Our 10 Years’ Experience in Breast Asymmetry Correction

We read with great interest the article titled: ‘‘Our 10 Years’ experience in Breast asymmetry correction’’ by Patlazhan G. et al. The authors presented their personal experience with breast asymmetry correction, reporting a very large case series including different types of clinical findings. We completely agree with the authors that correction of asymmetry is a common problem in breast surgery, representing a difficult challenge for plastic surgeons, including preservation of the long-term results. Breast surgery includes a wide range of clinical aspects, and therefore, every single case should be carefully evaluated. We congratulate the authors for the significant number of presented cases and results, but we have some elements to discuss. According to the authors, simple augmentation mammoplasty with different implants in patients with native breast asymmetry could not be sufficient and breast glands should be remodelled to achieve a long-term satisfactory symmetry. The authors’ personal classification of asymmetry includes shape, volume, presence and severity of ptosis and nipple–areola complex aspects, but we believe that also the difference in consistency between the breasts, including gland and soft tissue coverage, should be considered and included as parameter in the classification of breast asymmetry. This parameter is a very sensitive finding, especially in some congenital breast malformations such as tuberous breasts because different consistencies strictly reflect in maintaining long-term symmetry [1–3]. Authors proposed the Volume Shift Test (VST) to assess breast asymmetry preoperatively as well as during the surgical procedure. While intraoperative VST is a real objective evaluation of asymmetry, preoperative VST is very subjective and affected by personal sensibility based on a great experience and therefore it could be useful for experienced surgeons. We cannot agree with the authors that in size 1-mammary glands-Grade 1-asymmetry patients, different implants alone could be sufficient to maintain long-term results. Forty ml in difference could be considered a very low difference in larger breasts, but it could represent a very sensitive issue producing an evident asymmetry over time for size 1 mammary glands-Grade 1-asymmetry patients, strongly reflecting in conserving long-term stability of surgical correction [1]. In fact, this relatively small amount of breast in this type of patient could be considerably modified during the woman’s life and therefore gland reduction of the bigger breast should be considered also in size 1-mammary glands-Grade 1-asymmetry patients. Moreover, breast reduction of size 1-mammary glands-Grade 1-asymmetry patients represents a non-invasive surgical step without particular morbidities [4, 5].