Our 10 Years' Experience in Breast Asymmetry Correction

Optimizing Surgical Outcomes: A Case Series on BREAST-V for Treating Breast Asymmetries

BACKGROUND

Breast asymmetry occurs when there is a discrepancy in the shape, volume, or positioning of the breasts. Various factors, including unequal development of breast buds, endocrine disorders, chest wall deformities, and surgical or posttraumatic sequelae, can contribute to this condition. Although breast asymmetry is common, clinically severe cases are rare and often require surgical correction because of potential postural, aesthetic, and psychological issues. Accurate assessment of the breast volume is crucial for planning and evaluating surgical interventions.

METHODS

This prospective, non-randomized, interventional study was conducted between 2019 and 2024 at the Breast Reconstruction Section of the Federal University of São Paulo, Brazil. Forty patients with breast asymmetry were evaluated using the BREAST-V, which calculates the breast volume based on three linear measurements. Patients underwent various surgical procedures, including augmentation, reduction mammoplasty, and mastopexy, tailored to their specific type of asymmetry. Preoperative and postoperative breast volumes were compared to assess the effectiveness of surgical correction RESULTS: The study included 40 participants, with an average age of 25.2 years. The mean preoperative breast volumes were 469.6 g (right) and 448.8 g (left). The postoperative volumes decreased to 338.3 g (right) and 331.1 g (left), showing an average reduction in asymmetry of 72.9%. The minimal clinically important difference (MCID) for pre-treatment asymmetry was 65.4 g.

CONCLUSION

The BREAST-V tool has significant potential for the objective assessment of breast asymmetry. Reliable volumetric measurements can aid in surgical planning and postoperative evaluation, ultimately enhancing the clinical outcomes.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Sisters But Not Twins: A Critical Appraisal of Long-Term Results in Breast Asymmetry Correction

BACKGROUND

Breast asymmetry is a common disorder, which can lead to significant emotional distress. Despite this, there is currently no widely accepted approach for managing this prevalent condition. Due to the high dimorphism of the breast, despite a satisfactory result in the short-term post-op, the recurrence of asymmetry is one of the most common weak points of breast recontouring. The purpose of this paper is to investigate the long-lasting maintenance of breast symmetry in women who have undergone surgical correction of asymmetric breasts through mastopexy or reduction mammoplasty and to try to identify some specific elements to achieve more stable outcomes in the long term.

METHODS

A retrospective study was conducted on 1,984 breast surgical procedures carried out between 2002 and 2020 to evaluate patient satisfaction and the recurrence rate of asymmetry disorders. All the patients enrolled in this study were given a questionnaire to evaluate their satisfaction level. A retrospective iconographic-chart review was investigated by the same senior surgeon, who recorded the presence or the absence of recurring breast asymmetry.

RESULTS

In total, 1984 patients were enrolled who respected the minimum standard of the study; 596 showed up at post-op follow-up longer than three years. Most of the patients showed great satisfaction with the results, even if several recurrences of asymmetry were reported.

CONCLUSIONS

The recurrence of asymmetry is one of the most common weak points of breast asymmetry correction procedures due to the high dimorphism of the breasts. In order to fully assess the results of asymmetric breast correction, patients should be required to attend a post-op follow-up examination after a long time frame. Indeed, the strength of this paper lies in the focus on long-term postoperative follow-up.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of Postoperative Breast Asymmetry Using Vectra 3D Imaging in Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction

Background/Objectives: Implant-based breast reconstruction (IBBR) is increasingly favored over autologous reconstruction due to its procedural simplicity and recovery benefits. Conducting this reconstruction using either the subpectoral or prepectoral planes has varied aesthetic outcomes. This study utilizes VECTRA XT 3D imaging to objectively assess breast symmetry differences between these surgical techniques. Methods: A retrospective cohort study was conducted analyzing data from patients undergoing unilateral total mastectomy followed by immediate silicone implant reconstruction via subpectoral or prepectoral techniques. The VECTRA XT 3D system provided measurements, including sternal-notch-to-nipple (SN-N), midline-to-nipple (ML-N), and nipple-to-inframammary fold (N-IMF) distances, as well as breast width, volume, and projection, taken more than a year postoperatively, to assess symmetry and aesthetic outcomes. Results: The study included 63 patients-29 in the subpectoral group and 38 in the prepectoral group. The SN-N ratio was 0.91 for the subpectoral group compared to 0.95 for the prepectoral group (p = 0.014). Among patients with a BMI of 25 or higher, the prepectoral group had an SN-N ratio significantly closer to 1 (0.97 ± 0.07) than the subpectoral group (0.89 ± 0.06) (p = 0.027). No statistically significant differences were found in metrics based on the surgical method across age categories divided at 50. Conclusions: The prepectoral IBBR technique shows improved nipple positioning and breast symmetry compared to subpectoral methods, as assessed via precise 3D imaging. This finding suggests potential advantages for surgical planning and patient satisfaction, indicating the need for large cohort studies to further investigate the factors influencing breast symmetry.

Relative Distribution of Common Breast and Chest Asymmetries in 2051 Primary Augmentation Mammoplasties in Nonptotic Subgroup of Patients

Background

Breast and chest asymmetries are extremely common, and primary augmentation mammoplasty can be challenging in these cases. However, there is a paucity of information on the relative distribution of these asymmetries and the implant sizes used in these patients.

Methods

A retrospective chart review of all consecutive cases of primary augmentation mammoplasty performed by a single surgeon from May 1999 to May 2012 was conducted. Patients with chest and breast asymmetries were noted by clinical examination and observation. These patients were selected to review how many patients had similar or different-sized implants. Patients presenting with unilateral or bilateral ptosis and requiring mastopexy were excluded.

Results

A total of 2051 patients underwent primary augmentation mammoplasty. Uneven chest wall or uneven ribs were noted in 274 patients (right more prominent 72, left more prominent 202). Of these, 169 patients had implants of the same size, and 37 patients had implants of different sizes. Similarly, 1008 patients presented with uneven breasts, and of these, 272 patients had different-sized implants. One patient needed revision surgery for implant size and breast volume readjustment.

Conclusions

Chest and breast asymmetries are extremely common. Routine clinical examination is more than adequate to delineate such asymmetries. The majority of these patients have small differences, and not all patients with asymmetries require implants of different sizes.

Breast Reconstruction following Mastectomy for Breast Cancer or Prophylactic Mastectomy: Therapeutic Options and Results

(1) Importance of problem: Breast cancer accounted for 685,000 deaths globally in 2020, and half of all cases occur in women with no specific risk factor besides gender and age group. During the last four decades, we have seen a 40% reduction in age-standardized breast cancer mortality and have also witnessed a reduction in the medium age at diagnosis, which in turn means that the number of mastectomies performed for younger women increased, raising the need for adequate breast reconstructive surgery. Advances in oncological treatment have made it possible to limit the extent of what represents radical surgery for breast cancer, yet in the past decade, we have seen a marked trend toward mastectomies in breast-conserving surgery-eligible patients. Prophylactic mastectomies have also registered an upward trend. This trend together with new uses for breast reconstruction like chest feminization in transgender patients has increased the need for breast reconstruction surgery. (2) Purpose: The purpose of this study is to analyze the types of reconstructive procedures, their indications, their limitations, their functional results, and their safety profiles when used during the integrated treatment plan of the oncologic patient. (3) Methods: We conducted an extensive literature review of the main reconstructive techniques, especially the autologous procedures; summarized the findings; and presented a few cases from our own experience for exemplification of the usage of breast reconstruction in oncologic patients. (4) Conclusions: Breast reconstruction has become a necessary step in the treatment of most breast cancers, and many reconstructive techniques are now routinely practiced. Microsurgical techniques are considered the "gold standard", but they are not accessible to all services, from a technical or financial point of view, so pediculated flaps remain the safe and reliable option, along with alloplastic procedures, to improve the quality of life of these patients.

Optimal strategies for addressing developmental breast asymmetry and the significance of symmetrical treatment: A systematic review

BACKGROUND

Approximately one quarter of women are affected by asymmetry as a result of abnormal breast development, which can lead to significant emotional distress. Despite this, there is currently no widely accepted approach for managing this prevalent condition. This systematic review aimed to review the available literature on the management of developmental breast asymmetry.

METHODS

A comprehensive search in MEDLINE, EMBASE, and CENTRAL databases was conducted for primary clinical studies reporting on the management of developmental breast asymmetry from 1962 to November 2022. The primary outcome measures were long-term aesthetic outcomes and patient-reported outcomes.

RESULTS

Eleven case series and 2 cohort studies were included, comprising a total of 1237 patients with a mean age of 26.5 years (range 14-65 years). Twelve studies (92%) addressed asymmetry through surgical means, using various augmentation and reduction procedures, whereas one study (8%) utilized external prostheses. Meta-analysis of the data was not deemed to be possible because of heterogeneity of data; a narrative synthesis of the literature was provided.

CONCLUSIONS

There is no consensus on how to manage developmental breast asymmetry. Furthermore, there is a lack of consistency in the classification of patients with developmental breast asymmetry and in the reporting of outcomes, highlighting the need for a consensus. Further research outlining long-term aesthetic and patient-reported outcomes is needed to understand which procedures provide optimal outcomes. In addition, external breast prosthesis is a promising nonsurgical alternative, and further studies into its efficacy are needed.

Surgery of congenital breast asymmetry-which objective parameter influences the subjective satisfaction with long-term results

PURPOSE

Congenital breast asymmetry is a serious gynecological malformation for affected patients. The condition hits young women in puberty and is associated with socio-esthetic handicap, depression, and psychosexual problems. Surgical treatment is usually early in the patient's lifetime, so a long-term sustainable solution is important. Although postoperative outcome has been evaluated in several studies before, this study is the first to analyze which objective parameters have the greatest influence on subjective satisfaction with long-term results.

METHODS

Thirty-four patients diagnosed with congenital breast asymmetry that underwent either lipofilling or implant therapy between the years of 2008 to 2019 were examined. On average, our collective comprised patients seven years after surgery. Data were mainly gathered through manual measurements, patient-reported outcome measures (Breast Q^™), and breast volumetry based on 3D scans (Vectra^® H2, Canfield Scientific).

RESULTS

Among all analyzed parameters, only areolar diameter correlated significantly negatively with the subjective outcome satisfaction of the patient. Regarding the subjective assessment of postoperative satisfaction with similarity of the breasts, again the mean areolar diameter, but also the difference in areolar diameter and breast volume between the right and left breasts correlated significantly negatively.

CONCLUSION

Areolar diameter was revealed as being a significant factor influencing subjective long-term satisfaction in breast asymmetry patients. Moreover, 3D volumetry proves to be an effective tool to substantiate subjective patient assessments. Our findings may lead to further improvements to surgical planning and will be expanded in further studies.