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Khan Volume difference management in asymmetrical breasts

implants were used with similar breast tissue reduction of this residual asymmetry. In the author’s opinion and
or where two different weight tissue reductions were practice, careful examination and measurements are
performed with same size implants. In author’s opinion the most time efficient, cost effective and reproducible
3D photography is a more scientific and accurate method. In this series of 278, only one patient was
tool to evaluate the difference as it measures the unhappy with the postoperative results requiring
difference of chest wall asymmetry as well as breast revision surgery for implant volume difference
volume asymmetry. Use of 3D photography has shown readjustment. High profile implants of different
an incidence of 100% asymmetries and comprised of sizes are the choice for patients requiring volume
soft tissue, chest wall and combined soft tissue and adjustment alone. Those patients who present with
chest wall asymmetries. The breakdown of volumetric asymmetry of skin excess, breast volume and ptosis
differences was also reported in the study. The article requiring one stage mastopexy and augmentation,
noted a difference of 0-10 mL in 2.2%, 11-25 mL in moderate profile implants is the choice of author.
21.9%, 26-50 mL in 28.9%, 51-100 mL in 29.3% and Combination of different profiles implants is seldom
> 101 mL in 17.7% of the females. However revision required and limited to patient who present with
rate for the size or shape of the implants was not hemithoracic disjunction or noticeable anteroposterior
reported in the study neither the relative distribution chest dimension asymmetry with or without breast
of larger size breast, chest or combined asymmetries volume asymmetry. [4,14]
of the two. In a previously published author’s article,
[5]
a retrospective analysis of the volume differences in In conclusion, breast and chest asymmetries are very
146 augmentations mammoplasties showed twice as common. The left breast or chest or both are likely
many patients needing larger implants on the right side to be larger than the right chest, breast or both. Not
to compensate larger breast on the left. Less mean all patients request or require different size implants.
volume was needed on the right side to compensate When different volume implants are used, the vast
left larger breasts than the mean volume used on majority the patients do not require a volume difference
the left side to offset larger breast on the right. In the of more than 60 mL. When the breast is larger on the
same study 0-30 mL volume difference was needed right then larger mean volumes are used on left side to
in 35.6%, 31-60 mL difference was used in 48.6%, offset the larger right breast.
60-90 mL difference was used in 7.5% and > 90 mL
difference was used in 8.2% of the patients. There was Authors’ contributions
only one patient who required revision surgery for size U.D. Khan contributed solely to this paper.
change on one side. [14] Sample included patients who
had augmentation mammoplasties alone, all patients Financial support and sponsorship
were operated by the same surgeon using muscle Author has no financial interests in any of the products
splitting technique for implant pocket. In current study, or devices used in this retrospective study.
asymmetries of breasts requiring augmentation and
mastopexy were added to augmentation mammoplasty Conflicts of interest
group. It was again noted that when asymmetries
are present, left breast was larger in majority of the Author declares no potential conflict of interest with
patients. In subgroup A1 with larger left breasts, 87.6% respect to the research, authorship and publication of
needed implants with a difference of less than 60 mL the article.
as compared to 61.1% in subgroup A2 with larger right
breasts. Similarly, when a volume greater than 60 mL Patient consent
was needed to compensate for size difference, it was All patients signed an informed consent form.
mostly needed on left side for the right larger breasts
[Table 7]. [14] Ethics approval
This is a retrospective data analysis of procedures
There are many approaches to assess and manage performed in a private centre therefore international
breast and chest asymmetries. The options include review board approval was not required. All procedures
preoperative planning using 3D photography or simple were performed in accordance with the ethical
examination and measurements of breasts. Intra standards of the 1964 Declaration of Helsinki.
operative management includes use of sizers and
adjustable implants. Despite of the various measures REFERENCES
taken to achieve symmetry in breast asymmetries, it is
not guaranteed that a perfect result can be achieved 1. Penn J. Breast reduction. Br J Plast Surg 1955;7:357-71.
in all cases. Some degree or level of differences are 2. Smith DJ Jr, Palin WE Jr, Katch VL, Bennett JE. Breast volume and
likely to persist and that a patients should be warned anthropomorphic measurements: normal values. Plast Reconstr Surg
114 Plastic and Aesthetic Research ¦ Volume 4 ¦ July 19, 2017