Breast Asymmetry

• Improved balance in size and shape
• Greater ease in finding clothing that fits evenly across the chest
• Improved sense of comfort, particularly in body-conscious clothing

During the initial consultation, you and your surgeon will discuss the changes that you would like to make in your appearance. He/she will explain the different options available to you, the procedure itself, and its risks and limitations. He/she will also explain the kind of anesthesia required, surgical facility, and costs.

Your surgeon will begin with a complete medical history. He/she may also give you specific instructions preparing for surgery, including guidelines for eating and drinking, smoking, and taking or avoiding vitamins, supplements and medications.

Take this opportunity to ask all the questions you have about the surgery. Ask for, and follow up on, patient references. Learning everything you can about your options, risks and benefits is the key to making an informed decision. See Questions to ask your doctor below.

Augmentation: In this procedure, the surgeon makes an incision either under the armpit, in the crease under the breast, around the areola (the pigmented tissue around the nipple), or through the navel. The surgeon then lifts the breast tissue, creates a pocket in the chest area ? either above or below the muscle, and then places the implant inside the pocket. Almost all implants used today are filled with a saline solution.

Reduction: In this procedure, an anchor-shaped incision is made on the breast itself. The excess fat tissue removed in a liposuction-type procedure, and then the incision is closed, creating a contour closer in size and shape to the other one. If less tissue will be removed, a doughnut-shaped area of skin may be removed just around the nipple. An advantage to this procedure is that the incision and stitches may be less visible.

Augmentation: Breast augmentation stretches the tissues, and can be painful. This is especially true when the implants are placed under the muscle, and in young women who have never had children. The pain is greatest within the first 48 hours, but improves with each day and is somewhat relieved by pain medications. In spite of the initial discomfort, most women report that they are very satisfied with the results of the surgery.

When you wake up you will feel tired, sore, and stiff. It is important to take the medication prescribed to you by your doctor. You?ll need someone to drive you home, and you may need assistance at home over the next couple of days.

Your surgeon may prescribe an antibiotic and an anti-inflammatory medication to be taken after the surgery. It is a good idea to have these prescriptions filled beforehand.

Reduction: Although the surgical incision for this surgery is quite large, it is placed in areas of the breast that are not very sensitive. Thus, the pain after surgery is usually easily managed with a pain reliever. Initially, there is discomfort in walking, getting out of bed, and any activity that causes the chest to move. You may continue be sore for the first few days after surgery.

Your breasts will be wrapped with gauze bandage, plus a tighter bandage for protection and support. You also may have small drainage tubes coming out of the incisions, to help drain some of the excess fluid.

It is important to take the medication prescribed to you by your doctor. Someone will need to drive you home, and you may need assistance at home over the next couple of days.

If your skin is very dry following surgery, you can apply a moisturizer, but be sure to keep the suture (stitches) area dry.

You will receive instructions about changing the gauze and keeping the incisions clean, positions for sleep and rest, raising your arms, breathing exercises and massage.

• Expect to feel tired and tender for the first 24 to 48 hours. Your breasts will be bruised and sore?be prepared to take it easy.
• Drink plenty of fluids and be sure to follow your medication schedule.
• Allow enough time for recovery. If your job is not too physically demanding, you?ll probably be able to go back to work in a week or so. If your work requires physical energy and stamina, you?ll need to allow more time for your recovery.
• Avoid vigorous or strenuous exercise for six weeks.
• Know what to expect. Your stitches will be removed in a week to 10 days. The incision scars will be firm and pink for at least six weeks, and then will begin to fade. Your breasts will remain swollen for three to four weeks following surgery. They will be tender to touch and movement.
• Avoid lifting and pushing for two weeks--no heavy lifting or pushing for four weeks.
• Allow about two months for complete recovery.

Discomfort following surgery (which lessens and disappears over time) is expected; however, be sure to tell your doctor if:

• There is an increase in pain, swelling, redness, drainage or bleeding in the surgical area;
• You develop headache, muscle aches, dizziness or a general ill feeling and fever, nausea or vomiting.

These can be symptoms of infection, and may require medical attention. The usual follow ups after surgery are at one week, one month, three and/or six months, and thereafter at annual exams.

• 18 years of age or older
• Not currently pregnant or nursing
• In good physical health
• Psychologically stable
• Wanting to improve their appearance
• Realistic in their expectations
• Having this surgery for the first time

In addition, the candidate for reduction surgery also should understand that scarring on the breast, although diminishing over time, will be permanent.

The above is only a partial list of the criteria that your surgeon will consider in determining whether or not breast augmentation or reduction is appropriate for you. Be sure to ask your surgeon if he / she considers you an ideal candidate for a breast augmentation or reduction in order to improve symmetry.

Augmentation: Some of the more common possible complications include postoperative infection, hematoma (a blood clot in the breast tissue requiring evacuation of the blood clot during a subsequent surgical procedure); implant rupture, deflation or leakage; capsular contracture, calcium deposits, changes in nipple or breast sensation, interference with mammogram readings, shifting of the implant. A detailed description of the complications along with further readings can be found at "www.fda.gov/oca/breastimplants/bitac.html".

Reduction: Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples. There is also permanent scarring on the breast itself. Liposuction of the breasts can reduce the size of the breasts without causing significant scarring, but most women do not choose this option because it makes the breasts sag more (since the size of the skin is not reduced).

All operations carry some risk and the possibility of complications can include (but are not limited to) infection, unsatisfactory results, excessive bleeding, adverse reaction to anesthesia, and the need for second or sometimes third procedures. In addition, the following should be noted with regard to augmentation and reduction in particular:

Augmentation: There are several concerns regarding breast augmentation: the surgery itself, the implants, breast cancer, and the risk of anesthesia. The risks involved with breast augmentation have received a lot of attention, but it is very unlikely that you would get breast cancer or arthritis solely caused by the breast implants. We recommend you read the specific complications outlined in the "Food and Drug Administration Infomation for Women Considering Saline-Filled Breast Implants" (courtesy of McGhan Medical Corporation and FDA). To obtain this information, contact the McGhan Medical Corporation, F.D.A. Consumer Information Line at (800) 532-4440 or your surgeon. There is no known association of breast implants with breast cancer in human beings, and in fact several large studies have shown a lower incidence of breast cancer in women with breast implants. (Breast implant type devices have been shown to cause a rare form of cancer in rats that are prone to cancer, but this cancer has not been reported in humans with breast implants.)

Other side effects specific to breast augmentation include:

• capsular contracture, which occurs when the scar or area around the implant begins to tighten, causing the breast to feel hard.
• nipple sensitivity or loss in sensitivity. This usually disappears after several weeks, but for some may be permanent.
• rippling: indentations on the breast, often caused when the implant moves.
• rupture: when the breast implants tear and/or leak. This may require a second operation to replace the implant.
• symptoms of immune system disorders: some women have reported having symptoms such as joint pain swelling, fever, fatigue, or breast pain. Although research has not found conclusive evidence correlating breast implants with these symptoms, the FDA has requested that further study be done on this subject.

Many times patients will not be aware of complications until days or months after the procedure has been performed.

Reduction: In this surgery, serious complications are quite rare, but there is often significant blood loss due to the magnitude of the surgery. In addition, small areas of infection are not uncommon; nor is delayed healing in areas of the incisions. There is also a possibility of developing small sores around the nipples, which can be treated with antibiotic creams. If you carefully follow all your surgeon?s instructions both before and after the surgery, you can minimize the risks.

As mentioned previously, future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples. Some patients may experience a permanent loss of feeling in the nipple or breast after reduction. Rarely, the nipple and areola may lose their blood supply, and the tissue dies.

Costs for these procedures vary, depending on the doctor, the location, technique used and the difficulty of the specific case. Reported costs apply to surgery involving both breasts: ask your doctor about differences in cost where only one breast is corrected.

The fees listed below do not include anesthesia, operating room facility, hospital stay and other related expenses.

Augmentation: The national average of 1999 surgeon fees for augmentation was $3,142 (Source: The American Society of Aesthetic Plastic Surgery). Regional averages: New England states: $3,949; middle Atlantic states: $2,820; north central states: $2,936; south central states: $2,739; and mountain/Pacific states: $3,248. In most cases, health insurance policies do not cover the cost of augmentation.

Reduction: The national average of 1999 surgeon fees for reduction was $5,024 (Source: The American Society of Aesthetic Plastic Surgery). Regional averages: New England states: $5,789; middle Atlantic states: $4,771; north central states: $5,196; south central states: $4,789; and mountain/Pacific states: $4,689. You should ask your surgeon if your needs are medically indicated, in which cast the costs may be covered by your medical insurance.

• How long has the surgeon been doing corrections?
• What is the total number of augmentation/reduction procedures that the doctor has performed?
• Has the plastic surgeon ever had his/her malpractice insurance coverage denied, revoked, suspended? (No)
• In the event that a second procedure is needed, does the original cost cover the additional expense?
• Where will the procedure be performed?
• What type of anesthesia will be used, and who will administer it?
• Will the doctor provide references of patients who have had the same procedure? (The doctor should have a list of references available.)
• Will the doctor provide before/after photographs he/she has performed?
• Can you observe the exact procedure you are having before you decide to have the surgery? (Yes, either on videotape or ask to view one in real life.)
• What should you expect post-operatively, in terms of soreness, what to watch for, medication, bathing, and level of activity?
• Who will be assisting the doctor during the asymmetry surgery? What are their qualifications? Does the plastic surgeon perform the entire surgery?

Candidates for asymmetry hould ask:

• Does the FDA approve the implant the doctor will be using?
• Do you offer patient financing?
• What procedure is the doctor recommending and why? (Discuss different incision types, location of the implant, type of implant, and whether the plastic surgeon recommends a breast lift in addition to augmentation.)
• What are the risks associated with the procedure, including: capsular contracture, infection, nipple sensitivity, rippling, rupture, symptoms of immune system disorders?
• What percent of patients have experienced any of the aforementioned risks?
• Is there a warranty on the implant?
• What are the guidelines and recommendations for selecting the implant size?
• How will a breast implant affect the way routine mammograms are performed?

Candidates for reduction should ask:

• Should I have blood drawn ahead of time in case I need a transfusion? (Breast reduction doesn't usually require a blood transfusion, but if large amount of tissue will be removed, the need for a transfusion is a possibility.)

• Tell your doctor about any allergies you have (to foods, drugs, environmental elements)
• Tell your doctor about all medications you are taking (both prescription and non-prescription)
• Be sure to tell your doctor if you smoke. Smoking can interfere with the healing process.
• Avoid aspirin and aspirin-containing medicines, as well as anti-inflammatory medicines such as Nuprin, Motrin, and Advil for two weeks prior to surgery. Also avoid herbal remedies such as St. John?s Wort, gingko biloba, some types of Chinese black mushrooms and other natural medicines and foods that may thin the blood.
• Try to schedule surgery at a time other than your menstrual period.
• Arrange for someone to drive you home after surgery.

The information on this web site is intended only as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified surgeons who are able to answer specific questions related to your situation.

• Modern Approaches to Asymmetry Surgery
• Making the Right Choice
• Enhancement Procedures, Asymmetry, to Fit Your Needs
• Modern Approaches to Breast Asymmetry
• Best Reduction Method for Women of Color
• Reconstruction After Mastectomy
• Reduction
• The best candidates for enlargement
• The best candidates for a lift
• Short Scar Reduction and Lift Surgery