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Congenital Asymmetry Washington DC

All women have some degree of breast asymmetry; however, some women have asymmetry that is so significant that it is visible in clothing. These women may be candidates for surgical correction. It is important to note that surgery can yield vast improvements in asymmetry, but will often not yield perfect symmetry.

The most common types of asymmetry we see are summarized below.

  1. Unilateral hypoplasia: one small breast

    In unilateral hypoplasia, one breast does not develop to the same degree as the other breast, leaving patients with significant asymmetry. For most women, the difference is first noticeable when they hit puberty. One breast grows at a normal rate, while the other breast never develops, or develops much slower and smaller than the other side. There may also be a difference in the shape of the breast mound and the position of the nipple.

    Treatment of unilateral hypoplasia varies depending on the severity of the difference in size and shape. Typically, correction of asymmetry requires a breast augmentation on the smaller side, and a symmetrizing procedure (reduction, mastopexy, or augmentation) on the other side.

    If the underdeveloped breast is extremely small, then we need to stretch out the skin envelope to make room for a breast implant. This is done using a tissue expander. A tissue expander looks like a deflated breast implant that has a special port on the outside that allows us to access it through the skin with a needle. The tissue expander is surgically placed under the pectoralis muscle and slowly inflated with saline once a week to stretch the breast skin. Once the skin is stretched enough to accommodate a breast implant, we go back to surgery and replace the expander with a permanent silicone or saline breast implant.

  2. Tuberous breast deformity

    A tuberous breast is small and constricted at the base, with a large prominent areola. This type of breast does not have enough skin, so it looks long and skinny, and the breast tissue herniates into the nipple-areolar complex. The inframammary fold is also displaced upward from its normal position.

    Correction of a tuberous breast deformity can be challenging, as the natural anatomy of the breast is already distorted. The size, shape, and position of the breast all need to be addressed surgically.

    • Size. The breast is augmented to increase the size. Augmentation is performed with a periareolar incision, and the implant is placed below the pectoral muscle. Some patients need a tissue expander prior to augmentation because they do not have enough skin to accommodate a breast implant. A tissue expander looks like a deflated breast implant that has a special port on the outside that allows us to access it through the skin with a needle. The tissue expander is surgically placed under the pectoralis muscle and slowly inflated with saline once a week to stretch the breast skin. Once the skin is stretched enough to accommodate a breast implant, we go back to surgery and replace the expander with a permanent silicone or saline breast implant.
    • Shape. The tuberous breast is constricted at the base and has an oblong shape. In order to make the breast appear round, we radially score the breast tissue from the inside. The effect of radial scoring is to widen the base of the breast and make it look less narrow.
    • Position. The inframammary fold is typically too high in a tuberous breast. This is addressed by dropping the inframmamary fold from the inside to an anatomically normal position.

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