Breast asymmetry

A photo of a patient's breasts, showing their asymmetry.

Today I saw a patient who had been operated on for a condition known as “tuberous breast deformity” and asymmetry. Tuberous breast deformity occurs when a patient has a narrow base of the breast. The fold underneath the breast is tight or narrow and the breast mass appears to hang over the breast base. The term “tubular” breast deformity is also used to describe this as the breast has a tubular shape instead of rounded one. Some patients are also unfortunate in that their tubular breasts are also different in size.

These patients present a challenge from the technical point of view. There is no accepted general consensus on how to “fix” a tuberous breast, which means no single approach works well for everybody. On top of that, you have to make the two different sized and shaped breasts match as much as possible. Unlike cancer patients, who are battling a grave disease, and realize their involved breast is somehow “damaged” and in need of reconstructive surgery, the tuberous breast deformity patient wants to make her natural breasts “match” and be “prettier” than they are now. Their expectations are much higher than the mastectomy patient. From the surgeons viewpoint, the surgery is more difficult than a breast reconstruction and the patient is harder to please.

The patient I saw today was very unhappy with the previous surgeon. She had been concerned about scarring and had wanted “natural looking” breasts. Looking at her, I think I understand what the previous surgeon thought. Since she was so adamant about scarring, he decided to place the scar under the breast fold. This would hide the scar, but also eliminated the chance to reposition the nipple-areolar complex. As a result, the patient got a “hanging breast” with a downward pointing nipple, which looks natural, as the patient stated she had wanted, but final result was not she was hoping for. I offered the patient a supra areolar scar (at the upper border of the areola) to bring the nipples to better position, and adjustable implants. She wanted to think about it, but I could tell she was not thrilled.

In summary, patients with asymmetry have to be psychologically ready for a certain amount of scarring. I use the supra areolar scar, as it is a minimal amount of scarring compared to the inverted T scar. The patient also should know she is going to look better, not perfect. Most patients are very happy, and this procedure really does change people’s lives.

By Dr. Ricardo L. Rodriguez MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.

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3 thoughts on “Breast asymmetry”

  • alexandra says:

    I was really concerned about why my severe asymmetry with one tuberous breast happened. I feared it was a sign of ill health. I really got the impression from my doctor & a couple of surgeons that it was a very trivial thing. That is, not just "not a health problem" but foolish to be unhappy with. I know some breast cancer survivors are rejected by partners because of their disfigured breasts. To me there are 2 separate issues: a life threatening disease and then a social/sexual/psychological struggle. When there are no longer surgeons making a sizable proportion of their incomes changing women's breasts i will accept this superficial generalization that women like me are harder to please and just want prettier breasts. My expectations weren't that high - ultimately the large round breast is just smaller & I designed a tattoo to fit around the smaller - in art school they called that "asymmetrical balance." I didn't need complicated surgery or implants either. They're still not the same size or shape. The social/sexual/psychological side tends to get discounted by plastic surgeons when they discuss this problem - odd under the circumstances.
    • Dr. Ricardo L Rodriguez says:

      This is not a trivial thing. Check out this blogpost I wrote on correction of tuberous breast and go to the comments section. There is an outpouring of emotional stories from patients, and even an unsympathetic post from a woman who considers it vain, so I am fully aware of the personal toll this takes. Most conditions we treat are not detrimental to physical health nut they do affect people deeply. Patients ask me "Do I need this?" and I have to answer "No, you don't need it, but your life will be much better with it" You don't have to live with this. You may elect to, but there are alternatives out there including the use of your own fat tissues to enlarge the smaller breast so you don't necessarily have to use implants. I am sorry some Plastic Surgeons discounted your condition, from my experience with colleagues, I can assure you it is not the rule.
  • Laura says:

    I found this while searching for information regarding "tuberous breast deformity." I had a consultation with a plastic surgeon in my area (Southlake, TX) and he spent a good two hours discussing the positives and negatives regarding augmentation w/mastoplexy for the correction of my tuberous breast deformities. He wanted to make it clear that there would be some scarring. The thing about it is that I could care less about the scarring as I HATE them as they are. If he could make them look somewhat "normal" while hidden behind a bra or clothing, I would be overjoyed, even if it left an anchor-type scar. He, however, said that a lift could be done by incising around the areola, removing a crescent-shaped bit of tissue above the areola, and pulling those together (obviously I'm no surgeon and therefor lacking in terminology and procedural information generally). He also said that while doing this, he would release a band of scar tissue that resides at the edge of the areola and that would help "free-up" the tightness there. He said that he would insert the implant via an incision in the "crease," for he felt a better pocket could be formed, the IMC could be lowered, and he could place the implant completely behind the muscle wall. This would leave the smallest amount of scarring possible while still performing a moderate "lift." After reading your entry about this subject, I feel much more confident that my surgeon is doing what's in my best interest. Thanks so much for the entry.