Small breasts

Disease Description (Causes and Symptoms)

• Definition: A condition in which the breasts are small or underdeveloped because breast tissue has not developed sufficiently (micromastia). This also includes cases caused by atrophy/sagging after childbirth and breastfeeding or due to aging.
• Causes
  • Congenital breast hypoplasia (insufficient development of the mammary glands during the development of secondary sexual characteristics in puberty). In some cases, it may be accompanied by deformities of the chest wall or muscles, such as Poland syndrome.
  • Acquired causes: tissue loss due to breast surgery, radiation therapy, or trauma; age-related atrophy; and others.
• Pathophysiology: Reduced development of glandular and fatty tissue results in small breast volume. The breast structure (ducts and glandular tissue) is generally preserved, so function (milk secretion) is not completely lost. However, lactation ability may be reduced in cases of mammary gland hypoplasia.
• Main symptoms: Primarily cosmetic concerns (small breasts, asymmetry), and rarely psychological or self-image-related discomfort. Physical pain or functional symptoms are uncommon.
• Diagnosis: Clinical examination is fundamental (evaluation of size, symmetry, breast tissue, skin, and nipple status). When necessary, breast ultrasonography, mammography, and other tests may be performed to identify deformities or distinguish other lesions.

Treatment Methods

• Treatment goals: Improve breast volume and shape (for aesthetic purposes) and improve symmetry. Pharmacological treatment to restore function is not standard.
• Nonsurgical methods
  • Temporary alternatives such as wearing external prostheses.
  • Autologous fat grafting: Fat from the patient's body can be grafted to increase volume, but the absorption rate and the possibility of repeated procedures when necessary should be considered.
• Surgical methods (standard treatment)
  • Breast augmentation (insertion of breast implants)
    • Types of implants: saline implants and silicone gel implants (including cohesive silicone gel implants). Each type differs in feel, risks in the event of rupture, weight, and other characteristics, so the choice should be made after discussing the advantages and disadvantages.
    • Placement: beneath the gland (subglandular), beneath the muscle (submuscular), or dual-plane placement.
    • Incision sites: the inframammary fold, around the areola (periareolar), the armpit (axillary), or, rarely, the navel (trans-umbilical), among others. The choice takes into account scarring, surgical access, and effects on breastfeeding.
    • Anesthesia: General anesthesia is generally used.
  • Other surgery: Depending on complex deformities (such as pseudo-symmetry or insufficient skin), surgery to improve the areola or breast shape may be performed at the same time.
• Preoperative/postoperative care and recommendations
  • Before surgery: Assess overall health (including electrocardiography and blood tests), recommend smoking cessation (to reduce the risk of impaired wound healing), and review and adjust medications (such as anticoagulants).
  • After surgery: If a drain is used, it is removed within several days; wear compression bandages or a supportive bra; sutures are removed after 1–2 weeks. Light daily activities may be possible within 1 week, but strenuous arm exercises are generally restricted for 2–3 weeks. Seek medical attention immediately if abnormalities such as infection, bleeding, or severe pain occur.
• Complications and precautions
  • Capsular contracture, causing breast hardening or deformity
  • Implant rupture (especially over the long term); rupture rates differ by implant type
  • Infection, bleeding/hematoma, scarring, changes in nipple sensation (most recover), and effects on the interpretation of mammograms
  • Rare complications such as breast implant-associated T-cell lymphoma (BIA‑ALCL) have been reported; the possibility of an association with textured implants should be assessed
  • Implants are not permanent, so the possibility of long-term follow-up and replacement should be explained
• Follow-up examinations
  • Regular clinical examinations are recommended. In the case of silicone implants, suspected rupture is evaluated with ultrasonography or MRI. A plan for imaging surveillance should be established according to recommendations from the manufacturer and the relevant country.

Outpatient Visit Checklist (Including Preparations, Items to Confirm, and Example Questions)

• Preparations/information to bring
  • List of medications currently being taken (including vitamins, herbal medicines, and anticoagulants)
  • History of previous surgeries and anesthesia
  • Smoking and alcohol use and recent changes
  • History of allergies (including medications and latex)
  • Family history (including breast cancer)
  • Results and images of previous breast examinations (mammography, ultrasonography, and MRI), if available
  • Breastfeeding history and whether pregnancy is planned
• Items useful to record before the outpatient visit
  • When changes in breast size or symmetry began (for example, since adolescence or after childbirth)
  • Whether there is pain, sensory change, or skin abnormality
  • Aesthetic expectations (desired size and shape)
• Simple example questions to prepare for the doctor
  • Assessment of suitability for surgery (including whether growth is complete)
  • Recommended implant type and expected recovery period
  • When daily activities can be resumed after surgery and what restrictions apply

General Example Questions to Ask the Doctor

• What are the advantages and disadvantages of this surgery/procedure? What complications can be expected?
• Which implant (or fat-grafting) option is most suitable for my body type and breast condition?
• How long do implants usually last, and how likely is replacement to be necessary?
• How will the surgery affect future mammography (screening)?
• Will the surgery affect my ability to breastfeed in the future?
• What is the recovery period, and when can I resume daily activities and exercise?

Disease-Specific Example Questions

• In my case, based on my age, developmental status, and body type, how can it be determined whether breast development is complete? (Regarding the timing of surgery)
• What are the advantages and disadvantages of each implant type (saline vs. cohesive silicone gel), and what is the recommended schedule for long-term follow-up examinations?

(Note: Recommendations regarding treatment methods, complications, and follow-up examinations may vary depending on the individual's condition, the healthcare provider's recommendations, country-specific regulations, and the manufacturer's recommendations. Consult the attending physician to determine a specific diagnosis and treatment plan.)