Breast Asymmetry

Breast asymmetry is a condition when one breast is a different shape or size than the other. It is extremely common and affects more than half of all women. Most women’s breasts mildly differ in shape, size, and position. Uneven breasts are usually not a cause of concern. However, significantly uneven breast tissue may adversely affect a woman's self-esteem, confidence, and body image.

Breast asymmetry can be of three types:-

1. Anisomastia is a significant difference in the breasts’ volume and size. 
2. Anisothelia is a difference between the nipples and areolas. 
3. Combined asymmetry includes both anisomastia and anisothelia. 

Some other types of asymmetrical breasts include:-

1. Sagging breasts: Saggy breasts, also known as breast ptosis, occur when your breasts sit lower on the chest with the nipples pointing downwards. It may be caused due to the loss of skin elasticity while ageing. Asymmetry may occur when one breast sags more than the other. 
2. Small breasts: Also known as breast hypoplasia or mammary hypoplasia, this condition is characterised by underdeveloped breasts. 
3. Large breasts: Hormonal changes during pregnancy or milk production for breastfeeding can cause breasts to get bigger. 
4. Irregular breasts: These are uneven breasts where one breast is larger than usual and the other smaller. 
5. Pointed breasts: These breasts are characterised by a cone-like shape in which the nipples point outwards. When asymmetrical, one nipple may be more pointed than the other. 

The common symptoms of breast asymmetry include:-

1. The breasts do not match each other in position and shape
2. A marked breast size discrepancy

1. Developmental Causes
   1. Puberty: The left and right breasts often develop at slightly different paces during puberty. Usually, breast asymmetry resolves by the time the breasts have finished growing or may remain slightly different throughout a person’s life. 
   2. Prepubescent injury: Injury to the breast tissue before it develops fully can lead to breast asymmetry. Trauma, radiation, or infection to one side of the chest are some possible injuries to breast tissue.
   3. Hormone level changes: Hormonal changes during the normal menstrual cycle or hormonal contraceptives like birth control can lead to breast asymmetry. 
2. Growth or Masses
   1. Infection: A bacterial infection can cause a breast abscess which is a swollen mass in one breast, causing pain, redness, and warmth. 
   2. Benign breast mass: Breast asymmetry may be caused due to a breast mass that you can feel. Some possible benign breast masses include cysts, tissue damage following breast trauma, or fibrous changes with the menstrual cycle. 
   3. Malignant breast mass: Multiple types of invasive and noninvasive breast cancer can cause a breast mass. Usually, malignant masses are hard and present in one breast in older women. 
3. Medical Conditions
   1. Pregnancy: For some women, breast asymmetry can develop during pregnancy. As the body prepares for breastfeeding, the breast may grow larger and lopsided. The breasts can also change their shape and size during breastfeeding, especially if the baby feeds on one side. 
   2. Tubular breasts: They can develop in one or both breasts during puberty.
   3. Poland syndrome: The condition restricts the chest muscle from developing properly, affecting the breast on one side of the body. 
   4. Amastia: It is a condition that causes problems in the development of breast tissue, nipple, or areola. 
   5. Atypical ductal hyperplasia: A condition that affects the breast tissue cells. It can lead to benign breast lumps, affecting the breast’s appearance. 
   6. Juvenile hypertrophy: It is a rare condition that causes one breast to grow significantly larger than the other. 
4. Other Causes
   1. Skeletal abnormality: Abnormalities in the bones of the spine or ribs can cause the breasts to appear asymmetric. 
   2. Curved spine: A spine curved more than usual (scoliosis) can give the breasts an appearance of asymmetry. 
   3. Surgical changes: Treatments of breast cancer such as lumpectomy (removing a part of the breast tissue) and mastectomy (removing the entire breast) can cause breast asymmetry. 

The first step in the diagnosis of breast asymmetry is a breast exam. During the test, your doctor will examine both breasts and the area under your armpits through touch and pressure to feel for abnormalities. 

Next, a doctor uses a mammogram to diagnose breast asymmetry or other abnormalities, including lumps. A mammogram is a breast X-ray that evaluates its internal structure and reveals whether the breasts have different densities. If a mammogram diagnoses asymmetrically dense breasts, the difference in density can be classified in the following categories:-

1. Asymmetry: The breasts are evaluated using one projection. The doctor will call for a three-dimensional imaging test for further examination if an abnormality or lesion is found. 
2. Global asymmetry: In this, one breast has more density or volume than the other, normally due to hormonal changes. The doctor will request additional imaging if a mass is found. 
3. Focal asymmetry: A density is seen on two mammographic views. The doctor will need further imaging and evaluation to check if it is a cancerous or abnormal mass. 
4. Developing asymmetry: This type of asymmetry detects a significant change between past and current exams. These findings can detect potentially malignant cells. 

If a mammogram detects asymmetry, your doctor may require additional tests to examine whether the change in density or size is normal. These additional tests include:-

1. Breast Ultrasound: The test uses sound waves to produce images of your breast’s internal structure. A breast ultrasound helps the doctor diagnose abnormal findings from mammogram images. It helps determine whether a mass is benign, a fluid-filled cyst, or a cancerous tumour. 
2. Biopsy: If a doctor suspects an abnormality to be cancerous or if the imaging tests come back abnormal, he/she may perform a biopsy. A sample of your affected breast tissue is taken during the procedure for further testing and cancer check. If the biopsy is negative, your doctor may recommend regular breast exams to monitor changes. 
3. Breast MRI: It is used to detect breast cancer and other abnormalities. The test is especially helpful for women with a high risk of cancer due to heredity or family history.

At-Home Treatments

1. Observation: If you are below 30 years of age and notice a new breast lump, it is most likely benign. The doctor may suggest you observe the lump at home over several menstrual cycles to see whether it changes or resolves on its own. 
2. Paddings, Bras, and Inserts: You can use bras with padding on one side or foam or gel inserts for an existing bra to improve the appearance of asymmetrical breasts. This is helpful for self-conscious adolescents about their asymmetrical breasts during puberty. 

Surgical Options

Certain breast reconstruction surgeries can be used to treat breast asymmetry. These surgeries include:-

1. Breast Augmentation: It is a surgical procedure in which the surgeon places breast implants behind your breast tissue to make it look bigger. This procedure can help you improve your confidence and self-esteem if you have extremely uneven breasts. 
2. Breast Lift: If one of your breasts is more sagged than the other, the doctor may recommend a breast lift surgery to reposition the breast. 
3. Breast Reduction: It is another procedure to match the size and shape of your enlarged breast with the other. During this surgery, the surgeon removes excess fat, skin, and glandular tissue from the enlarged breast to reduce discomfort and improve symmetry. 
4. Combined Augmentation and Lifts: Sometimes, the doctor may suggest a combined surgery to address both sag and lack of volume in the breasts. The surgery can be useful in matching the breasts as much as possible. While an augmentation can create a symmetrical size and shape, lifts can reshape or reposition the breasts. 

Psychotherapy Support

1. Counselling: A counsellor or mental health professional can help you guide and support you towards accepting your body.
2. Online Support Group: You can join an online support group on breast size or body image to connect with women who face the same issues. 

Please Note: The treatment selection for breast asymmetry is based on the severity of asymmetry and your doctor’s opinion. 

If severe breast asymmetry is left untreated, it can lead to breast cancer. Improper evaluation can result in a delay in the diagnosis of cancer until it is too late.