Preoperative Sizing and Breast Asymmetry

Abstract

Sir: With recent developments in surgical technique and growing patient expectations, the search for more accuracy has become of prime importance. Research of symmetry has always been one of the goals in plastic surgery, especially in breast aesthetics, even if with the awareness that obtaining a perfect match is impossible. We read with interest the article entitled “Preoperative Sizing in Breast Augmentation” by Hidalgo and Spector.1 We would like to share with the authors our enthusiasm for their method, which points the way to better preoperative sizing in breast augmentation. The authors also discuss the use of “two different size implants that can be tested simultaneously in patients with volume asymmetry.” We agree that preoperative studies can be extremely useful in asymmetrical breast patients. Previous studies have proposed several preoperative measurements of breast volumes or volume differences between asymmetrical breasts, including water displacement methods2 and use of adjustable geometric conical forms3; interestingly, Kirianoff4 in 1974 suggested the use of templates in the brassiere positioned over the breasts to measure, preoperatively, “unequal breasts.” Several other body mapping techniques have been described for morphometric assessment of breasts.5,6 However, most of these procedures are very cumbersome and time consuming. Others involve high costs and require complex setup with high expertise and technological assistance. We have used a method of measurement of preoperative breast volume differences for preplanning of surgical correction of breast asymmetries. The test, basically the same as the one described by Hidalgo and Spector,1 is performed using various fixed volume implant sizers: the patient is advised to wear a sports bra that fits the larger breast. The size discrepancy on the smaller breast side is addressed by positioning in the bra the appropriate sizer and obtaining visual breast symmetry. The volume of the prosthesis inserted thus estimates the difference in volume between the two breasts. This information can be used for different purposes, as follows: Indication of the volume of the implant to use on the smaller breast if unilateral augmentation has been planned. Indication of the volume difference to keep in the implant size choice if differential bilateral breast augmentation has been planned. Indication of the volume of reduction from the larger breast required to achieve volume symmetry if unilateral breast reduction has been planned (Figs. 1 and 2).Fig. 1.: Positioning in the bra of a 220-ml implant sizer over the left breast to obtain visual symmetry.Fig. 2.: Right breast vertical scar mastopexy surgical planning in a 24-year-old patient with asymmetrical breasts.Indication of the volume difference to maintain between the two reduction specimens where bilateral differential breast reduction is indicated. The first author (F.S.) has used this technique for preoperative assessment of breast asymmetry over the past 10 years in 47 consecutive patients, achieving good results in terms of symmetry. The advantage of this procedure is that it is simple, easily adapted, and very cost effective. It is clear that, if required intraoperatively, appropriate changes to the preoperative measurements should always be made. Fabrizio Schonauer, M.D., Ph.D. Department of Plastic Surgery University “Federico II” Naples, Italy Shivram Singh, F.R.C.S.(Plast.) Selly Oak Hospital Selly Oak Birmingham, United Kingdom Ivan La Rusca, M.D. Guido Molea, M.D., Ph.D. Department of Plastic Surgery University “Federico II” Naples, Italy