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Updated 07/30/09
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Breast
Asymmetry
Most
women have slightly
different-sized - or
asymmetrical - breasts.
However, in some cases the
difference in size is
pronounced. In these cases,
correction is often desired.
The best procedure will depend
on several factors, including
how you want to balance the
breasts. You may want to
augment (enlarge) the smaller
breast to look like the larger
one, or reduce the size of the
larger breast to match the
smaller one.
Both breast
augmentation and reduction are
widely performed
procedures. If
you're considering
augmentation or reduction to
correct breast asymmetry, the
following information will
provide you with a good
introduction to the procedures
involved.
For
even more information, you may want
to read through our breast
augmentation and breast
reduction procedure
descriptions. For more detailed
information about how these
procedures may help you, we recommend that you schedule a consultation with
Dr. Kremer / Dr. Zettl.
What
will happen at the initial
consultation?
During
the initial consultation, you and Dr. Kremer / Dr. Zettl
will discuss the changes that you
would like to make in your
appearance. He will explain the different options available to you, the
procedure itself, and its risks and
limitations as well as the kind of
anesthesia required.At
this time, he will also ask about
your medical history, and inspect
your breasts. Dr. Kremer / Dr. Zettl
will also measure your
breasts, take photographs, and
possibly require a mammogram (breast
x-ray).
Take
this opportunity to ask all the
questions you have about the
surgery. Learning everything you can
about your options, risks and
benefits is the key to making an
informed decision.
Asymmetrical
breasts can be made more even either
by augmentation of the smaller
breast, or by reduction of the
larger one. Both breasts, of course,
can also be changed in the same way
but to a different extent in order
to match them:
Augmentation:
In this procedure, Dr. Kremer / Dr. Zettl
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. He 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.
Reduction:
In this procedure, incisions are
made on the breast itself. The
excess breast gland and fat tissue
is removed, and then the incision is
closed, creating a breast contour
closer in size and shape to the
other one. Depending on the
individual situation and the amount
of necessary lifting and tissue to
be removed, a doughnut-shaped area
of skin may be removed just around
the nipple or you will require a
vertical or an inverted T-scar.
Maybe. The location chosen for the
surgery depends on the procedure
performed and the extent of the work
being performed. Most breast
augmentation and reduction surgeries
are performed in an outpatient
surgicenter as an outpatient
procedure. In this case, you’ll be
able to return home within a few
hours of the surgery. However, if
large amounts of tissue are removed
during a reduction procedure, Dr. Kremer / Dr. Zettl
may want you to stay overnight in
the hospital where medical personnel
can monitor your initial recovery.
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 Dr. Kremer / Dr. Zettl. You’ll need
someone to drive you home, and you
may need assistance at home over the
next couple of days.
Dr. Kremer / Dr. Zettl
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 breasts 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 Dr. Kremer / Dr. Zettl.
Someone will need to drive you home,
and you may need assistance at home
over the next couple of days.
You
will receive instructions about
changing the gauze and keeping the
incisions clean, positions for sleep
and rest, raising your arms,
breathing exercises and breast
massage.
Whether
you choose augmentation or
reduction, you should:
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. 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.
What
is the long-term outcome like for
most people?
Correction to breast asymmetry can
help clothes to fit better as well
as improve the overall silhouette by
balancing the breast contours.
Remember, though, that as with
breasts in general, the pull of
gravity will affect a surgically
corrected breast over time. However,
since the breasts are now more equal
in size and weight, they may undergo
such changes more evenly.
In
general, the best candidates for
asymmetrical breast correction are:
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 Dr. Kremer / Dr. Zettl
will
consider in determining whether or
not breast augmentation or reduction
is appropriate for you.
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.
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 risks
involved with breast augmentation
have received a lot of attention,
but neither breast cancer nor
arthritis have been shown to be
caused by breast implants. All
operations carry some risk and the
possibility of complications can
include (but are not limited to)
infection, excessive bleeding,
adverse reaction to anesthesia, and
the need for second or sometimes
third procedures.
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: occurs when the
scar or area around the implant
begins to tighten, causing the
breast to feel hard. This occurs
more frequently in silicone-gel
filled implants than in
saline-filled ones.
nipple
sensitivity or loss in
sensitivity: usually disappears
after several weeks, but for
some this is permanent.
rippling:
dependent on thickness of skin,
type and size of implant.
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.
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 Dr. Kremer / Dr. Zettl’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.
Tell
Dr. Kremer / Dr. Zettl about any allergies
you have (to foods, drugs,
environmental elements)
Tell
Dr. Kremer / Dr. Zettl if you have a history
of bad scarring, such as keloids.
Tell
Dr. Kremer / Dr. Zettl about all
medications, herbal supplements
or natural supplements you are
taking (both prescription and
non-prescription)
Carefully
follow any instructions Dr. Kremer / Dr. Zettl
gives you regarding
eating and drinking and smoking.
Avoid
aspirin and aspirin-containing
medicines for
two weeks prior to surgery.
Arrange
for someone to drive you home
after surgery or after discharge
from the day surgery center or
the hospital.
Please
inform Dr. Kremer / Dr. Zettl immediately in
case you should experience fever
or symptoms of an infection
after surgery.
Try
to schedule surgery at a time
other than your menstrual
period.
The
information on this web site is only
intended 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
personal options is to schedule a
personal consultation with Dr. Kremer / Dr. Zettl. He will be able to answer
specific questions related to your
situation.
