A difference in each side of our bodies is normal and there is always some unevenness of the breasts. Dissatisfaction can occur when the extent of the differences is enough to cause self-consciousness or impact choices of clothing or social activities. In previous articles I’ve reviewed some of the causes of breast asymmetry that occur during adolescent development or other natural causes. Here we’ll review some of the more common external causes of breast asymmetry including disease, surgery and trauma.
Overall, disease of the breast is the most common external cause for breast asymmetry. Infection from a variety of causes may lead to abscesses that often require open drainage. The infective process, the resulting destruction of breast tissue and the scarring process that develops during the healing phase can lead to distortion of the breast tissue. Surface changes including indentations, distortion and scars can lead to unacceptable cosmetic results and asymmetry of the breasts.
Treatment for tumors of the breast, especially when large or malignant, often requires removal of a significant portion of the breast. This may lead to noticeable volume asymmetries and distortion of the shape of the breast. Commonly, the breast may be treated with radiation as a part of the treatment for malignant tumors. The radiation also can cause distortion of the breast with shrinkage of tissue often with shape changes, and an increased firmness to actual hardness of the breast tissue.
Breast asymmetry may occasionally develop after cosmetic procedures such as breast augmentation and/or breast lifts. Breast implants sometimes develop capsular contracture. This is the formation of scar tissue about the implant that is noticeable. In all cases, the body creates a thin layer of scar tissue around the implant. In some cases, this layer of scar tissue can thicken and tighten about the implant causing a hard firm appearance to the breast or distorting the position of the implant. Breast implants that are too heavy for the strength of the tissues supporting the implants can lead to excessive descent of the implants. The skin and other breast tissues become stretched, the implants settle into a low position and the overall appearance can be both asymmetrical and unsatisfactory.
A relatively uncommon external cause of breast asymmetry is breast trauma. In cases of a severe impact to the breast there may be damage to fat cells of the breast. If the damage is enough to disrupt the blood supply and/or crush the fatty tissue, the fat cells may die in that area. During the healing process that follows there can be shrinkage of the damaged tissue and it may be replaced by scar tissue. Either of these can cause irregularities in the surface of the breast, distort the shape and alter the size.
The last couple of articles have reviewed both developmental and external causes of breast asymmetry. In subsequent articles we will discuss treatment options to improve symmetry and breast form.