In short. A difference that is new, changing, or comes with a lump or discharge is a diagnostic problem first. Why imaging comes before any planning.
Key points
- These are the two most useful pieces of information you can bring, and they are the ones patients most often have to guess at.
- A difference that has been present since the breasts developed and has not changed is a different situation from one noticed six months ago.
- Before an appointment, write down when you first noticed it and what, if anything, has altered since.
Asymmetry is common, and most of it is an anatomical finding rather than a disease. A proportion of it is not, which is why the assessment of a difference between the breasts begins by establishing what kind of difference it is rather than by planning an operation.
The history that changes the route
Three things move a patient from the cosmetic route to the diagnostic one. A difference that is new, meaning it was not present during development and has appeared since. A difference that is changing, in size, in shape, or in the skin over it. And a difference accompanied by something else: a lump that can be felt, a change in the skin, discharge from the nipple, or a change in the nipple itself. Any of those means the finding is assessed first and planned afterwards, if it is planned at all.
Note when you first noticed it, and whether it has changed
These are the two most useful pieces of information you can bring, and they are the ones patients most often have to guess at. A difference that has been present since the breasts developed and has not changed is a different situation from one noticed six months ago. Before an appointment, write down when you first noticed it and what, if anything, has altered since. If you are not sure, say that you are not sure.
What the assessment involves
An examination of both breasts and of the lymph nodes, and imaging where the history or the findings call for it. Which imaging is used depends on your age, your history and what the examination shows, and it is a decision made by the clinician rather than by the patient. Where a finding needs to be characterised further, a sample of tissue is taken. None of this is unusual, and none of it is a reason to be alarmed before a result exists.
Why it comes before the plan
Because a plan built on an unassessed finding is a plan built on an assumption. If the difference turns out to be an anatomical one, the planning proceeds. If it turns out to be something that needs treatment in its own right, that treatment comes first, and the question of symmetry is revisited afterwards. The order matters more than the speed, and no reputable assessment will reverse it.
Findings that need assessment before any plan
- A difference that has appeared recently, or that is changing in size or shape.
- A lump that can be felt, or a change in the skin over either breast.
- Discharge from the nipple, or a change in the nipple itself.
The purpose of this page is not to alarm anyone. It is to make clear that the cosmetic route and the diagnostic route are two different routes, that the second one is taken when the history calls for it, and that being sent down it is a sign of a careful assessment rather than of something being wrong.
Frequently asked questions
When is a difference a diagnostic problem rather than a surgical one?
When it is new rather than lifelong, when it is changing, or when it comes with a lump, a skin change, nipple discharge or a change in the nipple itself. Any of those means the finding is assessed as a diagnostic question before it is planned as an anatomical one, and that assessment comes first rather than alongside a cosmetic plan.
What does the diagnostic assessment involve?
An examination of both breasts and the lymph nodes, and imaging where the history or the findings call for it, which may include a mammogram, an ultrasound, or both. Depending on what is found, a sample of tissue may be taken. It is a standard pathway rather than an unusual one, and it is arranged by the clinician who examined you.
Does an always-present difference need imaging?
Not necessarily. A difference that has been there since development and has not changed follows the ordinary planning route, subject to your age and history and to what the examination finds. What triggers the diagnostic route is change, or a finding in the breast itself rather than a difference between the two.
Risks & Limitations
- No operation produces a matched pair. The two sides start differently and heal on different schedules, so a small residual difference in size, shape or position is the expected outcome rather than a complication.
- The recovery is that of the larger of the two operations in the plan, not an average. A lift carries scars that an augmentation does not, and a longer period for those scars to mature.
- Where the difference is partly in the chest wall, that part cannot be corrected from the breast and will remain after the operation.
- Scars are permanent, and a plan that treats the two sides differently leaves scars of two different kinds.
- A difference that is new, changing, or accompanied by a lump, skin change or nipple discharge is assessed as a diagnostic question before any surgical planning.
- Changes in nipple or skin sensation may occur, are often temporary, and may be lasting. Where an implant is used, its own long-term considerations apply.
When to Seek Care
- A new lump, a change in the skin over either breast, discharge from the nipple, or a change in the nipple itself &mdash — have it assessed promptly rather than waiting for a cosmetic appointment.
- Fever, spreading redness, warmth or discharge from a wound, or a wound that is opening.
- A breast that becomes hard, swollen, painful or red around an implant &mdash — contact the team the same day.
- Calf pain, swelling or tenderness in one leg, or shortness of breath or chest pain &mdash — seek emergency care at once.
- Chest pain, breathlessness or a racing heartbeat after surgery &mdash — seek emergency care at once.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) - breast surgery and patient safety guidance
- National Institute for Health and Care Excellence (NICE, UK) - guidance on breast surgery and on venous thromboembolism prevention
- Cochrane Library - systematic reviews in breast surgery and wound care
- British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) - patient information on breast surgery
- Chinese Medical Association Plastic Surgery Branch - clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.