Breast differences can occur in both males and females. There are many different kinds of breast differences, and we only address a few here. For more information and a complete discussion, please schedule a visit with our pediatric plastic surgeons for a consultation.
Poland syndrome occurs when part of the chest muscle is missing, as well as the breast tissue. Normally there is still a nipple, however it is usually smaller than the other side. Hand differences on the same side are common as well.
Accessory breasts and nipples (supernumerary breast and nipples)
Accessory breasts and nipples have a wide range of presentations, from a small third nipple to an entire breast. Usually they are in the same line as the “milk” line, which runs from the armpit down to the groin area. Often these will enlarge during puberty and can even produce milk in a woman during lactation.
Breast asymmetry is common and is actually the rule, rather than the exception. No one has completely symmetrical breasts, however there are times when the asymmetry is dramatic. These differences in size and/or shape can be congenital or have other causes, such trauma at the breast bud. Depending on the degree of asymmetry, a patient might want to change the shape or size of one breast to match the other.
These are uncommon conditions where either the nipple is not present (athelia) or the breast tissue is not present (amastia). Treatment is guided by restoring symmetry to the other side.
Larger breasts or nipples can occur during puberty in males, but they often disappear. There are times, however, when excess breast tissue is present and can lead to a larger, female-like breast. Being overweight can also lead to larger breasts, but with true gynecomastia, there is more overall breast tissue than there should be. When this affects peer relationships and self esteem, gynecomastia can be treated.
Although there is a nipple present, there is also a lack of soft tissue bulk where the breast should be and a noticeable lack of chest muscle. Hand abnormalities can also be present in addition to the lack of chest muscle.
Accessory breasts and nipples can range in appearance from small blemishes or buds to a full actual nipple or an entirely separate breast. These will enlarge with puberty, as the tissue is essentially misplaced nipple or breast tissue.
Difference between breasts in both shape and size is normal. Larger differences usually occur when there has been a trauma that has resulted in damage to the breast bud or nipple, causing breast growth to cease. Burn scarring can also affect breast growth, resulting in a large difference in size.
There is a complete absence of nipple or breast on one side.
There is excess breast tissue and sometimes fat that leads to a feminine breast. It is not uncommon for young boys, as well as males during puberty, to develop a rounder breast. However, when these breasts fail to disappear over time, they can become problematic. Some of these breasts may have extra tissue and drooping, known as ptosis. Although weight loss can help dramatically in many cases, this will not help when there is extra breast tissue present.
The treatment for Poland syndrome, breast asymmetry, athelia and amastia differs depending on the amount of asymmetry involved. Constant communication between the pediatric plastic surgeon and the patient’s family is essential to balance the needs of the patient and his or her development. Not only is physical development important, but social development is equally as important in deciding what kind of reconstruction is best. Pediatric breast reconstruction is different than adult reconstruction because breast growth is not yet complete. This can dramatically affect our reconstructive plan. Every patient is different, and through constant communication we will decide together the best option for the patient.
There are several treatment options available to make breasts more symmetrical. These options include the use of implants as well as utilizing the patient’s own tissue. Implant-based reconstruction uses a saline implant, very similar to a breast augmentation procedure. Depending on the amount of tissue, tightness of the skin and the shape and size of the opposite breast, sometimes an expander might be required. Occasionally, both an implant and natural tissue treatments are used in tandem to conceal the implant if the affected side does not have high-quality skin and tissue.
Treatment involving the use of a patient’s own tissue is typically reserved for patients who are further along in their physical development, and there are two options:
Flap reconstruction uses a tissue from one part of the body and transfers it to the chest, recreating a breast. This is essentially the same procedure used in breast cancer reconstruction.
Fat grafting is another option, and it uses fat from the abdomen, flanks and thighs to graft in the patient’s chest.
Reconstruction depends on the amount of excess breast tissue, as well as excess skin. In milder cases, the excess breast tissue and fat can be suctioned out with liposuction using minimally invasive incisions, allowing excess tissue to redrape. When there is more breast tissue and extra skin, surgical removal of the breast tissue and skin is required. Our goal is to provide the most natural appearance with minimal incisions and scarring. In more severe cases, nipple removal might be necessary but will eventually be grafted back onto the chest, after removal of the excess skin and breast tissue. These are all outpatient procedures and generally take about two hours from start to finish, depending on the amount of tissue removal involved.
The previous descriptions and notes are intended to give an overview and are not at all comprehensive. Should you have any questions or concerns, please do not hesitate to contact the UK Department of Pediatric Plastic Surgery for a clinic consultation.