asymmetry procedure performed?

Asymmetrical breasts can be made more even either by augmentation of the smaller breast, or by reduction of the larger one:

Augmentation: In this procedure, the surgeon makes an incision either under the armpit, in the crease under the breast, around the areola (the pigmented tissue around the nipple), or through the navel. The surgeon then lifts the breast tissue, creates a pocket in the chest area - either above or below the muscle, and then places the implant inside the pocket. Almost all implants used today are filled with a saline solution.

Reduction: In this procedure, an anchor-shaped incision is made on the breast itself. The excess fat tissue removed in a liposuction-type procedure, and then the incision is closed, creating a breast contour closer in size and shape to the other one. If less tissue will be removed, a doughnut-shaped area of skin may be removed just around the nipple. An advantage to this procedure is that the incision and stitches may be less visible.

How long does breast asymmetry procedure take?

The length of the surgery depends on the type of procedure you choose, your anatomy, the incision technique, and type of anesthesia.

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What type of anesthesia is used?

The breast asymmetry procedure is most often performed under general anesthesia. In some cases, you may choose to be sedated instead. (This will make you sleepy and comfortable without being completely asleep).

Where is the procedure performed?

The location chosen for the surgery depends on the procedure performed and the extent of the work being performed. Most breast augmentation and reduction surgeries are performed in a surgical suite as an outpatient procedure.

When can I return home and resume normal activities?

If surgeries are performed in a surgical suite as an outpatient procedure then you'll be able to return home within a few hours of the surgery. However, if large amounts of tissue are removed during a reduction procedure, your doctor may want you to stay overnight in the hospital where medical personnel can monitor your initial recovery.

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How do I prepare for a breast asymmetry procedure?

During your initial consultation, your surgeon will discuss the changes that you would like to make to your appearance. Since the appearance of your breasts is a matter of personal perception and preference, you will need to discuss your concerns in detail so your surgeon can determine the appropriate alternatives. Your surgeon will explain how your age, the size and shape of your breasts, and the condition of your skin may affect the results of this procedure. You also should make arrangements ahead of time for someone to drive you to and from your procedure and to assist you with your daily activities during your recovery period.

Prior to your surgical procedure, the surgeon will perform a complete health history and physical. This will include examining and measuring your breasts, as well as photographing them as a frame of reference during the surgery and afterwards. Your surgeon may also require you to have a mammogram (breast x-ray). Knowledge of your allergies, medications and previous surgeries should be brought to your surgeon's attention at this time. Specific instructions to assist you in preparing for this procedure will be given to you after the health history and physical is complete. Depending on your individual health status, the instructions may include guidelines regarding your diet, alcohol intake, smoking and which medications to take or avoid. Your experience will be much smoother if you remain compliant with your surgeon's instructions.

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What precautions are necessary during recovery?

You will receive instructions about changing the gauze and keeping the incisions clean, positions for sleep and rest, raising your arms, breathing exercises and breast massage. Whether you choose augmentation or reduction, you should:

Expect to feel tired and tender for the first 24 to 48 hours. Your breasts will be bruised and sore, therefore, an adequate amount of rest is advised.
Drink plenty of fluids and be sure to follow your medication schedule.
Allow enough time for recovery. If your job is not too physically demanding, you'll probably be able to go back to work in a week or so.
Avoid vigorous or strenuous exercise for six weeks.
Know what to expect. Your stitches will be removed in a week to ten days. The incision scars will be firm and pink for at least six weeks, and then will begin to fade. Your breasts will remain swollen for three to four weeks following surgery. They will be tender to touch and movement.
Avoid lifting and pushing for two weeks, and no heavy lifting or pushing for four weeks.
Allow about two months for complete recovery.
Discomfort following surgery (which reduces and disappears over time) is expected; however, be sure to tell your doctor if:
There is an increase in pain, swelling, redness, drainage or bleeding in the surgical area.
You develop headache, muscle aches, dizziness or a general ill feeling and fever, nausea or vomiting.
These can be symptoms of infection, and may require medical attention. The usual follow ups after surgery are at one week, one month, three and/or six months, and thereafter at annual exams.

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What are the possible complications after a breast asymmetry procedure?

Breast Augmentation: Even though the implant is well tolerated, your body's natural reaction to a foreign material is to surround it with a thin membrane called a "capsule" in order to stay in the desired pocket. The formation of this capsule is not a problem and occurs in every patient. In some cases, for reasons that are as yet not completely understood, this capsule can shrink around one or both implants, compressing the implant and making it round and firm. This is called capsular contracture and can occur in varying degrees. Although some women may consider some firmness desirable, the capsule can cause the breast to become unnaturally firm, misshapen or uncomfortable. Capsular contracture may occur from a few weeks to several years after the initial procedure. There is no way to predict your body's reaction and if you will develop capsular contracture. Placing the implant under the muscle, in some cases, can reduce the incidence of this condition. If a patient does develop capsular contracture, surgical intervention may be required.

The opposite of capsular contracture can also occur when breast implants are in a satisfactory position but several months later there is spontaneous expansion of the capsule. This is described medically as an inferior and lateral migration of the implants. If this happens, the patient will require closure of the breast pocket to reposition the implant either through the original incision or through a small inframammary incision.

While there is no evidence that the saline breast implant causes breast cancer, it is recommended that the patient have a preoperative mammogram as a baseline. Thereafter, when having a mammogram be sure to go to a radiology center where the radiologist is experienced in the (Eklund) special technique required for an accurate x-ray of a patient with breast implants.

It is emphasized that regular breast examination and mammograms are the best way to detect early cancers. It is always important to be informed about the possible complications before any surgery. Be sure to discuss any concerns you may have with your surgeon.

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Breast Reduction: The scars in breast reduction procedures are placed in natural skin demarcation lines around the areola, down the breast, and across the bottom of the breast. In most women, the scars from the incisions will be pink for about six months and gradually fade thereafter. It is important to know that all scars are permanent and their height, width and final color are never completely predictable.

As with any surgical procedure, small nerves to the skin are interrupted during surgery. Portions of the nipple area may feel numb or have less than full feeling. Sensitivity returns over several weeks, but some diminished feeling may last indefinitely. This does not usually interfere with erotic sensation and many women even report an increased erotic sensitivity with their new breasts.

No procedure is without risks; however, the majority of complications known to be associated with a breast reduction are minor when the procedure is performed by an experienced board certified plastic surgeon. It is always important to be informed about the possible complications before any surgery. Be sure to discuss any concerns you may have with your surgeon.

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What results can I expect after a breast asymmetry procedure?

Your breasts will be wrapped with gauze bandage, plus a tighter bandage for protection and support. You also may have small drainage tubes coming out of the incisions, to help drain some of the excess fluid. It is important to take the medication prescribed to you by your doctor. Someone will need to drive you home, and you may need assistance at home over the next couple of days.

If your breast skin is very dry following surgery, you can apply a moisturizer, but be sure to keep the sutures (stitches) area dry.

Breast asymmetry can help clothes to fit better as well as improve the overall contour by balancing the breasts. Remember, though, that as with breasts in general, the pull of gravity will affect a surgically corrected breast over time. However, since the breasts are now more equal in size and weight, they may undergo such changes more evenly.

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