It’s extremely rare for two breasts to be perfectly symmetrical. Most women have some degree of asymmetry, but the difference is usually not significant enough to notice while wearing a bra, bathing suit or even with the naked eye.  But sometimes, the asymmetry is more pronounced. Generally, when breasts differ by one cup size or more, this is considered abnormal and cosmetic plastic surgery is seen as the best treatment.

Causes of breast asymmetry include genetics, hormones, certain birth control medications, degenerative disease, pregnancy and menopause.  But there is another very rare condition called Poland’s Syndrome that also causes pronounced breast asymmetry.

What is Poland’s Syndrome?

Poland’s Syndrome is named for not for the country but for a 19th-century British surgeon named Sir Alfred Poland who was the first to discover it.

Poland’s Syndrome is a congenital defect present at birth that is marked by the absence of the big chest muscle (pectoralis) on one side of the body and the webbing of the fingers on the hand of the same side.

The four characteristics of Poland’s Syndrome are

1) shortened index, middle and ring fingers

2) syndactyly (webbing) of those same fingers,

3) underdevelopment of the hand and

4) the absence of the one chest muscle.

All of the characteristics affect only one side of the body.  Patients may have varying amounts of Poland’s syndrome-  in other words, there is definite asymmetry, but how much variation depends on the patient.

While the cause is unknown, we do know that men are twice as likely to have Poland’s Syndrome as women and it is five times more likely to affect the right side than the left, but overall, it is extremely rare.  Less than 200,000 people in the United States have Poland’s Syndrome.  It is estimated to affect 1 out of 20,000-30,000 live births.  But when a woman does have Poland’s Syndrome, it is likely that she will have severely asymmetric breasts or even no breast or nipple on side.

How Does Breast Augmentation Correct Poland’s Syndrome?

Typically, breast asymmetry is fairly easy to correct.  Plastic surgeons simply work with the patient to choose the desired size for both breasts.  The surgeon then uses measurements to account for the different volumes of implants needed. Appropriate adjustments are made and the larger implant is used on the smaller side.

Poland’s Syndrome presents some unique challenges for the surgeon because the missing chest muscle makes it difficult to determine how the implant will sit inside the chest.  In addition, the deformity of the chest makes saline breast implants more likely to rupture and deflate.  During the many years that silicone implants were banned by the FDA, saline implants were found to be less than ideal for correcting asymmetry due to Poland’s Syndrome.

Today, silicone implants are the preferred implant material and their solid gel make-up makes them ideal for withstanding pressure and resisting movement due to unusual anatomy.  But unlike saline implants, which are filled with saline after being inserted into the breast pockets, silicone implants are only available in pre-sized volumes.  So it’s a bit more difficult to be sure that silicone implant(s) will look symmetrical once they are placed inside the patient.

How do I ensure a good match? I use a temporary saline implant in the operating room.  After inserting it into the smaller breast, I fill it with saline solution until it matches the other side both while reclined and while the patient is sitting up.  Then I take out the temporary sizer, choose a silicone implant that matches the sizer, and fill the pocket with the appropriate implant.

If you have breast asymmetry, regardless of the cause, cosmetic breast augmentation on one or both sides can help.  To schedule a consultation, please contact our patient care coordinator, Caroline, at 415-354-8148.


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