Breast Asymmetry, Classification and Algorithm of Treatment: Our Experience

Dear editors, We read with great interest the article titled ‘‘Breast asymmetry, classification and algorithm of treatment: our experience’’ by Roy de Vita et al. The authors reported extremely interesting considerations among multiple aspects regarding one of the most sensitive items basing on their very wide experience.The authors proposed an algorithm for surgical correction of breast asymmetry, focusing their attention mainly on patients’ awareness of their disorder. We congratulate the authors for their results and for their effort to give surgical suggestion in correcting these very difficult aspects, that, in our experience, is one of the main reasons for complaints. We completely agree with the authors that correction of asymmetry represents one of the main fields of interest in breast surgery and therefore a real challenge for plastic surgeons because this issue requires a lot of technical experience and personal sensibility, including real criticism position by the surgeons. We also retain that patients must be considered as a central figure in the decision-making process, but we have some elements to discuss. Asymmetry conditions include objective parameters such as shape, volume and ptosis of the breasts. Although the patient’s awareness of the disorder is a crucial issue that may influence their preoperative self-confidence and postoperative satisfaction with the final results, we retain that objective parameters should be considered in the threegroup classification proposed by the authors. Including also objective measurements during patients’ classification into the different three groups should have been concretely considered [1, 2]. We completely agree with the authors that, in the presence of volume asymmetry, the reduction in the larger breast allows for use of more similar breast implants with the aim to ensure more stable and long-lasting results. We retain, as pointed out by the authors, that acquired breast asymmetry, in particular tuberous breast correction, should not be excluded from the paper because it represents one of the typical and extremely challenging examples of breast asymmetry correction due to multiple clinical aspects involved in the malformation [3–5]. The authors reported personal experience in fat grafting to achieve the symmetry. What kind of importance do they attribute to fat grafting in long-lasting results to maintain symmetry? Certainly, 48 months is a considerable followup, but for this sensitive procedure, longer evaluation should be taken into consideration due to the high variability in breast assessment during aging and/or ponderal modifications.