Breast Asymmetry - When Does It Need Treatment?
Frederick R. Jelovsek MD
"I am 21 years old and for the past several years I noticed my left breast was somewhat larger but nothing to worry about. Now my breast is much larger and it hangs lower. The nipple feels different. It is quite uncomfortable. Anyway, do you think this could somehow catch up with the other breast? ".
The right versus the left breast of any woman is very often of different size and even a different shape. Although common, these differences are perceptible but not very great. If it is a newly noticed size difference, the first question that should be asked is whether or not there is any solid or cystic growth in one breast that is making it larger than the other. Therefore be sure to visit the doctor, if you haven't already, to be sure that there are no breast masses causing the discrepancy in size.
The three major determinants of breast appearance are size, shape of the individual breast and the position of the breast and nipple when standing in an upright position. If surgical correction is undertaken with cosmetic surgery, the best success is obtained with correction of size alone. If both size and shape are different, the surgical results are not as good because each breast requires a different surgical procedure.
What causes a difference in the sizes of the breasts in a person?
Most doctors assume that breast size differences are either genetic tendencies or random events in which paired organs like the breasts just grow differentially with respect to starting and stopping. The breasts are stimulated to grow under the influence of estrogen hormone in young girls. It begins with breast budding and about two years after that the first menstrual period occurs. The breast continues to grow for about 2-4 more years and it is during that time that there can be differences in size. Catchup growth does take place but if you are now 21 years old and breast development has gone on more than about 6 years, then it is unlikely to change now until pregnancy or menopause. Those are the other two events that can change size and shape of the breasts.
A rule-of thumb that is commonly used is that most breast size differences are less than a bra cup size in volume and usually do not require surgical treatment. If you think your one breast is a full cup size or more different, then you may want to consider cosmetic surgery by a plastic surgeon. Plastic surgeons will still perform surgery with smaller differences than a cup size but you need to be the judge if it is worth it.
If you have a difficulty determining cup size you may want to measure the breasts the way the plastic surgeons measure it. Using this technique, you need a tape measure that has markings in inches. Start at the outside of the chest where the breast begins. Measure across the fullest part of the breast (usually across the nipple) to where the other side of the breast stops near the breast bone. If the measurement is:
- 7 inches (17.8 cm) - cup size is A
- 7.5 inches (19.0 cm) - cup size is full A
- 8 inches (20.3 cm) - cup size is B
- 8.5 inches (21.6 cm) - cup size is full B
- 9 inches (22.9 cm) - cup size is C
- 9.5 inches (24.1 cm) - cup size is full C
- 10 inches (25.4 cm) - cup size is D
- 10.5 inches (26.7 cm) - cup size is full D
- 11 inches (30 cm) - cup size is DD
When should asymmetry of the breasts be surgically corrected?
Many surgeons prefer not to perform cosmetic surgery prior to age 18 although this has been questioned and long term results may be as good when operating at age 17 or less. In general, however, it is best not to operate within the first two years after the onset of menses. An exception to this may be for massive enlargement of the breast called virginal hypertrophy. If there is asymmetrical growth with severe hypertrophy (cup size greater than D) in adolescence, then surgery may be performed at a much younger age even though the other breast has not yet completed its growth.
Surgery for breast asymmetry may involve augmentation of one or both breasts, reduction mammoplasty of one or both breasts if hypertrophy is present, or even augmentation of one breast and reduction in size of the other. Sometimes there is sagging (ptosis) of one of the asymmetrical breasts that needs to be corrected at the same time. Surgery to correct asymmetry is about 90% successful as far as women attaining their desired result.
What about sagging or drooping breasts (ptosis) ? Can they be fixed?
Breasts naturally sag after menopause when they lose fatty tissue and their support weakens. Prior to that, breasts may also show significant loss of fat and fluid after pregnancy and breast feeding. More often than not, the breasts do not actually sag, but rather they have a pseudo ptosis in the postpartum period. This can be a significant flattening and collapse of the breast.
True ptosis or sagging can happen before the menopause and may actually be a congenital change just like asymmetry. Several different types have been described. It can be improved surgically with what is termed a mammopexy or "fastening" of the breast. Implants alone may correct mild ptosis.
What other abnormal breast sizes and shapes are there and what can be done?
There are several other breast size and shape anomalies that may benefit from cosmetic surgery. Tuberous breasts get their name from being shaped like a tube. The base of the breast is not broad-based but rather constricted so that the breast appears more like a tube than a cone. Tuberous breasts can be changed through surgery. (image1, image2).
Lack of almost any breast development, hypoplasia, is another condition that may be a familial or congenital characteristic. Surgeons can add implants to the breasts (image). Hyperplasia is the opposite condition, i.e., the breasts are too large. Surgeons have corrected these conditions for many years.
Abnormal breast shape and size can be harmful to a woman's self esteem. It pays to know what some of the common differences in breast shape and size are. It is also very important to understand that almost no woman has two breasts of identical size and shape in the natural state. The differences are then just a matter of degrees.