Breast asymmetry, breast mal-development
Adult breast consist of mature mammary glands. Breasts are still underdeveloped until the age of 10-11. The first stage of breast development is the appearance of breast buds in young girls. One breast more developed than the other is quite common among girls during sexual puberty and is considered normal. In most women, symmetry between the breasts is apparent by the end of puberty. The duration of time between the first stage of breast development and fully developed breasts varies among women.
Minimal asymmetry between breasts is certainly common, to some extent, among most women, just as there exists asymmetry between any other paired body parts. For some women going through breast augmentation, it is necessary to insert a different implant size into each breast such that the final outcome will reveal breast symmetry. This is further discussed upon consultation prior to surgery.
Underdeveloped or excess tissue in one breast relative to the other is established only after full breast maturation. In certain cases it is necessary to have only one breast enlarged, or one breast reduced, in order to achieve symmetry; this, of course, is dependant on the specific situation, need, and desire of the patient.
At times, the cause of a single underdeveloped breast is due to a general condition of underdevelopment of the whole side of the chest, a condition known as “Poland” syndrome. In this situation, there is deficient growth of various tissues only on one side of the chest. In other words, there is underdevelopment of ribs, chest muscles (Pectoralis major and minor), breast, and nipple. This syndrome is not hereditary. Underdevelopment of chest tissue may differ in presentation among patients and not always manifest in complete underdevelopment of all tissues together. At times, the only manifestation may be a small breast. In more extreme cases, it may be necessary to perform comprehensive breast reconstruction.
Sometimes, development of both breasts is not perfect due to defects in breast tissue, the most common condition being called “tubular breast”. Several degrees of severity exist for this situation. The appearance of the breasts in these situations resembles a tube, with relatively wide nipples. The treatment for tubular chest is adjustment of breast dimensions. In mild cases, only augmentation is necessary, while in more extreme cases enlargement along with breast-lift and areola decrease is indicated. Commonly, only one breast in involved.
For the most part, it is possible to correct an underdeveloped breast in one surgery; however there are situations when more than one surgery is necessary to achieve the desired results.
Complications with this surgery are rare. Details of possible complications are further discussed in the relevant sections (breast augmentation, breast lift, breast reduction).
Redundant breast tissue (Accessory Breast)
This is anatomically most commonly found around the axilla region, and it is felt as a soft lump that may change in size during the ovulation cycle. At times, there may be local tenderness. The treatment for an accessory breast is complete surgical excision, similar to any other skin lesion. The surgery leaves a small scar at the site of excision. In some cases, liposuction may be effective enough to reduce the tissue.
This phenomenon exists along the “milk line” (the line where all mammals develop nipples, not just humans). At times, the accessory nipple is diagnosed as merely an additional birthmark or nevus. It is possible to remove this nipple via complete surgical excision, just like any other skin lesion. The surgery leaves a small scar at the site of excision.
A nipple that is indented, or concaved, cannot protrude because the connective tissue attaching it to the underlying tissue draws it inward. There are several degrees of severity for a retracted nipple. In its most mild form, the retracted nipple regains its protraction in lightly cold weather or fine stimulation. In the most severe presentation, the nipple remains retracted at all times. In difficult cases, the patient is unable to breast-feed due obstruction of the lactating ducts within the nipple. Treatment for retracted nipples involves surgery under local anesthesia, and the goal is to elevate the nipple and immobilize it such that it will not retract once again. The surgery involves a small incision of a few millimeters, through which the pulling connective tissue is severed. After disconnected the nipple from the underlying connective tissue, the nipple is immobilized via internal sutures. In most cases, the patient will no longer be able to breast feed from the same breast after the procedure.
The initial recovery time from this surgery can be accompanied by bruising, redness, local sensitivity, and swelling. These signs will go away after several days. The final shape of the nipple will take place after several weeks. During the recovery period, it is advised that the patient wear protection above the nipple.
Complications of this surgery are extremely rare, and include:
-Overlying skin ischemia, and possible necrosis
-Opening of sutures
-Recurrence of nipple retraction
-Hypertrophic or keloid scarring
-Necessity for additional surgery.