Breast implants–as iconic of “Plastic Surgery” as you can get. Most of the press we see about breast implants is typical Hollywood fare: those are too big, she just had them done, did you see how fake she looks, etc. Yet, breast implants are a critical component of a much more serious topic, breast reconstruction after mastectomy for breast cancer. Did you know that the majority of mastectomy reconstructions performed in the United States depend upon and utilize breast implants? Restoring of shape, size (and the spirit) becomes just as important as the cancer treatment itself. Plastic surgeons know that they can rely on breast implants to help them with this special responsibility. But there are some circumstances for women that are sort of “in between” these two seemingly extreme ends in the use of breast implants. Women are often not aware as to how breast implants can be used to help them with these less commonly known, but not uncommon, conditions.
Some young women will find as they mature through adolescence that one breast seems to remain relatively small and even misshapen while the other breast develops more normally. They may have a condition that has actually been present since birth called “Poland’s Syndrome”. Poland’s Syndrome is really a spectrum, or range of abnormalities affecting one of the breasts. A woman may have what appears to be simply a noticeable cup size or shape difference or as severe a situation as a nearly complete absence of development of one entire breast! Creative use of a breast implant along with special cosmetic augmentation techniques in this situation can restore symmetry, proportion and confidence. Many women will say that they always knew that “something was wrong” or “off”, but no one ever validated their feelings with an actual diagnosis. It is important for a plastic surgeon to make this diagnosis even in mild cases because the strategies and techniques involved to create proper shape and symmetry can be quite different from those used for a typical breast augmentation. Interestingly, Poland’s Syndrome can also be associated with a difference in size of the rib cage, the chest muscles, the shoulder, the arm, and even the hand. Men can have Poland’s Syndrome too!
“Tubular Breast Deformity” is another relatively common condition that can affect the size and shape of one of the breasts. Typically, however, both of the breasts are affected and have an abnormal shape. Tubular Breast Deformity (TBD), like Poland’s Syndrome, is a true birth deformity and is present long before the maturing of the breasts begins to “reveal” the extent of the problem. In the most severe forms of TBD, the breasts develop a droopy, tube-like shape (almost like a hanging sock) rather than being full and rounded out at the bottom. Often, the nipple/areola tissue can seem to protrude as if it is disconnected from the rest of the breast (called “pseudoherniation”). Milder cases are very common and might appear as a breast that seems to be a bit “constricted,” tight or narrow at the bottom. Many cases of TBD are subtle, such as a breast that looks “off” because it makes an unleveled, upturned angle with the chest at the crease (the “inframammary crease”). The embarrassment and poor body image that women suffer as a result of this condition is significant, made all the worse by finding their complaints dismissed as “normal” by their physicians. Once TBD is finally diagnosed, a treatment plan must be devised so that special surgical techniques can be used to get the best cosmetic results. Sometimes, even seemingly severe and very distressing cases will respond quite well to modified augmentation techniques using breast implants alone. But even in situations where more involved reconstructive efforts may be needed, breast implants will still play the dominant role in helping to reshape the breasts more normally.
Two related conditions with some tough Latin names, Pectus Excavatum and Pectus Carinatum, are deformities of the chest wall and rib cage that are also present since birth, but may only become noticeable when asymmetric breast development seems to have occurred. “Funnel chest” or “Pigeon chest” are the less than complimentary nicknames for these problems, which have a wide range of presentations. Milder forms create the optical illusion that one breast is fuller or more projecting than the other. The breasts may actually be identical, but the chest underneath curving in or curving out changes the apparent size and shape. Severe forms can make the entire chest look like it is “caving in” or that one breast is completely flat. Some situations will require very intense rib and/or sternum reconstructions; these are often performed in the childhood years. However, in women with this problem, creative use of breast implants alone can often yield very satisfying results with much improved symmetry (and without the need for the more invasive surgery). The key here once again is that the proper diagnosis is made from the beginning so that the best surgical approach can be implemented. For even in the subtle forms, when appreciated by the plastic surgeon, better results will be obtained when breast augmentation and implant techniques are modified and artistically applied.
Many women do not have a deformity or a syndrome at all but simply have a significant size difference between the breasts. Shopping for clothes, bras, bathing suits– all can be quite frustrating. Gel inserts (which patients have nicknamed “chicken cutlets”) are a common remedy. The most straightforward and easy solution to definitively deal with this situation will be breast implants. Saline implants can be adjusted in the operating room so that the smaller breast can get the extra it needs to “catch up”. Alternatively, silicone gel implants of different sizes can be used. Usually it is a better decision to use implants on both sides because other, but more subtle shape and asymmetry issues may become more obvious and noticeable if only one side is treated.
Breast implants can be quite useful in creating reasonably symmetrical breast shape and size in a variety of complex situations. They are a very useful and important tool for the Plastic Surgeon to restore and reconstruct the breasts in ways that go far beyond simple augmentation or enhancement.
Dr. Lyle Back is originally from New York City, receiving his medical and surgical training at Rutgers Medical School, Cooper Hospital – University Medical Center, and Ohio State. He is Board Certified in General Surgery (ABS) and Plastic Surgery (ABPS). He is a Fellow of the American College of Surgeons (ACS), the American Academy of Cosmetic Surgery (AACS), and a longstanding member of the premier American Society of Plastic Surgeons (ASPS). He served as a Professor of Plastic Surgery at Temple University and St. Christopher’s Hospital for Children and performed reconstructive surgery with “Operation Smile” in Vietnam. He specializes in the full range of the most modern and state of the art cosmetic surgery procedures for the breasts and non-surgical cosmetic enhancement techniques available today.
