Most people have slightly different-sized -- or asymmetrical -- breasts. However, in some cases the difference in size is pronounced and correction is often desired. The best procedure will depend on several factors, including how you want to balance the breasts. You may want to augment (enlarge) the smaller breast to look like the larger one, or reduce the size of the larger breast to match the smaller one.
Both breast augmentation and reduction are widely performed procedures. If you're considering augmentation or reduction to correct breast asymmetry, the following information will provide you with a good introduction to the procedures involved. For more detailed information about how these procedures may help you, we recommend that you consult a plastic surgeon who is board certified or has completed a residency program that includes instruction in these procedures.
*The price of breast asymmetry surgery can vary significantly depending on the extent of surgery required. The cost will also be largely determined by whether breast implants are used or not.
*Women ages 18 years and under represented 18.5% of the total women who had Breast Asymmetry in 2010.
*Many girls and women may have up to a 20% difference in their breast size. However, these asymmetries are considered normal and are usually not obvious, except under close scrutiny.
- What are the most common benefits of this surgery?
- How is asymmetry correction performed?
- How long does the surgery take?
- Will I have to stay in the hospital?
- How much pain is there?
- What can I expect after surgery?
- What is the recovery period like?
- What is the long-term outcome like for most people?
- Ideal candidate:
- Other important information
- Risks and limitation
- Improved balance in breast size and shape
- Greater ease in finding clothing that fits evenly across the chest
- Improved sense of comfort, particularly in body-conscious clothing
Asymmetrical breasts can be made more even either by augmentation of the smaller breast, or by reduction of the larger one:
Breast 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. Patients may choose between saline and silicone gel breast implants.
Breast 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.
The length of the surgery depends on the type of procedure you choose, your anatomy, the incision technique, and type of anesthesia. Surgery may take two to four hours to complete.
Maybe. 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. In this case, 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.
Augmentation: Breast augmentation stretches the tissues, and can be painful. This is especially true when the implants are placed under the muscle, and in young women who have never had children. The pain is greatest within the first 48 hours, but improves with each day and is somewhat relieved by pain medications. In spite of the initial discomfort, most women report that they are very satisfied with the results of the surgery.
When you wake up you will feel tired, sore, and stiff. It is important to take the medication prescribed to you by your doctor. You'll need someone to drive you home, and you may need assistance at home over the next couple of days.
Your surgeon may prescribe an antibiotic and anti-inflammatory medication to be taken after the surgery. It is a good idea to have these prescriptions filled beforehand.
Reduction: Although the surgical incision for this surgery is quite large, it is placed in areas of the breast that are not very sensitive. Thus, the pain after surgery is usually easily managed with a pain reliever. Initially, there is discomfort in walking, getting out of bed, and any activity that causes the breasts to move. You may continue to be sore for the first few days after surgery.
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 suture (stitches) area dry.
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—be prepared to take it easy.
- 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. If your work requires physical energy and stamina, you'll need to allow more time for your recovery.
- Avoid vigorous or strenuous exercise for six weeks.
- Know what to expect. Your stitches will be removed in a week to 10 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--no heavy lifting or pushing for four weeks.
- Allow about two months for complete recovery.
Discomfort following surgery (which lessens 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.
Correction to breast asymmetry can help clothes to fit better as well as improve the overall silhouette by balancing the breast contours. 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.
In general, the best candidates for asymmetrical breast correction are:
- 18 years of age or older
- Not currently pregnant or nursing
- In good physical health
- Psychologically stable
- Wanting to improve their appearance
- Realistic in their expectations
- Having this surgery for the first time
In addition, the candidate for reduction surgery also should understand that scarring on the breast, although diminishing over time, will be permanent.
The above is only a partial list of the criteria that your surgeon will consider in determining whether or not breast augmentation or reduction is appropriate for you. Be sure to ask your surgeon if he / she considers you an ideal candidate for a breast augmentation or reduction in order to improve symmetry.
Augmentation: Some of the more common possible complications include postoperative infection, hematoma (a blood clot in the breast tissue requiring evacuation of the blood clot during a subsequent surgical procedure); implant rupture, deflation or leakage; capsular contracture, calcium deposits, changes in nipple or breast sensation, interference with mammogram readings, shifting of the implant.
Reduction: Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples. There is also permanent scarring on the breast itself. Liposuction of the breasts can reduce the size of the breasts without causing significant scarring, but most women do not choose this option because it makes the breasts sag more (since the size of the skin is not reduced).
All operations carry some risk and the possibility of complications can include (but are not limited to) infection, unsatisfactory results, excessive bleeding, adverse reaction to anesthesia, and the need for second or sometimes third procedures. In addition, the following should be noted with regard to augmentation and reduction in particular:
Augmentation: There are several concerns regarding breast augmentation: the surgery itself, the implants, breast cancer, and the risk of anesthesia. The risks involved with breast augmentation have received a lot of attention, but it is very unlikely that you would get breast cancer or arthritis solely caused by the breast implants. We recommend you read the specific complications outlined in the "Food and Drug Administration Infomation for Women Considering Saline-Filled Breast Implants" (courtesy of McGhan Medical Corporation and FDA). To obtain this information, contact the McGhan Medical Corporation, F.D.A. Consumer Information Line at (800) 532-4440 or your surgeon. There is no known association of breast implants with breast cancer in human beings, and in fact several large studies have shown a lower incidence of breast cancer in women with breast implants. (Breast implant type devices have been shown to cause a rare form of cancer in rats that are prone to cancer, but this cancer has not been reported in humans with breast implants.)
Other side effects specific to breast augmentation include:
- capsular contracture, which occurs when the scar or area around the implant begins to tighten, causing the breast to feel hard.
- nipple sensitivity or loss in sensitivity. This usually disappears after several weeks, but for some may be permanent.
- rippling: indentations on the breast, often caused when the implant moves.
- rupture: when the breast implants tear and/or leak. This may require a second operation to replace the implant.
- symptoms of immune system disorders: some women have reported having symptoms such as joint pain swelling, fever, fatigue, or breast pain. Although research has not found conclusive evidence correlating breast implants with these symptoms, the FDA has requested that further study be done on this subject.
Many times patients will not be aware of complications until days or months after the procedure has been performed.
Reduction: In this surgery, serious complications are quite rare, but there is often significant blood loss due to the magnitude of the surgery. In addition, small areas of infection are not uncommon; nor is delayed healing in areas of the incisions. There is also a possibility of developing small sores around the nipples, which can be treated with antibiotic creams. If you carefully follow all your surgeon's instructions both before and after the surgery, you can minimize the risks.
As mentioned previously, future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples. Some patients may experience a permanent loss of feeling in the nipple or breast after reduction. Rarely, the nipple and areola may lose their blood supply, and the tissue dies.
The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified surgeons who are able to answer specific questions related to your situation.
*Disclaimer: Sources: American Society for Aesthetic Plastic Surgery (ASAPS), nationally in 2010, http://www.womenrepublic.co.uk/beauty/cosmetic/breast_asymmetry.htm, and http://www.menstrual-cycle.info/137-Breast-asymmetry.html. Most surgeons offer convenient payments plans for this procedure. Cost does not include anesthesia, operating room facility, hospital stay, and other related expenses. Costs may vary depending the extensiveness of the procedure, location, and other factors. Costs are provided solely for research purposes. For specific estimates, please contact a qualified plastic surgeon.