“Sisters, not identical twins”: breast asymmetry

As one of the busiest breast surgery practices in Central Florida, I see many patients who would like a breast augmentation performed. As part of our routine, we carefully examine the patient, and during our examination, it’s very common to find several differences or asymmetries between the two sides.

Most patients have no idea about these minor asymmetries of the breast until we show them…and then they see them. The reason we do this, of course, is to explain that these asymmetries will still be there post-operatively after a standard breast augmentation operation, since they were present pre-operatively.

There are several interesting studies about pre-operative asymmetry in patients undergoing breast augmentation.

Rohrich, Hartley & Brown, in their 2003 review of 100 patients, published in Plastic and Reconstructive Surgery found:
– 88% of women had natural breast asymmetries when critically examined,
– 72% of these women had more than more asymmetric feature.

In other words, nearly nine out of ten women have some degree of breast asymmetry. We commonly say “Think of the two breasts as sisters, not identical twins!”

Common asymmetries in this study included:
– nipple / areola position differences in 53%
– breast volume differences in 44%
– infra-mammary fold position differences in 30%
– chest wall (bony) differences in 9%

Similar findings were seen in 2009 study by de Chardon and associates, who examined 200 breast augmentation patients. They found a higher incidence of chest wall asymmetries, at 17%, which was most commonly caused by scoliosis of the spine with secondary changes in the rib shape.

Perhaps the most interesting finding from this French study was, of the patients that complained about breast asymmetry after surgery, 83.3% (five out of six) of them had the same asymmetry pre-operatively.

This finding certainly indicates the need to explain to patients what is present prior to the implant surgery, and help the patients to understand which features can or can not be corrected by implants alone.