Augmentation mammoplasty for breast volume asymmetry
Authors: V. G. Mishalov  , M. I. Slyusarev  , L. Yu. Markulan  
Published: July 2019

The aim — to evaluate the submuscular augmentation mammoplasty long‑term results in women with relative breast volume asymmetry with identical and different size implants.Materials and methods. The study included 102 women with breast volume asymmetry, in whom the submuscular augmentation mammoplasty was performed in the period from 2012 to 2017 in the Clinic of Plastic Cosmetic Surgery. In the comparison group (n = 49), breast implants of different volume were installed, in the main group (n = 53) — the same volume calculated with developed nomogram and formula. In all cases, anatomical implants were installed. Women in both groups were representative by age, pregnancy rate, breastfeeding, absolute volumetric asymmetry of the breast (in the comparison group — 133.8 ± 3.9 ml (from 78 to 244 ml), in the main group — 134.8 ± 4.2 ml (from 79 to 206 ml), p = 0.907) and relative volumetric asymmetry of the breast (relative breast volume asymmetry) (32.2 ± 0.6 % (from 21.0 to 47.7 %) and (31.9 ± 0.7 % (from 21.4 % to 44.1 %), respectively, p = 0.925). Evaluation of the relative breast volume asymmetry was carried out in 12 — 15 months. According to previously obtained data, the value of relative breast volume asymmetry from 1.1 to 25.4 % can be considered the population norm, from 19.3 to 25.4 % — the upper limit of the norm. In the same period, the presence of such complications as caudal prosthesis migration, breast fluid ptosis, in particular asymmetric ptosis, contouring of the prosthesis were determined. The analysis of the obtained data was performed using descriptive statistics, the comparison of the mean values of the variables was carried out with the Mann — Whitney U‑test, the comparison of the shares of the variables was performed with the χ2‑Pearson test.Results and discussion. The average values of absolute breast volume asymmetry and relative breast volume asymmetry in the comparison group decreased significantly compared with the preoperative values and amounted to 76.7 ± 2.5 ml and 10.9 ± 0.3 %, all p < 0.01 after the submuscular augmentation mammoplasty. The absolute breast volume asymmetry in the main group was not statistically significantly changed (130.8 ± 3.5 ml, p < 0.05), while the value of relative breast volume asymmetry has significantly decreased (15.5 ± 0.3 %, p < 0, 01) and was within the population norm. By mean values, the indices of absolute and relative breast volume asymmetry in the main group were statistically significantly higher compared with those in the comparison group (p < 0.05). Aesthetic complications occurred in 33 (32.4 %) women: in 17 (34.7 %) in the control group and in 16 (30.2 %) in the main group: one complication in 11 (22.4 %) women in the comparison group and 12 (22.6 %) in the main group, two complications respectively in 5 (10.2 %) and 4 (7.5 %), three complications in 1 (2, 0 %) women in the comparison group (p = 0.714) in 12 — 15 months after submuscular augmentation mammoplasty. The groups did not statistically significantly differ in the incidence of complications such as caudal implant migration (p = 0.453), contour implant contouring (p = 0.638) and breast ptosis (p = 0.330), but in women in the comparison group, asymmetrical ptosis occurred with a statistically significantly higher frequency (in 8 (16.3 %) versus 1 (1.9 %) in the main group, p = 0.019). These women, despite the elimination of the volumetric asymmetry of the breast, considered the result of the operation unsatisfactory.Results and discussion. The technique of breast volume asymmetry correction with submuscular augmentation mammoplasty using identical prostheses, the volume of which is calculated according to the developed method, makes it possible to reduce the relative breast volume asymmetry value to the limits of the norm and, unlike the use of prostheses of various sizes, is associated with a statistically significantly lower frequency of breast asymmetric ptosis 2 — 3rd degree in the postoperative period.Key words: breast volume asymmetry; submuscular augmentation mammoplasty; treatment.