title: Our surgical approach to treatment of congenital, developmental, and acquired breast asymmetries: a review of 30 cases.
abstract: BACKGROUND
  Peer pressure and the modern definition of beauty have led people to strive for breast perfection. The aim of our study was to emphasize the importance and frequency of nonmastectomy-related breast asymmetry and explain our approach to such patients using a combination of techniques.
  
  
  METHODS
  We retrospectively reviewed 30 patients with nonmastectomy breast asymmetry (i.e., patients with Poland's syndrome, tumors, burns, and tuberous breasts) admitted to our clinic between 2001 and 2011. Patients were followed up for a mean of 25 months postoperatively (range 4-72 months). These patients completed a satisfaction questionnaire regarding scarring, size, symmetry, shape, and nipple-areola complex sensation.
  
  
  RESULTS
  Patient distribution and preferred treatment method according to etiology were screened. For mild Poland's syndrome, breast implants with symmetrization procedures (when needed) were used. In two patients, however, fat grafting was sufficient to correct the deformity. For severe Poland's syndrome, a tissue expander was first placed and wrapped by regional local flaps, such as the pedicled latissimus dorsi muscle flap, accompanied by fat grafting for infraclavicular depression and an absent anterior axillary fold. After adequate expansion of the skin and muscle flap, a silicone prosthesis replaced the tissue expanders.
  
  
  CONCLUSIONS
  Tissue expanders with or without muscle flaps along with fat grafting in multiple sessions are necessary steps in the treatment of breast asymmetry. Knowledge and application of multiple techniques in a step-by-step fashion helps the surgeon to achieve optimal functional and aesthetic results for each patient.
  
  
  METHODS
  This journal requires that authors  assign a level of evidence to each article. For a full  description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors                       http://www.springer.com/00266                                        .
authors.affiliation: Department of Plastic and Reconstructive Surgery, Sisli Etfal Research and Training Hospital, Istanbul, Turkey.
authors.forename: A K
authors.initials: AK
authors.lastname: Yesilada
authors.forename: K Z
authors.initials: KZ
authors.lastname: Sevim
authors.forename: S S
authors.initials: SS
authors.lastname: Sirvan
authors.forename: S
authors.initials: S
authors.lastname: Karsidag
authors.forename: H S
authors.initials: HS
authors.lastname: Tatlidede
mesh_terms: D000293:Adolescent; D000328:Adult; D001940:Breast / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult