This is a rare condition in which the muscles, soft tissues and occasionally ribs do not develop normally. Usually affecting only one side of the body and is seen more commonly in boys than girls. Clinically this manifests in absence or underdevelopment of the breast. The muscles of the chest, the pectoralis minor and major, occasionally the hand and fingers are involved. This is a sporadic condition with no defined inheritance patterns.
Young ladies present with their mothers with a normally developing breast on one side and the other much smaller. In extreme cases the breast tissue, the nipple and areola and underlying muscle are totally absent. Fortunately total aplasia of the breast and nipple is rare.
Development of the nipple areola complex is dependent on the underlying expanding and growing breast. When one breast is markedly smaller than the other the nipple areola is also much smaller and will always be that way. The best outcome on making the affected breast most closely match the normal side is to start early. A specially designed implant called a tissue expander is placed as in a breast reconstruction. As the young lady’s body develops saline is added to the tissue expander to match growth. This expansion process stresses on the overlying nipple areola complex to develop more evenly.
When full growth has occurred the tissue expander is replaced with a permanent implant. The “normal” breast may benefit from procedures to match the constructed breast. Patients and their families must always understand that our tissues change throughout life. The effects of pregnancy, aging, and changes in weight all can affect the body and revision surgeries sometime in life will most likely be needed to maintain optimum balance.
One of the greatest satisfactions of my practice has been at a post-op visit, to observe mother and daughter talking, with great anticipation, of shopping for a dress without the concerns of the constraints of severely asymmetric breasts.
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