Breast Asymmetry: Causes and Diagnosis

Are asymmetric breasts a sign of cancer?

Annual or biennial mammograms are essential to a woman’s breast health because they detect early signs of cancer or abnormalities. A common abnormality seen on mammogram results is breast asymmetry.

Breast asymmetry is usually no cause for concern. However, if there’s a large variation in asymmetry or if your breast density suddenly changes, this could be an indication of cancer.

Breast asymmetry occurs when one breast has a different size, volume, position, or form from the other.

Breast asymmetry is very common and affects more than half of all women. There are a number of reasons why a woman’s breasts can change in size or volume, including trauma, puberty, and hormonal changes.

Your breast tissue can change when you’re ovulating, and can often feel more full and sensitive. It’s common for the breasts to look bigger because they actually grow from water retention and blood flow. However, during your menstrual cycle, they’ll return to normal size.

Another cause for asymmetrical breasts is a condition called juvenile hypertrophy of the breast. Though rare, this can cause one breast to grow significantly larger than the other. It can be corrected with surgery, but it may lead to a number of psychological issues and insecurities.

It’s common for two breasts to be different sizes, but they’re usually similar in density and structure. Doctors use mammograms, a type of breast exam, to evaluate the internal structure of the breast.

If your mammogram shows you have asymmetrically dense breasts, the difference in density could be classified into one of four categories if a mass is found:

1. Asymmetry. Your breasts are only evaluated using one projection. These images aren’t reliable because they are one-dimensional. Overlapping dense structures in the breast could be difficult to see. If your doctor finds a lesion or abnormality, they’ll call for another three-dimensional imaging test.
2. Global asymmetry. This finding shows there’s more volume or density in one breast than the other. Global asymmetry findings are normally the result of hormonal changes and normal variation. If a mass is found, your doctor will request additional imaging.
3. Focal asymmetry. These images show a density on two mammographic views, but your doctor can’t fully tell if it’s a true mass. They’ll request further imaging and evaluation to rule out cancerous or abnormal masses.
4. Developing asymmetry. This asymmetry type indicates a significant change between past and current exams. The density may be new, or could have increased. These findings are enough to raise suspicion of potentially malignant cells.

If your mammogram indicates asymmetry, your doctor will need additional images to determine if the change in shape or density is normal.

The first step is to compare past mammogram images for changes in shape or density. If you’ve never had asymmetric breasts or if your asymmetry has increased over time, your doctor will request extra tests.

Breast ultrasound

Your doctor may request a breast ultrasound. This method helps to diagnose abnormal findings from obscure mammogram images. A breast ultrasound uses sound waves that produce pictures of your breasts’ internal structure.

The breast ultrasound images can help determine if the mass is benign, a fluid-filled cyst, or if it’s potentially a cancerous tumor. In some cases, a mass can be both solid and fluid-filled.

Breast MRI

Magnetic resonance imaging (MRI) of the breast is a test used to help detect breast cancer or other abnormalities. While in some cases this test is used after a biopsy has confirmed cancer, breast MRIs can be used alongside mammograms to screen for breast cancer.

This is specifically helpful for women with a high risk of breast cancer from family history or heredity.

Biopsy

If your imaging test results come back abnormal, or if your doctor suspects the abnormality is cancerous, the next step is to have a biopsy. During this procedure, a portion of your affected breast tissue is removed for further testing and to check for cancer.

If the biopsy comes back negative, doctors recommend regular breast exams to monitor any change. If the biopsy comes back positive, your doctor will talk with you about treatment options.

Breast asymmetry is a common characteristic for women, and is often no cause for concern. However, if the size of your breasts change or the density variation becomes larger over time, these changes could indicate something is wrong.

Research is still being conducted on the relationship between asymmetric breasts and cancer risk. Some studies have shown women with breast cancer had a greater breast asymmetry, combined with other risk factors such as heredity and age, than women who were healthy. Further research is still needed.

If you have a predisposition to cancer from family history or if you notice irregular changes in your breasts, you should discuss your concerns and options with your doctor.

Kids Health Information : Unequal breast size

It is quite common for one breast to be bigger than the other as development occurs during puberty. Usually the breasts become the same size over time and do not need any treatment. However, if the breasts have not become more or less an equal size by the age of about 16 years old (or near
the end of puberty), they will probably remain unequal. About one in four adult women have some degree of asymmetry of the breasts.

In some adolescents the problem is that one breast is overdeveloped, whereas in others the smaller breast is underdeveloped.

When to see a doctor

There is no need to see a doctor for unequal breast size during puberty (when the breasts are still developing). However, you may wish to see a GP for advice if the breasts are of unequal size at the end of puberty. You may be referred to an endocrinologist (doctor specialising in
conditions related to hormones).

Treatment for unequal breast size

There is no medical need for treatment for uneven breast size.

The difference in breast size is usually caused by the fat layers, not the ducts that produce milk. Therefore, a mother with unequal breast size should be able to breastfeed as usual from both breasts. The amounts of milk produced should be the same from each breast. 

Because the difference in breast size is usually due to the fat layers, uneven breast size has no effect on the risk of breast cancer. If you have any concerns, you should discuss this with your doctor.

There are three treatment options for uneven breast sizes that can improve the cosmetic appearance of the breasts:

External breast prosthesis

An external breast prothesis is worn with a special bra. The prothesis has a hollow on the inside where the smaller breast fits comfortably. They are filled with a skin-coloured gel and feel just like a breast. The prosthesis can be matched to the size and shape of the
other breast. 

The prosthesis can be held in place with tape that can be left on the skin for several days at a time. Some breast prostheses can be inserted into special pockets in swimsuits or active wear.

There is no health risk associated with the breast prosthesis as it is worn outside the body. 

Breast reduction

Surgery to reduce breast size is done as an operation under general anaesthetic (where you are put to sleep) by a plastic surgeon.

Breast reduction can affect milk production if breast tissue is removed. Nipple placement is also important to ensure future breast feeding goes well. Discuss all risks and benefits carefully with a plastic surgeon.

Breast implant

Breast implants are done as an operation under general anaesthetic by a plastic surgeon. Implants are now filled with saline (salt water), which is considered harmless to the body. Silicone implants are no longer used because of fears that small amounts of silicone
could leak and damage the immune system. Breast enhancement should not cause any problems with breast feeding. Discuss all risks and benefits carefully with a plastic surgeon.

Key points to remember

• It is quite common for breast size to be unequal during puberty. If they are different sizes near the end of puberty, they are likely to stay unequal. 
• There is no medical need for treatment for unequal breast size. Unequal breasts won’t affect breastfeeding or increase breast cancer risk.
• An external breast prothesis looks and feels realistic and has no associated health risks.
• A breast reduction or breast implant are plastic surgery options that can improve cosmetic appearance. 

For more information

• See your GP, paediatrician  or endocrinologist.
• Talk to a plastic surgeon to discuss treatment options.

Common questions our doctors are asked

Which is the safest option: breast reduction or breast
implant?

This is something that should be discussed at length with
your plastic surgeon. It will depend on the shape and size of each breast, as
well as your desired outcome.

I have read that unequal breast size is linked with
increased risk breast cancer. Is this true?

This is not true. The asymmetry is usually caused by
differences in the fat layers, not the breast tissue. It is important to
perform regular self-checks for breast changes, as part of a healthy lifestyle.
You can discuss and learn these self-checks with your GP or paediatrician.

My baby has developed breast tissue, which is uneven, what
should I do?

There are many hormone changes that occur to
young babies, especially those who are breastfed. May babies will develop small
amounts of breast tissue, and some may even start to make breastmilk! If this
is happening with your baby, there is often no cause for concern, but have them
seen by your GP or paediatrician.

Developed by The Royal Children’s Hospital Endocrinology and Plastic and Maxillofacial Surgery departments. We acknowledge the input of RCH consumers and carers.

Reviewed June 2018.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit

www.rchfoundation.org.au.

Breasts of different sizes (breast asymmetry): how to fix it, what to do?

Asymmetrical breasts of different sizes are one of the most common phenomena. According to statistics, 90% of girls have a difference between the right and left mammary gland, and in 45% the size of the bust differs by half a standard cup. Another question is how to deal with it? Someone notices this difference and complexes, while others perceive it as a common occurrence and do not pay attention.

So what should you do if your breasts are of different sizes? Let’s figure it out.

Why do breasts come in different sizes?

Real asymmetry, when the breasts are of different sizes and differ from each other by one cup. The reasons can be very diverse. They can be divided into 2 groups.

Congenital causes :

• hypoplasia (developmental delay) of glandular tissue
• Poland’s syndrome is a congenital disease characterized by atrophy of the pectoralis major muscle
• hormonal problems during puberty
• micromastia – one breast is significantly reduced in size compared to the other
• problems with the endocrine system
• Prolonged malposition of the body which results in poor posture
• hereditary predisposition
• special feature

Usually congenital breast asymmetry is noticeable in girls aged 9-10 years. During this period, the ovaries already produce the hormones estrogen and progesterone, which are responsible for the development of glandular tissue. The bust can become disproportionate if hormones are in short supply or excess. If there is disproportion, then you need to contact an endocrinologist or mammologist. Usually this problem is leveled by 18-19years. If it persists at an older age, then it can only be corrected by a plastic surgeon.

Acquired causes :

• Breastfeeding. In this case, breast asymmetry is the so-called post-lactational involution of the mammary gland, which manifests itself, among other things, in disproportion. It depends on hormonal changes, and not on the duration of lactation, as many young mothers think. However, asymmetry can indeed develop if the baby is fed only on one side.
• Mastopathy (fibroadenomatosis). Benign breast tumor. A characteristic sign of mastopathy is palpable seals in the chest. The main reason is hormonal imbalance. Often, all types of mastopathy lead to the appearance of visible asymmetry.
• Neoplasms. After their removal, the breast requires restoration.
• Sagging and drooping of the breast. With age, the mammary gland loses elasticity, volume, and the muscles become less elastic. Because of this, the bust loses its former attractiveness and symmetry. Often this happens when a woman crosses the threshold of menopause.
• Injuries of the chest. At risk are athletes who play basketball, volleyball and other sports where there is a possibility of physical injury.

Classification of breast asymmetry

It is important to understand: there is no absolute symmetry – people are asymmetrical. We have different right and left parts of the face, legs, arms and, of course, the chest. This is absolutely normal. Pathological fixation on symmetry often turns into complexes and self-doubt.

You can talk about asymmetry when it is visible to the naked eye. Differ:

• bust shape and volume
• position and outline of the nipple and areola.

Doctors distinguish 3 degrees of breast asymmetry:

• mild. Breasts practically do not differ from each other. They come in one bra size;
• medium. The difference between the mammary glands reaches 0.5 size. Visually, this is noticeable, but usually does not interfere with everyday life;
• heavy. One breast can be 1.5-2 times larger than the other. In this case, there are problems with the selection of underwear and clothing.

Note that there is no exact way to measure the asymmetry, so in this matter you should rely only on the experience of the selected specialist.

Prevention of breast asymmetry

Is it possible to prevent breast disproportion? Yes, if we are talking about acquired asymmetry. Here are some examples:

• When breastfeeding, apply the baby alternately to both breasts. Avoid “preferring” one breast. If the baby loves one breast more, then be sure to pump the second;
• wear a corrective bra to prevent sagging breasts after lactation;
• do a contrast shower to improve blood circulation;
• physical exercises will strengthen your posture and pectoral muscles.

What if the breasts are of different sizes?

It is necessary to start with an objective analysis and answer the questions: how asymmetrical is the breast and does it affect the aesthetic appearance?

If there is a slight difference in the size of the bust, it can be corrected with underwear. It is also worth trying conservative methods – correcting posture, physical exercises to strengthen the pectoral muscles.

If the asymmetry is pronounced and causes discomfort to the girl, then it is worth contacting a plastic surgeon for surgical correction.

Can I fix the defect myself?

There are no general recommendations and universal methods for eliminating asymmetry. Everything is individual and depends on the degree of disproportion. The main methods of correction at home:

• correctly selected underwear
• drug therapy (only on the recommendation of the attending physician)

Surgical methods for correcting breasts of different shapes

Surgical correction methods differ depending on the degree of asymmetry. In such cases, the plastic surgeon offers a lift, breast augmentation or reduction.

• Breast augmentation. The most popular plastic surgery, which solves not only asymmetry issues, but also gives ideal forms. It is carried out using silicone implants. The size and volume are selected individually at the consultation. The following are taken into account: the height and weight of the patient, the initial state of the mammary gland. A plastic surgeon can install identical implants if the asymmetry is slight. With a significant difference in breast size, implants of different sizes are installed. Breast augmentation surgery lasts about 1 hour. No longer a consultation, the patient sees the result of the upcoming operation thanks to the fitting of sizers and 3D modeling.

How breast augmentation works – all stages

• Mastopexy (breast lift). Asymmetry, which is caused by significant sagging of the breast, is eliminated by removing and tightening excess skin and glandular tissue. The bust is not only tightened, but a new symmetrical shape is also created. If the difference between the mammary glands is insignificant, then a breast lift is performed using a periareolar approach around the areola. Please note: in this case, the scar is located on the border of dark and light skin, and is as invisible as possible, and there are no additional scars on the chest. With severe ptosis, either vertical mastopexy is performed (the scar runs from the areola to the inframammary fold) or anchor (the scar is located along the areola, vertically to the inframammary fold and along the line of this fold).

• Reduction mammoplasty (breast reduction). With a significant difference between the mammary glands, a breast reduction can be performed.
• Lipofilling. Correction of the mammary glands with the help of transplantation of own adipose tissue. Own fat is taken from the so-called “depot” zones – the stomach, hips, back flanks and injected into the problem area. Lipofilling allows you to increase one of the breasts to the desired size.

The technique is always determined individually at the consultation. During an individual meeting, the plastic surgeon will select the best technique for you, which will allow you to achieve the perfect breast shape.

Publication date: 12/13/2021 Author: Rabotenko Svetlana Anatolyevna

Breasts of different sizes | Different sizes of breasts in a girl

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• When does breast asymmetry become a problem?
• Why can breasts be of different sizes?
• What if the breasts are of different sizes?
• Surgical methods for correcting breasts of various shapes
• Postoperative period
• Result

Asymmetrical breasts of different sizes are common, but in some women the degree of asymmetry is so great and noticeable that it causes psychological discomfort and dissatisfaction with their appearance. Why do women have breasts of different sizes and what are the best ways to solve the problem?

When does breast asymmetry become a problem?

They say about asymmetry, if one breast is much larger than the other, differs in shape, areola diameter, nipple location.

There are three degrees of asymmetry:

• mild — the differences are insignificant and do not bring disharmony into the appearance of a woman;
• medium – the difference between the sizes of the breasts is up to 30%;
• heavy – one breast is 50% larger than the other.

Why can breasts be of different sizes?

Congenital causes include hypoplasia (developmental delay) of glandular tissue, hormonal problems during puberty. Girls at 9-10 years old, the ovaries begin to produce the hormones estrogen and progesterone, which are responsible for the development of glandular tissue, alveoli, and milk ducts. With their deficiency or excess, the bust may develop disproportionately. The exact reason why the breasts are different will be determined by a mammologist, an endocrinologist. If by the age of 18-19 the treatment was carried out and significant asymmetry remained, you can contact a plastic surgeon.

Acquired causes include the following:

• Lactation . Most often, the breasts become of different sizes during feeding, when, due to a nipple injury or carelessness, a woman gives the child predominantly one breast.
• Mastopathy . Hormonal disruptions in women after 30 years of age lead to the growth of breast tissue – diffuse or nodular mastopathy, affecting the volume of the bust.
• Neoplasms . After surgery to remove a benign and malignant tumor, the breast loses volume and needs to be restored.
• Bust lowering . With age, the pectoral muscles become less elastic, the glandular tissue loses volume. The process can occur unevenly in both breasts.

What if the breasts are of different sizes?

In some cases, asymmetry is easier to prevent in advance. When breastfeeding, following the rules of feeding and personal hygiene will help to avoid the problem of breasts of different sizes. The child must be applied to both mammary glands. If he prefers one, the second must be expressed. You should regularly massage the bust.

With a mild degree of asymmetry, the following are effective:

• physical exercises;
• wearing a corrective bra;
• massage (vacuum) procedures;
• cosmetic preparations for improving blood circulation.

If the asymmetry is significant, such remedies will not help. In this case, it is necessary to visit a mammologist and, in the absence of contraindications, consult a plastic surgeon. He will select the most effective method of surgical correction.

Surgical methods for correcting breasts of various shapes

Breast plastic surgery (mammoplasty) is carried out a year after the end of lactation, successful treatment of mastopathy, tumors. The surgeon may refuse to operate:

• in case of blood clotting disorders;
• serious cardiovascular diseases;
• endocrine pathologies;
• infectious, inflammatory processes in the body.

Several types of plastics are used to eliminate asymmetry.

• Augmentation mammoplasty. It involves an increase in one of the breasts with the help of an endoprosthesis made of safe silicone. To achieve a harmonious look, the doctor may suggest correcting both breasts. The surgeon will recommend the optimal shape, size, profile of the implant and determine the place of its installation: under the pectoral muscle, mammary gland or combined. The operation lasts 1-1.5 hours. The silicone insert is placed in the selected area through the armpit, the crease under the breast or the edge of the areola.
• Mastopexy (breast lift). The defect is eliminated by tightening the glandular tissues and skin. With a slight asymmetry, the doctor will perform a correction along the contour of the areola (periareolar mastopexy). With serious changes, the shape and size of the bust is corrected under the areola and in the inframammary fold (vertical and T-shaped mastopexy). The lift lasts 1.5-3 hours.
• Lipofilling. The operation allows you to increase one of the breasts to the desired size with the help of the patient’s own adipose tissue. To do this, adipose tissue is taken in the problem area (buttocks, abdomen, thighs), cleaned and prepared using modern equipment. Then gently injected into the corrected area of ​​the bust. Lipofilling time is 1.5–2 hours.

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Postoperative period

As with any surgery, there will be some swelling for a week. To eliminate discomfort, the doctor will select high-quality, safe painkillers. On day 7-8, the surgeon will remove the stitches. Within a month, the bust is supported by a compression bra. You need to give up hot baths, swimming pools, solariums, saunas and any physical activity.

Result

Preliminary assessment of the result is possible immediately after the operation. There will be no noticeable scars after it. The seams will gradually turn pale, visually hidden in the folds of the skin or merge with the contour of the areola. The bust will acquire an attractive and symmetrical shape, a harmonious and taut look. Six months later, you can enjoy a full life with new beautiful breasts.

Correction with implants does not require lifestyle changes. Restrictions apply only to jumping from a height. A year after the operation, you can carry and breastfeed a child.

After lipofilling, own tissues take root perfectly, but after a few years, their gradual resorption is possible, and the procedure will need to be repeated.

For many women, different breast size after feeding or due to age-related changes in the body becomes a real problem that causes psychological discord.