shutterstock_49230532Breast asymmetry can have profound psychological effects on adolescent girls, according to a new study in the December issue of Plastic and Reconstructive Surgery®.

“These findings suggest that patients suffering from breast asymmetry have poorer emotional well-being and lower self-esteem than their female peers,” conclude researchers who were led by Brian I. Labow, MD, and colleagues at the Boston Children’s Hospital.

The new study is the first to focus on the mental health impact of breast asymmetry.

Researchers evaluated psychosocial functioning and health-related quality of life in 59 adolescents and young women aged 12 to 21 with breast asymmetry. In all patients, the breasts differed by at least one bra cup size. About 40% of girls with breast asymmetry had tuberous breast deformity. Similar evaluations were performed in a group of girls without breast asymmetry and in girls with macromastia.

After adjustment for differences in body weight, breast asymmetry was associated with significantly lower scores for emotional well-being and self-esteem when compared to breasts without asymmetry, the study showed. The mental health impact is similar for girls with mild versus more severe breast asymmetry.

What’s more, these differences were similar to those seen in study participants with macromastia, and also resemble similar findings in boys with enlarged breasts and even women with differences in the breasts related to breast cancer surgery.

Breast asymmetry was also associated with “borderline” issues in social functional and eating behaviors and attitudes.

Role for Early Intervention Highlighted

Early intervention may have mental health benefits for young women with even relatively mild breast size differences, the study authors suggest.

Although federal provisions ensure insurance coverage for surgery to correct asymmetry in breast cancer survivors due to the known psychological effects, no such provisions exist for younger women with congenital breast asymmetry. As a result, treatment for breast asymmetry in adolescents is often not reimbursed by insurance, with the justification that there is “no functional impairment,” study authors write.

“The observed impaired psychological well-being of adolescents with breast asymmetry may indicate the need for early intervention to minimize negative outcomes,” researchers write. They note that this doesn’t necessarily mean surgery; especially for younger girls, “consultation and support” may be appropriate.

However, for girls who are finished growing and still have breast asymmetry, surgical correction may have important emotional benefits. “Though substantial barriers to care exist, early evaluation and intervention for these patients may be beneficial, and should include weight control and mental health counseling,” Labow and colleagues conclude.

“This important study was able to conclude that breast asymmetry—which, unfortunately, is often classified as a cosmetic issue—is truly a condition which has lasting psychological and emotional effects, just like macromastia,” says Plastic and Reconstructive Surgery® Editor-in-Chief Rod J. Rohrich, MD.