What is it?
Breast Asymmetry Surgery is a procedure for correcting size and shape differences between the two breasts. The usual indication for this procedure is a woman who has significant differences between her breasts. Such discrepancies of size and shape can sometimes be quite dramatic and may even be noticeable in clothes. Minor differences of the breasts are normal and do not need correction.

What alternatives are there for Breast Asymmetry Surgery?
There are no good alternatives to surgery for matching the two breasts. Breast augmentation, breast lift, breast reduction or a combination of these procedures may be necessary to achieve the desired result. Autogenous tissues (your own body’s fat and skin) used for Breast Asymmetry will leave an unsightly scar and therefore these tissues are not used for this operation.

What does it accomplish?
The purpose of the operation is to enhance the aesthetic appearance of the chest and to improve the symmetry and proportions of the chest as compared to the to the opposite breast. Often this also improves the self-esteem and psychological well being.

What happens during the first consultation?
In the first consultation you will get a chance to discuss your concerns with our patient care coordinators and Dr, Marefat. We will tell you what you need to know about your procedure and will help you determine what is best for you. You will receive information booklets and pricing on the procedures.

How is it done?
The operation is usually done under general anesthesia. This method of anesthesia is in the best interest of the patient in terms of the comfort and the ease with which the procedure is performed. There may be scars around the nipple, under the nipple, or under the breast fold depending on what is being done. The size and shape difference will determine the need for a lifting procedure. These lifting procedures always entail longer incisions. If an implant is to be placed I prefer placing the implant under the muscle because I believe that it not only provides a greater amount of camouflage for the breast implant it also reduces the risk of capsular contracture (hardening of the breast). If a breast lift is performed at the same time as the Breast Asymmetry in breasts that require repositioning of the nipple areola complex. I try to minimize the length of the scar by using short scar techniques. These will reduce the length of the scar but will not eliminate the scar. You have to be able to accept the idea of scars on your breasts if you want to achieve symmetry.
 Procedure: Breast Asymmetry continued

What can I expect after surgery?
You should expect a moderate degree of swelling and discoloration for the first week or two after surgery. The expected postoperative recovery would be approximately one week during which time you should limit your activities and rest as much as possible. The first two or three days are likely to be the most uncomfortable for you with a moderate degree of pain which is easily relieved with oral pain medications. After three to four days you should be able to attend to minor activities around the house and go on short walks. By the fifth or sixth day you should be able to return to work. Majority of patients return to work within a week. Although some patients feel good enough to exercise in the second week most do not resume their normal exercise routine until the third or fourth week. Undoubtedly with the placement of the breast implant there will be some changes in the your lifestyle. These would include the protection of the implant from being injured during strenuous activities and the protection of the breast from injuries sustained during mammography.

What size implants should I choose?
You should choose a size that is becoming to your body and you think is right for you. This will also depend on the size of the opposite breast. Sometimes we may choose to enlarge the breasts and sometimes we may want to reduce the size of the breast. It depends on what the shape and size of the breasts are prior to surgery. If one of breasts is completely normal and has an acceptable size we try to match the opposite breast to it. If on the other hand both breasts can be improved we may want to augment both of them if they are small or reduce both if they are large. Each case is individualized and treated for the specific problems that need to be corrected. These details are best explained to you by a plastic surgeon.

What risks are involved with this operation?
This operation is among the safest operations we perform. However like any surgery there are risk factors associated with operation. I will tell you what I generally discuss with my patients in their second consultation prior to surgery. You should understand that all these complications that I will mention are extremely rare and are not a deterrent to surgery for most people.
A complete list of possible side effects and complications will be provided to you when you schedule your surgery. You should talk to your surgeon for more information on each of these possible risks.
This procedure like breast augmentation may involve use of an implant. With implant breast surgery, the most common complication is the capsular contracture. This term refers to firmness of the breast caused by the shrinking of the scar tissue surrounding the implant. Unfortunately there is no way that one can predict in whom this problem will occur. It may occur in one breast but not the other.

If this problem occurs we may have to perform a corrective procedure. The treatment options for resolving this type of problem include non-treatment if the condition is mild and acceptable to the patient or it is surgical correction. Closed capsulectomy (release of the contracture by external pressure) is no longer done. Open capsulectomy would entail returning to the operating room for releasing the capsule either by making incisions in the scar tissues or by removing the scar tissue completely. This allows the breast implant to sit comfortably in its pocket and stay soft. The risk of developing Capsular contracture is approximately 10 % although higher numbers have been reported in some studies.
The implants themselves have a failure rate. They may leak or rupture. The risk for future implant replacement is approximately one percent per year for each implant.
Sometimes with breast surgery there may be a small degree of trauma to the breast tissues or the fatty tissues in the area and this may result in late calcifications. Occasionally, these calcifications may create some doubt as to the presence of breast cancer and may necessitate a biopsy.
There are risks associated with anesthesia. With modern equipment and techniques available in modern hospitals risks from surgical anesthesia are minimal.
Any surgery will have risks of bleeding or infection but the likelihood of such problems is very little.
There may be scars around your areola (the darker skin around the nipple) and under the areola. Sometimes there may be a scar under the breast fold. Anytime that you have incisions and scar there is the potential for poor healing and obvious scars. This happens very rarely however, and it does improve with time. Sometimes we may need to revise the scar at a later date. I generally do this after nine to twelve months from the time of the initial surgery.
There will be temporary breast and nipple sensory changes that usually resolve in 6-8 weeks. Very rarely there may be permanent loss of nipple sensation. Unfortunately there is no relationship between the type of incision used and the development of this problem
A few patients in the literature have been reported to have chronic pain as a result of Breast Asymmetry.
Most women have minor asymmetries in their breasts and this is completely natural. If there is a major difference between the two sides of the breasts this can be corrected to a certain extent. Major problems of asymmetry cannot be completely corrected and may persist after the operation.
Certain position changes may cause indentations in the breast that reveal the presence of the implant. This has generally been a problem in women who are very muscular and whose muscle contractions can displace the implants in its pocket.
Some patients are disappointed with the results of their surgery. This is sometimes related to the fact that they had unrealistic expectations in terms of the outcome of the operation

Am I at risk for breast cancer with this operation?
There may be a slight increased risk of compromised detection of early breast cancer with having an implant. However, with improved, state of the art, radiological techniques for detection of breast cancer, this is unlikely. Furthermore the saline implant is completely clear in the x-ray making it easier for the radiologist to see all the breast tissue. Patients who have breast implants are more likely to examine themselves and to be examined by a health professional. For this reason, the likely hood of having an undiagnosed tumor is less.

What about risk of Connective tissue disease and arthritis with breast implants?
The rare and unsubstantiated risk of connective tissue disorders such as arthritis relates to silicone implants and you should not worry about this with saline implants.

Will breasts implants affect future pregnancies or breast-feeding?
You should not have any problems with nursing, however there have been few cases in which the patient has not been able to nurse. Certainly this is not a common complication of this operation

When are the sutures removed?
Sutures are generally removed 2 weeks after surgery.

How many visits do I have after surgery?
We like to see our patients frequently after surgery. You are seen by the Doctor or nurse within 2-3 days of surgery. Then the normal postoperative routine is: 1 week, 1month, 3 months, 6months, and 12 months. Of course if there is a need you may be seen more. After a year we encourage our patients to come for routine follow-up visits every 3-5 years.

When can I cover my bruises with makeup?
You should be able to put makeup on the bruises after the first week. However we do not recommend your putting makeup on your incisions until they have completely healed because this may result in tattooing of the skin by the pigments of the makeup.

Will insurances cover costs for future problems with my implants?
Most insurance carriers may not cover you for problems related to the breast implant since it was placed for aesthetic reasons. You should have no problems however, in obtaining coverage for the breast diseases unrelated to the implant surgery. The breast implant manufacturers give lifetime warranty for their products. Some manufacturers will also cover for costs of surgery if the product was found to be defective. You should ask your plastic surgeon for details about coverage.

Should I get a baseline mammogram?
It is a good idea to obtain a baseline mammogram prior to placement of the implant. I recommend this in all patients over 35 years of age.

Am I a good candidate?
The best candidate for this surgery is a woman who have very asymmetrical breasts. Generally the younger you are the better a candidate you are for cosmetic surgery. But the physiologic age of person is more important than the chronological age. That is to say you may be 60 years old, but your skin and general health could be better than most who are 50 years old.

What does the surgery cost?
The cost of surgery varies but here are some guidelines that will help you determine roughly what you could expect. Remember that these are only rough estimates. These estimations include the cost of the operating room and the anesthesia. The fee may be subject to change without notice. The best way for you get an accurate cost analysis is to see a doctor.

Breast Asymmetry Correction: $4000-$7000

How do I pay for surgery?
You can pay for surgery by certified check, Credit card, or cash. Payments for cosmetic surgery are expected prior to the procedure. If you are scheduling several weeks in advance of surgery you can pay by personal check.

Are there scars?
Yes. But these scars usually heal very well and become almost imperceptible after several months. The benefit of having the scar in the fold of the breast is that even if it does not fade completely it is still hidden in an area that is usually not seen.

Does it hurt?
Yes. However, the pain involved in Breast Asymmetry is very tolerable. We have heard our patients describe it as ‘muscle aches and pain’ or just ‘soreness’. I like to inject the area of surgery with a long lasting anesthetic solution that significantly reduces the pain in the first few days after surgery. Many patients do not finish the pain medications prescribed to them for pain relief. But having said that remember that pain is very subjective, and it is not easy to predict what degree of pain you will have.

Will I be awake during surgery?
No. I like to do this procedure under general anesthesia. If there are risk factors related to your health for having general anesthesia we can sometimes do this procedure under heavy sedation. If you are having just a small touchup procedure and this can be done in the office then you will be awake. However if you are having a large revisional procedure, or having multiple changes made to your breast you will most likely be done in an outpatient facility under general anesthesia,

Where is the surgery performed? (i.e. office suite or hospital)
The surgery is done in an Ambulatory Surgery Center. I do not do this operation in the office. The Surgery Center provides a safe environment without the inconveniences of a busy hospital operating room.

Are medical photographs taken?
Yes. In all cosmetic and reconstructive cases medical photos are taken. Photographs are mandatory because this is the only way for us to compare you before and after results. Photographs in plastic surgery serve much the same role that x-rays serve for orthopedic surgery.

Date Revised: 12-5-04


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