title: [Constitutional asymmetries in aesthetic breast augmentation: incidence, postoperative satisfaction and surgical options].
abstract: BACKGROUND
  The clinically observable, constitutional breast asymmetries are frequent and physiological in the general population. Although there has been a preponderance of literature concerning breast augmentation, a conspicuous lack of data exists regarding the preoperative breast and chest wall asymmetries seen in the patient seeking consultation for aesthetic breast augmentation. These asymmetries can lead to postoperative dissatisfaction in patients.
  
  
  METHODS
  An independent plastic surgeon analysed the data of 200 patients who had a primary aesthetic breast augmentation. The mean follow-up was 36 months. All patients had pre- and postoperative standardized pictures of the anterior chest wall. The clinical examination was achieved using an original evaluation form. Patients were also asked to fill an exhaustive satisfaction form. Breasts and chest wall asymmetries were diagnosed by clinical examination and photographic analysis. Mastopexy-augmentations, breast reconstructions, breast malformations (tuberous breasts and Poland syndrome) and patients with incomplete data were excluded from the study. Stastical analysis was done using SPSS software version 15.
  
  
  RESULTS
  There were 77% of chest wall and breast asymmetries and 69,5% of breasts asymmetries (26,5% of breast mound volume asymmetry and 62,5% of shape asymmetry). An isolated chest wall asymmetry was found in 17% of patients. Scoliosis was the main cause of asymmetry (52,9% of chest wall asymmetries) as it is often associated with chest wall rotation, chest wall depression, submammary depression or rib asymmetry. Patients often noticed an asymmetry postoperatively (28%). Among the patients complaining from a postoperative asymmetry, 83,3% had a constitutional breast or chest wall asymmetry. Asymmetry was the third cause of dissatisfaction and the third argument for revision surgery (after volume dissatisfaction and ptosis). Thirty per cent of patients asking for a surgical revision and 35.3% of unsatisfied patients complained about asymmetry, which was preoperative in 83.3% of cases.
  
  
  CONCLUSIONS
  The asymmetry rate of our study is compared with the others studies found in the literature. In the daily practice, asymmetry can be diagnosed by a complete clinical examination and standardized chest wall pictures. Patients with constitutional asymmetry should be educated, helping to increase postoperative satisfaction. The authors propose and discuss a surgical pattern for the handling of the different types of asymmetries in breast augmentation.
authors.affiliation: Service de chirurgie plastique, réparatrice et esthétique, hôpital St-Roch, 5, rue Pierre-Dévoluy, 06000 Nice, France. v.mdc@mac.com
authors.forename: V
authors.initials: V
authors.lastname: Médard de Chardon
authors.forename: T
authors.initials: T
authors.lastname: Balaguer
authors.forename: B
authors.initials: B
authors.lastname: Chignon-Sicard
authors.forename: T
authors.initials: T
authors.lastname: Ihrai
authors.forename: E
authors.initials: E
authors.lastname: Lebreton