Most women have slightly different-sized - or asymmetrical - breasts. However, in some cases the difference in size is pronounced. In these cases, 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 even more information, you may want to read through our breast augmentation and breast reduction procedure descriptions. For more detailed information about how these procedures may help you, we recommend that you schedule a consultation with Dr. Kremer.
Frequently asked questions about Breast Asymmetry by Dr. Michael A. Kremer:
During the initial consultation, you and Dr. Kremer will discuss the changes that you would like to make in your appearance. He will explain the different options available to you, the procedure itself, and its risks and limitations as well as the kind of anesthesia required. At this time, he will also ask about your medical history, and inspect your breasts. Dr. Kremer will also measure your breasts, take photographs, and possibly require a mammogram (breast x-ray).
Take this opportunity to ask all the questions you have about the surgery. Learning everything you can about your options, risks and benefits is the key to making an informed decision.
Asymmetrical breasts can be made more even either by augmentation of the smaller breast, or by reduction of the larger one. Both breasts, of course, can also be changed in the same way but to a different extent in order to match them:
Augmentation: In this procedure, Dr. Kremer 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. He 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.
Reduction: In this procedure, incisions are made on the breast itself. The excess breast gland and fat tissue is removed, and then the incision is closed, creating a breast contour closer in size and shape to the other one. Depending on the individual situation and the amount of necessary lifting and tissue to be removed, a doughnut-shaped area of skin may be removed just around the nipple or you will require a vertical or an inverted T-scar.
The length of the surgery depends on the type of procedure you choose, your anatomy and the incision technique, ranging from 2-4 hours.
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 an outpatient surgicenter 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, Dr. Kremer 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 Dr. Kremer. You'll need someone to drive you home, and you may need assistance at home over the next couple of days.
Dr. Kremer may prescribe an antibiotic and an 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 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 Dr. Kremer. Someone will need to drive you home, and you may need assistance at home over the next couple of days.
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. 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.
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 Dr. Kremer will consider in determining whether or not breast augmentation or reduction is appropriate for you.
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:
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.
There are several concerns regarding breast augmentation. The risks involved with breast augmentation have received a lot of attention, but neither breast cancer nor arthritis have been shown to be caused by breast implants. All operations carry some risk and the possibility of complications can include (but are not limited to) infection, excessive bleeding, adverse reaction to anesthesia, and the need for second or sometimes third procedures.
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.
Read more about breast implants and health on the Food and Drug Administration (FDA) website.
Other side effects specific to breast augmentation include:
- capsular contracture: occurs when the scar or area around the implant begins to tighten, causing the breast to feel hard. This occurs more frequently in silicone-gel filled implants than in saline-filled ones.
- nipple sensitivity or loss in sensitivity: usually disappears after several weeks, but for some this is permanent.
- rippling: dependent on thickness of skin, type and size of implant. 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.
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).
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 Dr. Kremer'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.