All women’s breasts are a bit asymmetric. Is it volume? nipple position? inframammary fold? rib cage? When we do surgery assessment for breast augmentation, I use many tools to assess you: I use measurements, implant sizers, and 3D camera to do modeling. I point out your asymmetries not to torture you, but many women, particularly if you are small breasted, haven’t noticed they are different. I need to notice these to try to correct or minimize the differences. I aim for identical twins but end up with sisters.
What we have noticed with time in this profession for over 20 years, is that patients notice small differences post surgery that they didn’t notice before surgery. Even when they are actually improved after surgery (so less asymmetric than prior to surgery), the patient may notice it more.
This study addresses that, “A computerized Recognition System to assess Breast Asymmetry after Augmentation Mammaplasty” in December 2023 Plastic & Reconstructive Surgery Journal.
Study:
- 200 women including 100 patients 6 months postoperatively were recruited.
- Self assessments of breast asymmetry and objective measurements were taken
- Computerized 3D was used to look at the nipple areola complex, inframammary fold . lower pole length, volume.
- Participants evaluated if they recognized asymmetry in these areas.
- Findings? Self assessment was more precise after surgery to look at the NAC, IMF, lower pole distance asymmetry. They found that changing the inframammary fold to make the nipple closer improved patients symmetry evaluation.
In their discussion, they talk about how pre surgery patients had a “vague” distinguishing of breast asymmetry. But post surgery patients were much more critical, despite most of them actually being closer. Why? They theorize the women were accustomed to their pre surgery breasts – they have had them for years. But after surgery they look at their body more and look at it more from a third-party point of view.
This is so important. Expectations are so important. Understanding your current asymmetries, what can be achieved, and what will persist is so important. Understanding how tissue is dynamic, it stretches and settles, so planning in surgery is not completely predictable.
Patients studied themselves much more after surgery than before. They looked down and in the mirror more frequently.
NAC and IMF are the two pivotal landmarks of the breast, the NAC position being more important.
TAKEHOME messages for those considering breast augmentation:
- Breasts are sisters, not twins
- Despite being objectively closer after surgery in this study (ie more symmetric, less asymmetric), patients noticed the asymmetries more.
- Nipple position is more important than inframammary fold position. (When a breast implant sits higher or lower on the chest it will affect nipple position.)
My thoughts?
This is real, but interesting to see it proven by the study. I spend a ton of time showing people their asymmetries, again not to torture them but there are some things I cannot fix. I like my Vectra 3D imaging here, as it allows me to show patients how implant position can affect nipple position.
Anytime you have a pair of something- breasts, eyes, face sides- you want symmetry. We do lots of measurements to try to aim for twins. But bodies are inherently asymmetric. Forces on the bodies are asymmetric. Skin tone and sun damage and volume skin laxity are asymmetric.