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Breast Asymmetry & Breast Size- When Does It Need Treatment?

by Ron Keys, JD, PhD

A question was asked: Post subject: I need advice...

I am 19 years old and I have developed...but only on one side. I have one breast that is a lot bigger than the other. I know women usually have one bigger, but mine is...well, not normal at all. It is literally a whole size bigger. At first I wasn't too worried because I thought that I would keep growing and the other would eventually catch up. But I'm beginning to think that that's never going to happen. I don't know what I should do. I don't show it but I am extrememly self concious about it. I don't even like wearing bathing suits, and I can't ever go without a bra. I hate it. Can someone help me please?

Answer:

One needs a physical examination and a detailed medical history, first, in cases like this. All aspects of asymetrical breast development must be checked very carefully.

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. Thermography (heat distribution) is frequently helpful here in situations like this and it is non-invasive, also.

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. But there should be no rush to surgery if you are only nineteen (19) years old and all other avenues should be explored first.

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. Breast development occurs early in the sequence of somatic changes that accompany pubescence. 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. This underscores the importance of a detailed history on you. Catchup growth does take place but if you are already 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. But you are only 19 years old. 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. But we have no history detailed on your posting. 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 (3)

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. But as I said, surgical correction is the last thing you want to do if you are only 19 years old and still may have a growth spurt.

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. Hormone replacement therapies that are truly comprehensive will activate the collagen and elastin support systems in the gene clusters to return breast support and minimize sag everywhere, not just in the breats support systems.

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. This is besides activating collagen and elastin gene clusters to provide improved support everywhere for a truly comprehensive hormone replacement therapy.

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.

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. 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 and body ego. 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.

However, an emerging body of literature concerning women with cosmetic breast implants indicate a statistically significant 2- to 3-fold increase in suicide risk when compared with the general population. See: McLaughlin JK, Lipworth L, Tarone RE. Suicide among women with cosmetic breast implants: a review of the epidemiologic evidence. J Long Term Eff Med Implants. 2003;13(6):445-50. See also: McLaughlin JK, Wise TN, Lipworth L. Increased risk of suicide among patients with breast implants: do the epidemiologic data support psychiatric consultation? Psychosomatics. 2004 Jul-Aug;45(4):277-80.

Is breast augmentation intervention by surgery always necessary? What does this mean to the practitioner in screening patients for breast augmentation or similiar procedures? What should it mean? Operating on these patients may not correct their problem, which is oftentimes, essentially a mental or emotional one. Watch out! See: Crerand, CT, et al. Nonpsychiatric medical treatment of body dysmorphic disorder. Psychosomatics. 2005 Nov-Dec;46(6):549-55. Many individuals with body dysmorphic disorder seek nonpsychiatric medical and surgical treatment to improve perceived defects in their physical appearance. However, the types of treatments sought and received, as well as the treatment outcome, have received little investigation before this study. Now it is suggested that such treatment rarely improved body dysmorphic disorder, even though it provided income for the plastic surgeons in these cases. Thus, nonpsychiatric medical treatments frequently involving surgery, do not app ear effective in its treatment.

Counseling these patients as possible candidates for surgery or pre-surgical screening should take this matters into consideration. See: K. A. Phillips, J. Grant, J. Siniscalchi, and R. S. Albertini. Surgical Nonpsychiatric Medical Treatment of Patients With Body Dysmorphic Disorder Focus, April 1, 2005; 3(2): 304 - 309. Body Dysmorphic Disorder (BDD), a preoccupation with an imagined defect in physical appearance, may be the hidden, secret illnes in a patient seeking surgical correction of a mental problem. How would you know if you didn't look for it?

According to KA Phillips, Body dysmorphic disorder is the the distress of imagined ugliness !!!

Is this breast or other cosmetic surgery on this patient really necessary? Should counseling be mandated here?