Natural Breast Symmetry in Preoperative Breast Cancer Patients

Abstract

Background: Plastic surgeons aim to achieve breast symmetry during cosmetic and reconstructive breast surgery. They rely on measures of breast size, position, and projection to determine and achieve breast symmetry, but normative data on symmetry in preoperative breast reconstruction patients are scarce. Methods: A statistical evaluation was performed to examine the relationship of breast symmetry to demographic and clinical factors such as age, body mass index (BMI), race, and cancer status in a sample population of 87 patients who were scheduled to undergo mastectomy and breast reconstruction. The sternal notch to nipple (SN-N) distance and breast volume were measured on three-dimensional images, and distance and volume ratios across the left and right breasts were compared to determine symmetry. Ptosis grades were recorded and grade agreement (match) across the left and right breasts was assessed to determine shape symmetry. Results: A substantial portion of women (41.4%) showed SN-N distance differences >5 mm and 50.6% exhibited a volume difference >50 mL between their right and left breasts. Multiple linear regression modeling did not show any association between age, BMI, and cancer status and the SN-N and volume ratios. Race showed an association with volume symmetry but not with SN-N symmetry. A higher BMI increased the likelihood of ptosis disagreement. Additionally, tumor size did not impact overall breast symmetry. Conclusion: This study provides normative data on the extent of breast asymmetry in preoperative patients that can guide physicians in setting realistic goals for reconstruction procedures and manage patients’ expectations related to outcomes.

Left–right breast asymmetry and risk of screen-detected and interval cancers in a large population-based screening population

“…They found no association between tumour size and BV asymmetry. 36 Our study also broadly agrees with the findings of a previous small case-control study, which used a bespoke algorithm for estimating mammographic density percentage (%MD) asymmetry in 230 cases found clear of cancer at the time the image was taken but who were subsequently diagnosed with breast cancer and 230 matched cancer-free controls. 22,25 Increasing %MD asymmetry was positively associated with the odds of cancer at the subsequent screen (1-3 years later) after adjusting for age and subjective breast density category (BIRADS), 22,25 in line with our findings.…”

“…If asymmetry is simply attributable to the presence of a tumour in the breast, then a higher correlation between tumour size and asymmetry would be expected together with a closer correspondence between tumour laterality and the breast with larger volume/ density (in our study only ~55% of unilateral screen detected tumours were located in the breast with higher DV/BV) and previous studies found no evidence that the tumour was associated with the larger BV. 20,21,36 In our study, there was some evidence of a weak positive correlation between DV asymmetry and tumour size, but overall little of the observed asymmetry in our study can simply be explained by the presence of a tumour in the larger breast. We therefore conclude that asymmetry cannot be explained by the presence of a tumour alone but may be a biomarker of increased genetic/early life susceptibility to breast cancer.…”

Comparison of one-stage direct-to-implant with acellular dermal matrix and two-stage immediate implant-based breast reconstruction—a cohort study

“…Breast symmetry does also play an important role for satisfaction, but is not found to be a major determinant of outcome (22). Breast asymmetry is a common phenomenon and the proportions of patients in this study that obtained an acceptable symmetri of 0.5 cm or less difference in SSN:N measurement was in accordance with a normal population opting for BR (23). Absolut symmetry is not the ultimate goal and patients were informed of this prior to surgery in an attempt to manage patients' expectations.…”

Implants versus Lipograft – Analysis of Long-Term Results after Congenital Breast Asymmetry Procedure

“…This is consistent with our objective results on symmetry, as our newly developed Symmetry Index showed good results for both methods (93 %). The Department of Plastic Surgery at The University of Texas MD Anderson Cancer Center, Houston found that a substantial portion of women (50.6 % of a non-operated cohort) exhibit a volume difference greater than 50 ml between right and left breast [27]. This study provides normative data on the extent of breast asymmetry in preoperative patients that can guide us in setting realistic goals for reconstruction procedures.…”