Breast asymmetry is normal in the majority, if not all women. In the women who present for breast enhancement, breast asymmetry should be identified pre-operatively and discussed, but in most cases no correction is warranted.

• Breast asymmetry does move along a continuum of mild, moderate and severe, and it may vary in size and shape of the breast.

In patients where there is a mild, but noticeable size discrepancy and a breast implant is planned, this discrepancy can be compensated and corrected with different volumes of breast implants. Mild discrepancy in shape can also be corrected with breast implants, but slight nipple re-positioning may be added to level any nipple areolar differences.

Moderate breast asymmetry, is usually related to both breast volume (size) and the amount of sagging or ptosis on one side (shape). In these cases, different volumes of implants may be needed, but more commonly a more aggressive breast lift on one side with matching implants can usually correct size and shape differences. In these cases, it is important to have relatively matching scars, even if a breast lift is not needed on one side. This is usually a periareolar scar to match the other side’s breast lift (mastopexy) scar.

Severe cases of breast asymmetry, may be indicative of a congenital breast deformity with constriction of one breast and normal development of the other side. This can lead to difficulty fitting into bras, negative self-image, and social embarrassment as the young woman matures.

In these, severe cases a two staged or two surgery approach is often beneficial for an effective and long-lasting result.

• The first stage would include a breast reduction or a breast lift on the larger side, because typically there is breast sagging on that side, and then a tissue expander or expandable breast implant on the constricted side. This enables the expansion of the breast tissue gradually as the tissue expander is filled slowly with saline at regular intervals to help create a pocket for a permanent breast implant which would match the other side. a remote port is used for this tissue expander so that the central and sensate breast does not need to be poked with needles. A side chest port is easy to locate and reliable for gradual filling of the expander.
• The second stage after breast expansion is complete (usually 6 months), is the removal of the tissue expander and replacement with a permanent breast implant with a possible periareolar mastopexy if there is herniation or enlargement of the areola. A breast implant may be placed under the previously lifted breast on the other side. An auto-augmentation can sometimes negate the need for an implant on this non-constricted side.

Drains are often used when changing a tissue expander to a breast implant. These are typically removed in one week. Recovery is likened to any breast procedure:

• outpatient operation lasting 1 to 3 hours
• mild discomfort for 1 to 3 days,
• back to school or work in less than one week,
• cardio activity in 3 weeks and heavy lifting in 4 to 6,
• scar care starting at 3 weeks.

Fat injections are not reliable enough to precisely correct volume differences, but may be used is areas of breast pocket thinness after expansion and implant placement.

Correcting breast asymmetry is not always needed, but in noticeable and severe cases, correction can greatly benefit the patient physically and psychologically. These are complex reconstructive and cosmetic cases which may take over a year to complete the entire process. With this approach long-lasting results can be achieved and effective correction of the asymmetry can be expected.

The first step in correcting breast asymmetry is a consult with Dr. Trussler in his Austin Texas plastic surgery office. This will help determine what breast procedure is right for you.

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Nipple height can not only be decreased as in the inverted nipple, but can be increased with an overly projecting or long nipple. This problem can begin after breast feeding, but may be congenital. Long or oversized nipples may be a source of embarrassment and are commonly covered up with bra padding and pasties, but are difficult to conceal in bathing suits and when naked. Most women believe that this problem cannot be corrected and they are “stuck” with them, or they are embarrassed to seek treatment for the size of the nipple. Activities and clothing can be avoided because of this problem. Nipple height can be decreased with a very minor wedge excision of the nipple with a turn-down upper nipple flap. This procedure does disrupt the continuity of the nipple ducts and does make breast feeding not possible. It is easily performed under local anesthesia in a minor procedure room with minimal recovery.

All nipple procedures including decreasing the diameter of the areola, as well as correcting the length of the nipple can be performed easily and can be combined safely with breast augmentation, breast enhancement with breast implants and breast lifts (mastopexy) and reductions. The beauty of nipple surgery is that this area heals with minimal scarring.

Dr. Trussler will individually discuss each concern with the look and function of nipple and tailor the correction to each patient’s age and request, including the desire to breast feed.

The post Nipple Size and Breast Surgery: Getting the height right. appeared first on Andrew Trussler, MD, PLLC.

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