Asymmetry and malformations

What this covers

This is often a consultation for unsightly, asymmetrical or small breasts; the adolescent girl is often concerned.

This chapter groups together severe juvenile hypotrophy, simple breast asymmetry, tuberous breasts — often unrecognised by doctors — and Poland syndrome, which is increasingly rare.

Severe breast hypotrophy or agenesis is treated by augmentation mammoplasty, implants being the treatment of choice.

Volume asymmetry

It is treated by reduction and reshaping mammoplasty on the larger side, or by augmentation mammoplasty on the smaller side.

Every combination of treatment is possible. The treatment to be carried out on each breast takes into account, case by case, the anomalies present.

Tuberous breasts

Tuberous breasts, or tubular breasts, involve a developmental defect of the mammary gland linked to internal fibrosis that prevents its growth and spread.

The result is a constricted appearance, with a narrow base and a suspended breast whose inframammary fold sits high and is subject to a constriction, or ring, that is often difficult to treat. The areola is deformed, often very wide and bulging with a herniation of the gland. The defect may be one-sided or two-sided, hence an asymmetry of the breasts.

The classic treatment

The small tuberous breast is treated through a periareolar scar: the gland is shaped and spread out using glandular flap or bipartition techniques. An implant is often placed for additional volume and for the sake of symmetry. The fibrous ring is broken and the inframammary fold lowered. The areolar scar makes it possible to reduce the diameter of the areola and to treat the protrusion of the gland, or even the sagging.

The contribution of fat transfer

Today, the use of fat transfer has revolutionised this surgery: fat can be used for volume and to shape the breast naturally — all the more so as the opposite breast often does not require an implant, or requires a different volume, which is then ideally done with fat.

Deformities of the fold and of the lower, constricted part of the breast are treated by percutaneous needle techniques, or fasciotomies. They constitute a true release of fibrosis and an immediate expansion of the skin, helped by the fat, whose softening, shaping and reconstructive properties are well known.

Poland syndrome

Increasingly rare, it involves, on one side, hypotrophy of the gland, a very small dystopic areola placed high and towards the outside, and agenesis of the lower part of the pectoral muscle, which creates a visible notch towards the armpit.

Treatment combines fat transfer and implants.