Comment to: “Comparison of Same Versus Different Projection Implants in Asymmetric Tuberous Breasts: Long-Term Outcomes and Patient Satisfaction Analysis”

Dear Editors, We read with great interest the paper titled ‘‘Comparison of Same Versus Different Projection Implants in Asymmetric Tuberous Breasts: Long-Term Outcomes and Patient Satisfaction Analysis’’ by Barone, Mauro et al. [1]. Symmetry is commonly defined as balanced and harmonic correspondence in size, shape, projection and positioning appearance between elements. Breast asymmetry is a common disorder which can led a significant emotional distress. It may include different clinical features such as: size, volume, shape, position and projection of the mammary cone. It can also concern the nipple-areola-complex and the infra-mammary-fold. Depending on several factors, correction of breast asymmetry is a real challenge, especially in the presence of tuberous breast (TB) disorder. The Authors proposed a real interesting analysis comparing same versus different projection implants in TB correction, but we have some elements to discuss. Breasts is a soft appendage consisting of fat and glad wrapped in a skin envelope. Since these two different tissues act in very dissimilar way to the physiological inputs, a woman’s breasts are considered to be highly dimorphic body parts, at the same or different time and in different conditions. Their mutability represents an additional delicate difficulty that requires complex and articulated clinical and surgical considerations. For these reasons, surgical correction procedures of asymmetric breasts represent a significant challenge for surgeons, particularly when aiming for long-lasting results [2–5]. Following the variations in body weight, each breast will change its volume independently, according to the percentage of adipose tissues present. In the same way, breast appearance is affected by the glandular modifications resulting from the hormonal stimuli or the aging process; the entity of these changes diverges between the two mammary cones, according to the percentage of parenchyma present in each breast. We completely agree with the Authors that different implants could efficiently restore volume discrepancy, but acting in very dissimilar way, fat and glands might suffer from different modifications in the same subject, at the same or at different times and in different conditions with a high risk of recurrence of the asymmetry disorder over time. Removal of parenchymal surplus from the bigger breast, could help the surgeon to rebalance the volume among the breasts, allowing more similar implants and probably more stable results over time, reducing the recurrence of unbalanced breast appearances. Due to the high dimorphism of the breast, despite a satisfactory result in the short-term post-op, the recurrence of asymmetry between two separate organs, so close one to each other in the thorax is one of the most common weak points of breast recontouring. For these reasons, in order to fully assess the results of asymmetric tuberous breast correction, patients should be required to attend a longer post