Breast augmentation is one of the most common cosmetic plastic surgery procedures that I and most board-certified plastic surgeons perform each year, according to statistics by the American Society for Aesthetic Plastic Surgery. Most women I see for breast augmentation here in San Diego are primarily concerned with enhancing the size of their breasts with breast implants. They feel somewhat self-conscious about breast size and feel that they are not proportional and may have problems wearing certain clothing, including bathing suits.
At the initial consultation, I will examine the patient in a full-length glass mirror so we can both look at her areas of concern. I always inform patients that breast asymmetry is the rule rather than the exception. This observation has been borne out in studies such as one done at UT Southwestern Medical Center’s department of plastic surgery, which demonstrated 88% of women who sought breast augmentation had breast asymmetry. However, if you look closely enough, I think you’ll find that nearly all women have some degree of asymmetry.
So, what causes breast asymmetry to be so common? The answer is that breast asymmetry may be due to a variety of causes, including variations in breast volume, breast shape, nipple position, position of the breast on the chest wall, and diameter of the breast. In addition, patients may have intrinsic differences in chest wall shape from one side to the other as well as congenital variations in the muscles of the chest wall. Patients may also have slight curvatures or asymmetries of the spine that can create even subtle differences between the breasts. Finally, asymmetry can result from genetics, breastfeeding, or simply natural changes that occur over time.
What is the role of breast implants in breast asymmetry? I always inform patients that breast implants will simply make the breasts larger. While breast augmentation will improve breast asymmetry, it is unlikely that breast implants will completely correct the asymmetry as there are multiple factors and causes, many of which are unrelated to volume differences between the breasts. You have to accept that some degree of asymmetry is natural with the human body—from head to toe. It is important that prospective patients understand the role of breast implants so that they have realistic expectations and are pleased with the results of their breast augmentation surgery.
In cases where breast asymmetry is due to breast sagging or ptosis where nipple position is not ideal, then breast lift surgery (technically called mastopexy) may be added to breast augmentation surgery to improve symmetry. Breast reduction may also be an option when it is necessary to reduce an overly large breast to match a smaller breast. Or, in some cases, women may choose to have a breast implant in only one breast to correct asymmetry.
It’s important to know that some causes of breast asymmetry may not be improved with breast augmentation surgery. Such causes include curvature of the spine (scoliosis), chest wall deformities such as pectus excavatum, and variations in breast width or position on the chest wall.
The consultation is a time for patients to learn about the various types of implants available to them. In many cases, it is helpful for patients to try on a variety of sizers. This can help both the patient and me determine which size and shape implant meets their aesthetic goals. The surgical approach to implant placement is also discussed at this time, including incisions. Our patients are also informed of final implant placement, which will be either beneath the muscle (subpectoral or submuscular) or beneath the breast gland (subglandular). We will also discuss the advantages and disadvantages of each option.