Breast asymmetries: Classification and systematic review

Pietro Susini; Anastasia Fidanza; Luca Grimaldi; Giuseppe Nisi; Roberto Cuomo; Mattia Brogi; Giulio Menichini; Luca Delcroix; Aurelio Portincasa; Alessandro Innocenti

doi:10.23750/abm.v96i5.16961

Breast asymmetries: Classification and systematic review

Authors

Pietro Susini Department of Medicine, Surgery and Neuroscience – University of Siena – Italy
Anastasia Fidanza Plastic and Reconstructive Microsurgery - Careggi University Hospital, Florence, Italy
Luca Grimaldi Department of Medicine, Surgery and Neuroscience – University of Siena – Italy
Giuseppe Nisi Department of Medicine, Surgery and Neuroscience – University of Siena – Italy
Roberto Cuomo Department of Medicine, Surgery and Neuroscience – University of Siena – Italy
Mattia Brogi Plastic and Reconstructive Microsurgery - Careggi University Hospital, Florence, Italy
Giulio Menichini Plastic and Reconstructive Microsurgery - Careggi University Hospital, Florence, Italy
Luca Delcroix Plastic and Reconstructive Microsurgery - Careggi University Hospital, Florence, Italy
Aurelio Portincasa Department of Plastic and Reconstructive Surgery, Foggia Medical School, University of Foggia, via Pinto, Foggia, Italy
Alessandro Innocenti Plastic and Reconstructive Microsurgery - Careggi University Hospital, Florence, Italy

Keywords:

Breast asymmetry AND surgery; breast asymmetry AND classification; breast shape asymmetry; nipple areola asymmetry; acquired breast asymmetry; congenital breast asymmetry.

Abstract

Background and aim: Several classification systems have been proposed for breast asymmetries (BAs) considering volume, shape, position, nipple-areola complex and inframammary fold. In addition, breast consistency should be considered as an additional topic. The latter, although poorly investigated, depends on the adipo-glandular ratio of each breast. Since fat and gland undergo different changes in response to specific stimuli, breasts with different consistency can behave differently over time, even in the same subject, potentially leading to asymmetry. The present review aims to propose a comprehensive classification system of BAs, including the minor forms, taking into account, among the common clinical features, the preoperative consistence of breast tissue.

Methods: A PRISMA systematic review was carried out on the PubMed library from June 2004 to June 2024 searching for studies on BAs original classifications and management strategies.

Results: Thirty-six articles and 3979 patients were included. Specifically, 26 papers on BAs management strategies and 10 articles on BAs original classifications.

Conclusions: BAs of the NAC, the IMF and the breast cone can be distinguished into idiopathic or secondary and following quantitative (volume and projection) and qualitative parameters (shape, position and consistency). Consistency is particularly relevant for surgical stability of the results over time. Therefore, the preoperative evaluation should not be limited to a simple visual inspection but requires a careful palpatory comparison of each breast in order to assess any qualitative BAs and plan the appropriate strategy, aiming to improve surgical results and their long-term stability. (www.actabiomedica.it)

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