Perfect Balance

Created on 13th July 2009

Specialist cosmetic breast surgeon Mr Philip Turton explains how he tackles breast asymmetry

Some patients who are considering cosmetic breast surgery have very marked differences (asymmetry) between their two breasts which they are already aware of. Other patients are unaware of more subtle differences that exist and unless their surgeon is experienced at recognizing this, those differences can be missed.

The time to spot asymmetries is at the very first consultation. This requires a detailed assessment of the patient's starting dimensions, and here the skill and expertise of your breast surgeon is a prerequisite. We determine your breast dimensions, chest wall dimensions, skin envelope and breast tissue characteristics. I frequently pick up breast asymmetries that patients were unaware of.

If these are not identified prior to surgery, it is possible that they will be more obvious to patients after surgery. While many differences are small and unlikely to detract from the final cosmetic result, others need to be considered differently. In some cases a simple breast augmentation may need to be supplemented by additional surgery to improve the results.

Options for dealing with differences in breast size
Where there is an obvious difference in breast size but nipple height is similar, the options include using different size breast implants. If one breast is significantly larger than the other and there is also breast droop present, then a combination of partial breast reduction and partial breast uplift is often a very good option.

More major differences in breast size are seen occasionally as part of congenital problems and are not suitable for correction with this approach, but breast reconstruction surgery, often carried out in stages, can achieve good results.

Options for dealing with differences in nipple position
A fairly common situation after pregnancy or breast feeding is for one nipple to appear lower. This can also occur as a developmental problem during adolescence that gradually gets worse.

Patients will normally always identify the less drooping breast as the one that they want to match. If the good breast has a nice size and shape, the preferred option is for a breast mastopexy (uplift and minor reduction) on the other side.

A common scenario is to find patients request breast augmentation to correct the loss of volume that often occurs after childbirth. The assessment reveals that one breast has drooped slightly, with the nipple position being lower than it should be. Simply performing a breast enlargement in this situation is likely to leave very obvious differences.

I offer a combination of breast augmentation combined with a minimal scar mastopexy. This involves the addition of a circular scar at the outer margin of the areola on one side. The technique is derived from the Benelli approach and enables the nipple and areola to be re-positioned symmetrically on the breast at the time of breast enlargement.

Tuberous breasts
The bigger the difference between the two breasts the more careful one has to be. It is not always possible to correct major differences in one go.

Tuberous breast problems are a good example of this where one breast has developed into a sausage shaped projection in the most severe form, or the crease under the breast is much higher than it should be.

For the more severe cases of tuberous breast correction, I will plan a series of operations that usually include elements derived from breast augmentation and areola reduction techniques as well as corrections to nipple height.

Combinations of breast droop, asymmetry of size and empty breasts
My preferred approach in this situation is to perform two separate operations: the breast uplift procedure is performed first, usually with a full mastopexy. I will often add an internal suspension lift to enhance the result.

The second operation occurs after a period of six months to place breast implants. This is a more costly approach but is more preferable to combining both operations at the same time. The reason for this is quite simple - the biggest risk to a combination approach is of a catastrophic breakdown in wound healing which leads on to implant infection, swelling and potential loss of the nipple.

Waiting for six months allows the wounds to heal with minimal tension, the breast tissue to become soft and supple again, and for the blood supply to the nipple area to recover. Achieving the best shape and good symmetry with this approach is also much more likely. But above all, it is a far safer approach.

When a patient chooses to have cosmetic breast surgery, the experience, qualifications and dedication of their surgeon is paramount. My career is centered around the reconstruction of breasts after breast cancer, usually at the time of major surgery to remove the breasts. This surgery requires the highest levels of expertise to achieve the very best.

The techniques that I use are a combination of breast plastic surgery skills, aesthetic breast surgery techniques and breast oncology surgery skills. This unique combination is called oncoplastic breast surgery. I use all these approaches in my work as a cosmetic breast surgery specialist.
CS&AM