BREAST DEFORMITIES

Breast deformities can be developmental or post surgical. They can be associated with size differences, shape differences or scarring related to implants or previous surgeries. They represent some of the surgeons most challenging cases but some of the most rewarding to repair. Developmental Deformities may present as birth defects such as Poland's syndrome where there is absent or poor development of the chest muscles which is then associated with poor or absent development of the breast in the female. They can present during puberty as asymmetric breast development with one breast being much larger then the other or associated with strange shapes of the breast. These have frequently been called tubular breasts because they look like a cucumber or tuberous breasts because they may look like a potato. More recently surgeons have grouped all of these types into one category and call them Constricted Breasts. Perhaps the most frequent deformities seen, however, are from previous operations. Capsular contracture and/or improper placement of implants contributing to the greatest number of patients requiring re-operation. These patients have usually had several previous procedures and are very difficult to correct.

Breast Asymmetry

In general, most women have some degree of asymmetry (difference) between their two breasts. This difference can be seen as a difference in, shape, size or nipple height on the breast itself. In some women the inframammary creases may also be at different heights with one breast lower than the other. For patients with scoliosis there may be a difference in their chest wall causing one breast to protrude outward more than the other. Usually, the average breast differences are so minimal as to cause little or no concern for the patient pre operatively. Even if there are subtle breast asymmetries, Dr. Corbin likes to inform the patient prior to breast surgery. Sometimes a small difference in breast shape or size is magnified once the breasts are made larger.

In more obvious cases the difference between two breasts can be quite substantial, causing both physical imbalance and emotional distress for the patient.

In cases of breast asymmetry, each woman's situation is unique. The goal of corrective breast surgery is to create two breasts that match each other as closely as possible in both size and shape. This may be best achieved with corrective breast surgery on one breast or both breasts. Corrective breast surgery may include augmenting one breast and lifting or reducing the other breast. Dr. Corbin custom tailors the surgery to each individual patients needs.

Usually, following corrective breast surgery, women have a greater sense of physical balance, more self confidence, a better body image, and greater self esteem. Physical harmony can often create emotional harmony.

Types of Breast Asymmetries

• One breast is noticeably larger than the other.
• One or both breasts are different shapes.
• One or both breasts may have nipples that are at different heights, with one side higher or lower than the other.
• On one or both breasts the nipple is at or below the level of the breast fold. Sometimes most of the breast tissue is sagging low on the breast or at the bottom of the breast.
• One or both breasts may not have much breast tissue up top and there is a need for more upper breast fullness.
• One or both breasts may have large or misshapen nipple areolars that are not in proportion to the rest of the breast.

In cases of breast asymmetry, each woman's situation is unique and there are many differences that can occur with breast shapes and sizes.

In some of the more severe breast asymmetry patients no guarantee can be given that the breasts will ever be perfect or identical. However the ultimate surgical goal is to get both breasts as even in shape and size as surgically possible. Usually, following corrective breast surgery, women have a greater sense of physical balance, more self confidence, a better body image, and greater self esteem.

Breast double-bubble

There are a couple different breast shape abnormalities in which the description double- bubble can be applied.

The first type of the breast "double-bubble" deformity is an obvious deformity of shape in which the round part of the breast with the implant sits at the normal level for a breast, but the natural breast tissue and nipple have sagged downward. This double bubble look can occur immediately following surgery or over time because of pregnancy, weight loss or gravity.

The second double-bubble breast deformity is sometimes seen after submuscular breast implant surgery, however it can be also be seen in both sub-muscular and over the muscle breast augmentation. This look of a double bubble can be caused because the patients natural crease is very sharp, indented or constricted, and produces an obvious groove between the nipple and the new post surgical crease is lower causing a bulge below. In some cases, this condition gradually clears up if the breast tissue at the breast crease stretch out , however if it does not, a breast revision surgery may be needed to suture the skin and breast tissue down and correct the double bubble look.
Generally there are four indications for the breast double bubble to be present.

1. The breast pocket or breast tissue is not sutured down.
2. The breast implants are sub-muscular and the breast tissue has slid off the breast implant.
3. There may be capsular contracture of the breast distorting the breast shape.
4. The breast implants are submammary and the breast itself has drooped downward.

Usually, surgical correction of this type of double-bubble look requires a breast lift (mastopexy) or pocket revision.