Breast Asymmetry: A Real Patient's Struggle

Recently, a patient presented me with the following scenario:

At age 18, I had a breast reduction on one breast and breast augmentation on the other, due to radically asymmetrical breasts.  Since my small breast was so small, the doctor used a small implant, and there was still a considerable difference in size between the two breasts.  Moreover, the implant immediately encapsulated, leaving a small, hard bump high on my chest.

Fast-forward 30 years:  The natural breast is large, sagging, empty on top, and full on the bottom; while the implant remains a hard bump, with a flat triangle hanging beneath it.  As you can imagine, this looks pretty bad naked, and it is difficult to find clothes to disguise it.

Because of the capsular contracture of the initial implant, I'm not really keen on the idea of replacing it with a larger implant--I'm afraid of ending up with a large, hard bump instead of a small one! The only alternative that's been offered to me is to remove the implant, do a lift, and reduce the other breast to match. I'm a pretty large woman, and I don't want two itty, bitty breasts.

Are there any alternatives to implants? Is there any way to use fatty tissue to fill up the small breast?

There is no "right" answer to her problems.  My goal is to customize a plan that will work for her.

What she describes is a tough situation:

• Two breasts originally different in size and shape,
• treated via different techniques,
• aging differently,
• and a breast implant complication--a capsular contracture.

Nevertheless, all is not lost!  I have helped similar women in the past.

First, she and I need to decide what you she is and is not willing to put up with. If she doesn't like the idea of implants, then the first surgeon's opinion is sound:

• remove the current implant (and its capsule),
• lift that breast,
• and reduce/lift the other breast to match.

Obviously, perfect symmetry will be impossible but at least then the breasts will both be "constructed" of the same material--natural breast tissue.

However, if bigger breasts will be more proportionate to the rest of her frame, then an implant on the "small" side is the best option.  I would consider...

• removing the current implant (and its capsule),
• replacement with a silicone implant under the muscle (to minimize the risk of re-encapsulation),
• lift that breast,
• and then lift the other breast to match.

Regarding alternatives to implants, there are NONE that I would trust.  I have heard of patients receiving free silicone gel injections into the breasts.  This is NUTS!  A few years from now, those patients will likely have hard, painful breasts, and, for them, I have no solution other than mastectomy and breast reconstruction (as if they had cancer).

Fat grafting (taking fat via liposuction from one area and then carefully depositing it elsewhere) is somewhat unpredictable. I have had some success in the face, and other plastic surgeons have reported success in the buttocks (the so-called "Brazilian butt lift").  However, I would strongly dissuade this patient from using fat grafts from breast augmentation.

If that fat does not "take" (does not live), then it will form a scar.  That scar may look like a cancer on mammograms.  Then, it will be difficult to assess her breasts for the presence (or absence) of breast cancer.  Biopsies may be necessary to make sure that the abnormalities visible on mammograms are just scarred bits of dead fat grafts, rather than tumors.  A bunch of biopsies would produce more anxiety than I would be willing to put any patient through!

Ultimately, this lady needs to decide what is right for her.  It's her body!  Nevertheless, I think that the decision boils down to whether she is willing to put up with another implant and the ~20% risk of re-encapsulization, versus smaller breasts.

She has options and shouldn't despair!

Comments

[Texas breast reduction]

Scientists don't yet know for sure the reason for this underdevelopment. One theory is that at least in some women it would be linked to too little progesterone, since progesterone mediates the growth of alveoli (milk making glands).So keeping in mind one thing that acceptions are always there in biological aspects.

[Michael Pickart]

Thank you for the comment! I appreciate your input regarding the etiology of breast underdevelopment (too little progesterone, or inadequate response to circulating progesterone). It would certainly be ideal to correct the true underlying problem (hormonal) before surgery becomes necessary. Whata good idea for a valuable research project.

Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

428 Poli St.,#2C, Ventura, CA 93001
(805) 648-4567 | fax (805) 641-0811

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