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16 Importance ofGlandular andDermoglandular Flaps forBreast Surgery
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References
Pitanguy I. Breast hypertrophy. In Transactions of the Second Congress of the International
Society of Plastic Surgery. London: Livingstone, 1959-1960.
Pitanguy I.Surgical treatment of breast hypertrophy. Br J Plast Surg 20:78, 1967.
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icle. Acta Chir Scand 126:126, 1971.
Ribeiro L (1975) A new technique for reduction mammaplasty. Plast Reconstr Surg 55:330–334
Silveira Netto E (1976) In: Ely JF (ed) 13 Congresso Bras Cir Plástica. Mastoplastia redutora
sectorial com pediculo areolar interno, pp.13–15. Porto Alegre
Ariê G.Nova técnica em mamaplastia. Rev Latin Amer Cir Plast 3:28, 1957
Uebel CO.Uebel CO (1978) Breast reduction with the lateral dermo-glandular rotation ap. In:
Annals of the XVth Brazilian congress of Plastic Surgery, Sao Paulo, SP
Uebel CO (2011) Breast reduction using the supralateral dermoglandular ap. IPRAS J 3:16–17
Uebel CO.Combined abdominal contouring and mastopexy. In Rubin JP, ed. Body Contouring
and Liposuction. NewYork: Elsevier; 2012.
Pitanguy I (1962) A new technic of plastic surgery of the breast. Study of 245 consecutive cases
and presentation of a personal technic. Ann Chir Plast 7:199–208
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Chapter 17
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Classication andCorrection
ofAsymmetrical Breasts toAchieve
aBalance inBody Contouring
JuarezMoraesAvelar, MarceloVaccari, andJoseCarlosMiranda
Abstract Asymmetry of the breast is quite frequent, causing an imbalance in the
body after puberty when a great physical change occurs in female humans because
of hormonal metabolic alterations. At such an age for female humans, the development of the breasts starts. Even in male humans, growth may occur as gynecomastia, which requires immediate treatment to avoid other consequences. Any alteration
of the breasts can modify the body contouring, causing disharmony and imbalance
to the whole body, which could lead to patient dissatisfaction. Consequently, any
unwanted asymmetries in the breasts can be surgically repaired to achieve a balance
between the breasts and with the chest, which improves body contouring.
There is a wide variety of breast asymmetries, and they need to be examined
before surgical treatment aiming to achieve harmonious body contouring. There are
two major types of asymmetries: congenital and acquired. A congenital asymmetry
may appear without a chest deformity: bilateral hypertrophy, hypertrophy in the size
of one breast and normal size for the other, hypertrophy in the size of one breast and
hypomastia in the other, hypertrophy in the size one breast and ptosis in the other,
bilateral hypomastia, hypomastia in one breast and normal size for the other, and
asymmetrical breasts with bilateral ptoses. The following asymmetries appear with
a chest deformity: bilateral hypertrophy, hypertrophy in the size one breast and
normal size for the other, hypertrophy and hypomastia, bilateral hypomastia, and
hypomastia and normal size. The following asymmetries appear without a nipple
deformity: atelia and normal size, amastia and normal size, amastia and hypomastia,
polythelia, and polymastia. The following asymmetries appear with a nipple deformity: atelia and normal size, amastia and normal size, amastia and hypomastia,
J. M. Avelar (*)
Brazilian Scientic Institute of Plastic and Reconstructive Surgery, São Paulo, Brazil
M. Vaccari · J. C. Miranda
São Paulo, Brazil
Switzerland AG 2023
J. M. Avelar, R. Cavalcanti Ribeiro (eds.), Body Contouring,
https://doi.org/10.1007/978-3-031-42802-9_17
285© The Author(s), under exclusive license to Springer Nature
286
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polythelia, and polymastia. An acquired asymmetry may be the result of trauma
(e.g., a burn or a human/animal bite) or iatrogenesis (e.g., after mastectomy for
resection after breast cancer, secondary to augmentation mastoplasty, or secondary
to reduction mastoplasty).
Keywords Breast · Asymmetry · Imbalance in the body · Hypertrophy · Hypomastia ·
Undeveloped breast
J. M. Avelar et al.
Introduction
The breasts of female humans undergo signicant developments over a short period
of time during puberty, due to complex hormonal alterations. Just after birth, the
breasts may have minimal size because of hormonal inuences from the mother at
1 to 2weeks (Pitanguy 1961; Avelar 1989). Afterward, they remain as is in a latency
stage, but after a short period of time, several physical changes occur, giving shape
to the adolescent female body and acting as symbol of femininity. During adolescence, young girls’ bodies undergo profound anatomical alterations to the body’s
silhouette, and when the breasts exhibit asymmetry, this can result in body-image
disharmony and an imbalance in body contouring.
In addition, the appearance of asymmetric breasts may develop physical alterations on the vertebral column of the spine and torso (Fig.17.1), with severe repercussions on the respiratory system caused by an imbalance in the chest, according
to Pitanguy (1967). Therefore, its correction is a matter of physical reparation to
achieve harmony in the body and avoid negative repercussions on wellbeing of the
patient (Fig.17.2). The treatment is essentially a surgical approach that frequently
consists of mammary reduction in one side and a silastic inclusion in the other,
which makes achieving a balance in the chest even more difcult (Fig. 17.3)
(Pitanguy 1959). Until recently, when both breasts presented noticeable hypertrophies with severe asymmetry in adulthood, reduction mastoplasty can be performed
for the resection of the excess breast tissue (Figs.17.4 and 17.5). Even at such an
age, the presence of adipose tissue may cause a similar asymmetry that demands
careful management to achieve balance after the operation (Avelar 2000a). On the
other hand, asymmetric breasts may present with bilateral hypomastia, which
requires augmentation mastoplasty on both sides by using different sizes of breast
implants.
In addition to conducting an accurate physical examination, mammography is a
useful preoperative exam to reveal any alterations in the glandular tissue and the
proportions between mammary tissue and fat tissue. Because mammary
17 Classication and Correction of Asymmetrical Breasts to Achieve a Balance…
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cba
fed
287
Fig. 17.1 A 21-year-old patient presenting bilateral hypertrophy with asymmetry of the breasts.
Photos a, c, and e—preoperative showing the right breast larger than the left one presenting physical alteration on the chest with rotation forward of the shoulder; b, d, and f—the same patient
1year after reduction mastoplasty with resection of 950g on the right breast and 690g on the left
one. One can see correction of patient’s posture
asymmetry is the most common, most patients present with some sort of difference
in the size and shape of the breasts. Some abnormalities in the breasts that develop
after mastoplasty may be due to the structural asymmetry of the tissues given that
balance can be achieved through liposuction (Fig.17.6) (Avelar 1986, 1989, 1993).
Descriptions of the breasts and body contouring are necessary to safeguard plastic
surgeons against malpractice lawsuits (Avelar 1980, 2000b, c). When a patient
presents with some sort of asymmetry among their breasts and doesn’t mention it
to the surgeon, point it out to them before surgery is appropriate (Fig. 17.7). During
consultation and before examination, surgeons may ask whether they notice any
sort of asymmetry, though they rarely conrm it. However, during a physical exam-
abnormality.
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J. M. Avelar et al.
ba
c
Fig. 17.2 Asymmetry of the breasts presenting severe bilateral hypertrophy in a 21-year-old
patient. Photos a and c—preoperative photos showing physical alterations of the shoulder caused
by breast hypertrophy; photos b and d after reduction mastoplasty with resection of 850g on the
right side and 640g on the left side. Photos c and d with her arms up. After reduction mastoplasty
with correction of asymmetry she loss weight with diet. Even she presents correction of the physical posture
d
17 Classication and Correction of Asymmetrical Breasts to Achieve a Balance…
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ba
289
c
Fig. 17.3 Severe asymmetry of the breasts presenting hypertrophy and ptoses on the right side
hyponasty on the left breast in a 19-year-old patient. Photos a and c– preoperative; photos b and
d—1 year after reduction mastoplasty on the right side with resection of 500g of mammary gland
and silastic inclusion of 200ml on the left side
d
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J. M. Avelar et al.
ba
c
Fig. 17.4 Bilateral hypertrophy with severe asymmetric breasts on a 20-year-old patient. Photos a
and c—preoperative; b and d—the same patient 9months after reduction mastoplasty with resection of 850g on the right breast and 380g on left one
d
17 Classication and Correction of Asymmetrical Breasts to Achieve a Balance…
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ba
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c
Fig. 17.5 Asymmetric breasts with bilateral hypertrophy. Photos a and c—preoperative; b and
d—1 year after bilateral reduction Only with vertical approach without periareolar incisions with
resection of 210g on the right side and 150g on left, with reparation of asymmetry .. -
d
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ef
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J. M. Avelar et al.
ba
c
d
Fig. 17.6 Asymmetry of the breasts presents asymmetric mammary gland and cutaneous accidity as well. A 21-year-old patient complaint ptosis with asymmetry of the breasts (preoperative
photos a, e); underwent mastopexy in 1977 (photos b, f after surgery); The same patient at age
64years old presented asymmetry of the breasts with asymmetric hypertrophy (photos c, g before
the second operation) underwent reduction mastoplasty in January 2021 (photos d, h) 6 months
after surgery
gh
ab
cd
17 Classication and Correction of Asymmetrical Breasts to Achieve a Balance…
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Fig. 17.6 (continued)
293
Fig. 17.7 Asymmetry of the breasts presenting bilateral hypertrophy with ptoses. Photos a and
c—preoperative; photos b and d—9months after reduction mastoplasty with resection of 300g on
the right side and 550g on left with reparation of asymmetry
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