Breast Asymmetry Correction Sydney

Tuberous Breast Deformity (Snoopy or Constricted Breast) Poland’s Syndrome / Sequence Procedure Information Risks & Complications FAQs Pricing

Most women have naturally slightly asymmetrical breasts. However, in some, breast asymmetry is more defined, which can be a cause of embarrassment, or low self-esteem terrible enough to interfere with social and personal relationships.

Breast asymmetry can occur for several reasons which can include:

Tuberous Breast Deformity (also known as ‘Snoopy’ or ‘Constricted’ Breast Deformity)
Poland’s Syndrome
Breast Hypoplasia

A combination of techniques are employed to create a natural, beautiful and perky shape to the breasts and reduce the asymmetry between them. These techniques include:

Breast Lift/Reduction
Breast Augmentation
Lowering of the IMF or fold of the breast
Glandular reshaping or scoring
Fat grafting

Dr Aggarwal

Dr Aggarwal is a well regarded, respected, highly skilled and experienced Specialist Plastic Surgeon. Graduating at the top of his class throughout his training, Dr Aggarwal has completed fellowship training at some of the world’s most prestigious reconstructive and cosmetic plastic surgery institutions in Canada and the USA. He continues to publish research is prestigious plastic surgery journals, and is actively involved in the training of future plastic surgeons.

What sets Dr Aggarwal apart from others is his personal, affable and warm nature. Not only does he pay attention to detail, to producing natural, beautiful results but he ensures that the patient’s journey is just as special as their outcome. Dr Aggarwal looks after patients at one of Sydney’s most prestigious public hospital campuses (POWH/SCH/RHW), and operates privately on Sydney’s North Shore. Dr Aggarwal has treated thousands of patients throughout Sydney and beyond who have achieved outstanding results under his care.

Procedure Snapshot

Anaesthetic: GA by accredited anaesthetist
Time: 3+ hours
Duration of stay: Day Surgery (or overnight stay)
Hospital: Offered at a private hospital where Dr Aggarwal works
Medicare/Health fund rebate: Generally available to patients with appropriate health insurance cover.
Recovery: Most people can do most things at the end of the first week. Upper body exercise is disallowed for 6 weeks and strenuous exercise for 3 months. Avoid swimming in a pool or beach for 2 weeks.

Results: Correction of breast asymmetry can achieve excellent results. The scars initially however are obvious are bright pink, and take at least 3-6 months to settle down and fade. Similarly the shape of the breast can look odd initially, but it settles into its final shape over 3-6 months. It is important to remember this time frame and final results vary from patient to patient, and some degree of asymmetry is always to be expected, as often different procedures may need to be performed on each breast.

Tuberous Breast Deformity (Snoopy or Constricted Breast)

This is a syndrome rather than isolated deformity and can include a combination of the following features:
- Reduced volume of breast tissue (especially in the lower part of the breast, or it can be global and affect all quadrants of the breast)
- Shortage of skin of the breast
- Reduced size of the breast foot plate (‘constricted base’)
- High fold of the breast (high IMF)
- Enlargement of the nipple and areola
- Puffiness to the nipple and areola (pseudoherniation through the NAC – this is the reason the deformity is nicknamed ‘snoopy’ breasts)
- Sagging of the breast (Breast ptosis)
- Asymmetry of the breasts – it is not uncommon for one breast to be underdeveloped (and having the above features) while the other breast is much larger, and droopy with nipples
Many women probably don’t realise that they have tuberous breast deformity, but do realise that their breast development was not quite right. They live with it for years before seeking attention too embarrassed to discuss this with someone.
Severity of tuberous breast deformity: This can vary from mild to severe –

Correction of Tuberous Breast Deformity

Correction of this deformity involves addressing the issues that are a feature of the syndrome
- Shortage of breast volume and skin:
  - Breast augmentation or additional of an implant adds extra volume to the breast. Rarely in very severe cases a breast tissue expander (or temporary saline filled implant) may need to be inserted first and then changed to a permanent implant
  - The use of anatomical breast implants is generally preferred in tuberous breast as the deficiency of volume occurs in the lower part of the breast (where these implants provide most of their volume), and in severe cases the implant imparts most of the shape to the new breast.
  - Fat grafting: this can be used to add additional volume to the breast tissue, and hide the underlying implant
- High IMF (fold of the breast): via surgical techniques the IMF is lowered before implant inserted. Depending on how easily the old fold can be destroyed, some fat grafting may need to be performed in the area of the old fold to camouflage it.
- Enlarged nipple and areola:
  - This usually needs to be reduced via scar all the way around the nipple.
  - This in combination with an underlying implant predisposes to future enlargement of the nipple and areola – which can be reduced by a special suture made from Gore-Tex or via a lollipop scar where the vertical scar takes tension away from the scar around the areola, and reduces chances of future enlargement.
- Herniation through the areola (correcting the ‘puffiness’):
  - There is a constriction ring under the skin and around the nipple and areola which must be divided surgically
  - In addition glandular reshaping and scoring is performed so that the small breast gland fans out over the new underlying implant
- Correction of breast asymmetry
  - While the smaller breast is addressed in all the above ways, the larger breast (if present) needs different techniques
  - The larger breast may also have an unusual shape, has sagging and some degree of lower pole deficiency
  - The larger breast is addressed via a breast lift/reduction, performed to match the newly reshaped other breast.
- It is important to remember that in cases of significant breast asymmetry different procedures need to be performed on the two breasts and therefore perfect symmetry is difficult to achieve.

Poland’s Syndrome / Sequence

This syndrome has a variety of features and can affect males and females. In face males are more commonly affected, and for some reason the deformity occurs more commonly on the right than the left.

It is thought to occur due to an event while the baby is developing inside the uterus, where the blood supply to the area is interrupted (subclavian artery disruption).
Features include:
- Lack of development of the breast (Breast hypoplasia)
- Absence of the underlying pectoralis muscle (the armpit therefore looks like it does not have a fold in front of it)
- Lack of fat and hair in the armpit
- Deformity of the underlying ribs and cartilage
Other features can include
- Deformity of other muscles of the chest, back and arm
- Deformity of the hand, forearm and arm
- Facial paralysis (very rare, occurring in 1/500,000 births)
Given the lack of breast development, females generally present earlier and often during puberty. This is when this deformity can particularly affect self-esteem, personal relationships and social interactions.
Correction of Poland’s syndrome
- Different techniques need to be employed depending on the severity of the condition; and whether the patient is male or female
- Breast Augmentation
  - Most women can sufficiently hide the deformity by adequate placement of an anatomical implant on the affected side
  - The underlying rib deformity may need to be addressed to provide a stable platform for the implant
  - In developing females severely affected psychologically by the deformity, a good option is for the placement of breast tissue expander on the affected side. This can be slowly inflated as the opposite breast develops to provide symmetry during the developing years. Once breast development is complete the tissue expander can be exchanged to a permanent implant
  - This does not correct the difference in the fold of the armpit compared to the normal side
- Custom implant
  - More commonly used for males, this can be manufactured using images from a CT scan to provide a closer match to the normal side of the chest.
- Fat grafting
  - This may be needed in addition to the implant to camouflage the underlying implant, especially given that there is usually no pectoralis muscle to put the implant under on the affected side
- Transfer of latissimus dorsi muscle
  - More commonly required in males but may also be needed in females.
  - This reconstructs the fold of the armpit and also provides soft tissue cover under which an implant can be placed if required.
- Correction of Breast Asymmetry
  - The larger opposite breast may require a breast lift/reduction to match the smaller breast.

Procedure Information

The procedure is always performed under general anaesthesia given by an accredited anaesthetist in a fully accredited and licensed facility (usually one of the North Shore’s premier private hospitals). The procedure three or more hours and most patients stay overnight (some may go home the same day)

Mammogram and Ultrasound

Before any surgery on your breast Dr Aggarwal will refer you for a mammogram and ultrasound to ensure the breast is clear of any pathology.

Incisions

The actual surgery and incisions made depend on the techniques employed for correction. The techniques include:

Breast Lift / Reduction (see breast lift procedure by clicking here, and breast reduction by clicking here)
Breast Augmentation (see breast augmentation procedure by clicking here)
Gland Reshaping
- This does not place extra scars on the breast
- During implant placement the constriction ring under the skin and around the nipple and areola is divided.
- The gland itself is scored or divided so that it redrapes and enlarges over the underlying implant

Fat Grafting

Minor liposuction is performed from an area where there is sufficient fat for harvest – the most common sites are abdomen, inner and outer thighs or buttocks
The fat is collected in a sterile fashion, prepared and transferred to appropriate syringes for injection
The fat is then carefully injected into the breast taking care to make sure it is surrounded by tissue with good blood supply.

Transfer of the Latissimus dorsi muscle

Transfer of the Latissimus dorsi muscle – this is similar to when this muscle is used for breast reconstruction

Drains

In general drains are avoided during a breast asymmetry correction procedure allowing patients to go home the same day
The exceptions are
- Patients also having removal of old implants and capsulectomy (removal of the layer of tissue surrounding the implants)
- Patients on blood thinning medications
- If unexpected bleeding or alternative situation that could increase the risk of seroma (fluid collection) is found during the operation.
If a drain is inserted you may need to stay in hospital overnight, or alternatively go home with the drain and see Dr Aggarwal or his staff the next day in rooms.

After your breast lift (mastopexy) surgery

Dr Aggarwal will place waterproof dressings over the incisions.
You should wear a compressive sports bra or crop top for the first 6 weeks. This helps to reduce swelling, pain and discomfort in the early post-operative period as the area heals.
You will be able to get the area wet after 48 hours and go back into your crop top or sports bra after your shower. You will not be allowed to swim in a pool or beach for at least 2 weeks after surgery. This could be a little longer is there are wounds that are slower to heal.
You will be given a script for antibiotics by Dr Aggarwal which you must continue until the box runs out
You will also be given pain relief medications although most patients only report minor amounts of post-operative pain that is responsive to simple oral analgesia.
You will not be allowed to go back home on your own – you must have someone accompany you home, and it is best to have someone look after you for the first few days as you recover. You should not drive for at least 24 hours after having an anaesthetic nor operate heavy machinery.
While most sedentary activities can be resumed in the first week, you must not do any exercise for the first few days after surgery that could raise your blood pressure. You will also not be allowed to do any heavy lifting or upper body exercises for the first 6 weeks.
Dr Aggarwal will see you a week after your procedure to inspect how the wound is healing. You will be given instructions how to look after the wound as it continues to heal. You will be able to ask questions about what you can and cannot do. Generally we will see you at 1 week, 3 weeks, 6 weeks, 3 month, 6 months and 1 year post surgery.

Procedure FAQs

Do I need a referral for breast asymmetry?

It is advisable to obtain a referral for breast asymmetry correction as it is possible to claim a Medicare rebate of approximately $73 for the consultation if you have a referral
It is also possible that a Medicare/Health Fund rebate may apply to you depending on what procedure you need, and having a referral allows you to claim this reducing out of pocket costs substantially.

Where can I see Dr Aggarwal?

You can see us at our main practice at Gordon, or at our other locations at Hornsby, Hunters Hill or Camperdown.
Please scroll to the bottom of the page to find out more information about these locations.

Where will I have my operation?

Any of the hospitals where Dr Aggarwal works – i.e. Sydney Adventist Hospital, SAN Day Surgery, Hunters Hill Private or Castlecrag Private hospitals

What can I do to prepare for surgery?

Cease fish oil, and other supplements such as Ginkgo, Ginseng.
Please discuss with Dr Aggarwal if you are on blood thinning medications as to when you should stop and recommence those.

After surgery, will I need to wear a special surgical bra?

No but Dr Aggarwal recommends that you purchase a crop top or sports bra which you should wear for at least 6 weeks.
You should not wear any bras with an underwire during this period

Will I be able to exercise after surgery?

You should not do any exercise that raises your blood pressure for at least 72 hours after surgery to avoid the risk of an unexpected bleed
Heavy upper body exercise should be avoided for 6 weeks

Will I need special medications after surgery?

Dr Aggarwal will provide you with the necessary scripts for antibiotics and pain relief.

Will I need further surgery?

Not usually.
Occasionally we may undertake scar revision in a private hospital or under local anaesthesia in rooms.
Most patients are extremely satisfied following breast asymmetry correction surgery and will not require any additional surgery.

Can I travel in an airplane after surgery?

Yes
However we always encourage patients not to be away overseas shortly after having a procedure, so that we can closely follow your recovery and address any concerns that may arise.

When will I be able to swim after breast asymmetry correction?

You may swim in a pool or beach after 2 weeks as this is the time it takes for the incision to heal.

When will I be able to drive after breast asymmetry correction?

It is best to not drive for several days and up to 1 week after surgery.

Do you offer local anaesthetic or sedation for breast asymmetry correction?

No
You will require a general anaesthetic in an accredited private hospital.
It is usually a day surgery procedure but you will need someone to pick you up and accompany you home after the procedure
Minor scar revisions if required may be undertaken in the rooms under local anaesthetic.

Will breast asymmetry correction change the sensation of my breasts?

Yes it can if breast lift/reduction is part of the procedure
A third of women preoperatively have reduced sensation to their nipples, a third have normal sensation and a third have more than normal sensation (hypersensitivity). Literature indicates that these ratios are unchanged following breast lift/reduction surgery.
However we believe that it is possible to reduce the sensation to the nipple following any breast surgery. In most cases this should be transient and returns to normal, a process that takes up to 12 months.
Permanent loss of sensation to the nipple is rare.
If this is of significant concern to you, you should not have surgery on your breast.

Can I breastfeed after breast asymmetry correction?

It is important to note that it can change if breast lift/reduction is performed as part of the procedure.
Even in the normal population (women who have not had breast surgery) up to a third of women cannot breast feed at all, and a third require additional supplementation for their infant. The remaining third of women can breast feed normally. These proportions of women are unchanged after breast lift/reduction surgery.
- However we believe that it is possible to reduce the ability to breast feed following any breast surgery.
- If this is of great significance to you, you should either not have breast lift/reduction surgery or postpone it to when you have completed having your family.

Can I have imaging for breast cancer screening after having breast asymmetry correction?

Yes
If you have a breast implant inserted, radiographers can still take the image by partially displacing the implant and compressing the breast tissue in the imaging device.
If you have a breast lift/reduction as part of your procedure the additional scarring within the breast can make breast mammogram and ultrasound more difficult to interpret by radiologists.
It is therefore important that prior to undergoing surgery you have imaging of the breast – it makes sure there is nothing of concern in the breast tissue, and also forms a baseline against which a post-surgery mammogram can be compared.
It is important for you to participate in regular screening as you would have otherwise done for breast cancer based on your age and family history, after having surgery

Can breast asymmetry correction cause cancer?

No
There is no association between breast implants and breast cancer.
If you have a breast lift/reduction as part of your procedure – any tissue removed during surgery is sent for histopathological examination meaning it is examined by experts under a microscope. This is to ensure there is no evidence of suspicious pathology in that tissue.
Despite having preoperative imaging, it is possible for an occult breast cancer to be detected by having surgery. The rate of this is much less than 1%.
It is important for you to participate in regular screening as you would have otherwise done for breast cancer based on your age and family history, after having surgery
In Australia it is recommended for women who reach the age of 50 to undergo 2^nd yearly mammography for breast cancer screening in the absence of other significant family history – if you have a strong family history you may be required to start breast cancer screening earlier
You should also note that there is a more recent discovery of a disease called ALCL associated with breast implants – to read more click here.

Procedure Pricing

A quote for this procedure will be provided to you after a consultation with Dr. Aggarwal. You can also call or email our office for our current indicative pricing
The above costs would include:
- Surgical fees
- Hospital fees
- Anaesthetist fees
- Follow up
Please note that the above price does not include
- Preoperative consultation fees
- Surgical fees for future implant revisions

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