The psychosocial benefits of plastic surgery for young women with congenital breast asymmetry

Nearly all women have breasts that are slightly different from each other. However, some women have more marked differences in the size, shape, or position of the breasts even after development is complete—leading to negative effects on emotional well-being and self-image.

For young women with such severe breast asymmetry, surgery to create a more even appearance of the breasts has significant benefits in terms of self-esteem, quality of life and mental health, according to a new study by Brian I. Labow, MD, FACS, FAAP, and colleagues of Boston Children's Hospital.

"Surgical treatment of breast asymmetry in young women yields significant and sustained improvements in psychosocial quality of life," the researchers write. Their study—one of the first to analyze the benefits of surgery for benign breast asymmetry—appears in the October issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Dr. Labow and colleagues report on their experience with surgery to correct breast asymmetry in 45 young women, average age 18 years, between 2008 and 2018. All of the women had severe asymmetry, averaging two cup sizes difference between breasts. In all cases, the breast asymmetry was "benign"—not due to cancer.

Almost 70 percent of the women had "hypoplastic" breast asymmetry, with underdevelopment of one or both breasts; the rest had macromastia (excessively large breasts) on one side. Some patients were diagnosed with conditions such as tuberous breast deformity (breasts with a narrow base), while others had no formal diagnosis for their breast asymmetry.

For 28 patients, surgery consisted of breast augmentation on one or both sides. Fourteen patients underwent breast reduction on one side, sometimes with other procedures on the opposite breast. The remaining three patients underwent a combination or these or other procedures.

Before surgery, the women had significant reductions in self-esteem and in various aspects of quality of life compared to their peers—particularly social functioning (limitations in social activities due to physical or emotional problems) and emotional roles (limitations in usual activities due to emotional problems).

At follow-up 3.5 years later after surgery, the women had significant improvements in self-esteem, social functioning, and emotional roles, as well as in overall mental health. "Postoperatively, patients returned to a level of functioning commensurate with their peers," Dr. Labow and coauthors write.

Minor differences between breasts are common, especially during the early stages of breast development. All too often, breast asymmetry in adolescents and young women is dismissed as "simply a cosmetic concern." The researchers note that surgery isn't the only answer: some patients are reassured by hearing that breast asymmetry is common. In others, breast prostheses can help to camouflage the asymmetry and improve social functioning.

Dr. Labow and colleagues hope their experience will help to make plastic surgeons more aware of the positive outcomes of surgical correction in women who are bothered by severe breast asymmetry. The authors conclude: "Providers should be aware of the potential positive impact that surgical treatment can provide developmentally and psychologically mature young women with symptomatic asymmetry and consider surgery when non-surgical options fail."