Professor Ashton is a Melbourne based plastic surgeon who specialises in Breast Surgery For Congenital Breast Deformity. He is a Clinical Professor of Surgery, Honorary Professor of Anatomy at the University of Melbourne, and chair of Plastic Surgery at Epworth Freemasons Hospital. He is the former Head of Plastic Surgery at Royal Melbourne Hospital (2001 – 2016) and Royal Women’s Hospital (2000 – 2016).
Breast asymmetry is not uncommon. Almost all women’s breasts are slightly different from one side to the other.
When there is a significant discrepancy between the left and right breasts and the patient feels that they would like to have this corrected, surgical correction may be considered.
In essence, the options are centred around the patient requesting that the larger breast be reduced back to a more manageable size or the smaller breast to be enlarged to match the contra-lateral breast. In our experience the most common scenario is that one breast is larger than the other breast and the patient seeks to have this reduced to match the other slightly smaller breast (particularly if the smaller breast is of a C cup).
In this situation the most common method employed is a breast reduction technique based on the Hall Findlay breast reduction. This is usually a relatively straightforward procedure. Patients are usually admitted to hospital overnight. The operation takes approximately 1-2 hours and is able to closely match the opposite breast. Further information regarding the Hall Findlay technique can be found on our Breast Reduction article.
In patients in whom there is an under development of the breast, a breast enlargement or augmentation procedure may be considered. This may be because the breast is generally hypoplastic or smaller than the other breast or because it is part of a congenital abnormality in which other structures on that side of the body are smaller or have not developed. When the breast is essentially of normal shape and has developed but is slightly smaller than the opposite breast, placement of an implant behind the breast can be undertaken to achieve breast symmetry. This is usually undertaken using an inframammary incision but the other techniques, such as a peri-areola or an axillary incision may be utilized. Depending upon the degree of enlargement required and the shape discrepancy an anatomical or round implant may be employed.
Again, this procedure is relatively straightforward and would involve being admitted to hospital overnight. A drain tube is usually employed for 24 hours. The surgery usually takes about 90′ minutes.
In some patients the breast asymmetry is due to a congenital abnormality in the upper pectoral breast/shoulder area. By far the most common cause of this is a syndrome called Poland’s Syndrome. This originally described around the end of the 19th century and involves the under development of the breast, the nipple and areola, the loss or absence of the lower part of the pectoralis major muscle and / or the latissimus dorsi muscle on the back. There may be also shortening of the fingers on the affected right hand and there may be arm length discrepancy. Reconstruction of this abnormality is a little more complicated and involves replacement or enlargement of the existing right breast and /or reconstruction of the underlying pectoral muscles. Depending on the development or absence of the latissimus dorsi muscle, this muscle may also be utilized to reconstruct the upper anterior fold of the armpit. In severe hypoplasia of the breast, alternative techniques using your own tissue, such as the use of microsurgical transfer of tissue from the lower abdomen may also be utilized to reconstruct the breast.
Clearly treatment for Poland’s syndrome needs to be individualized to the patient depending upon the degree of asymmetry and the development or incomplete development of the breast, nipple, pectoral muscles, latissimus and latissimus dorsi muscles. Should you feel you have Poland’s syndrome I would be only too happy to provide you with more detailed information about this syndrome and can provide you with detailed information about the surgery and the options for surgical reconstruction.
If you would like to make an appointment with Prof Mark Ashton to discuss Surgery for Congenital Breast Deformity please give our rooms a call.