title: Psychological impact of breast asymmetry on adolescents: a prospective cohort study.
abstract: BACKGROUND
  This study measures the impact of adolescent breast asymmetry compared with macromastia and female controls.
  
  
  METHODS
  The following surveys were given to patients with breast asymmetry, macromastia, and controls aged 12 to 21 years: Short Form Health Survey, Version 2 (Short Form-36), the Rosenberg Self-Esteem Scale, and the Eating Attitudes Test. Demographics were compared, and linear regression models, adjusted for body mass index category and age, were fit to determine the effect of case status on survey score.
  
  
  RESULTS
  Fifty-nine adolescents with asymmetry, 142 controls, and 160 macromastia patients participated. After controlling for differences in body mass index category, asymmetry patients scored lower on psychological Short Form-36 domains and the Rosenberg Self-Esteem Scale than controls (p < 0.05), but did not differ in physical health. When compared with macromastia adolescents, asymmetry patients scored significantly better on Short Form-36 physical health domains (p < 0.05), but had similar decrements in emotional functioning, mental health, self-esteem, and eating behaviors/attitudes, after accounting for differences in age. Age and asymmetry type and severity had no effect on survey scores, independent of body mass index category (p > 0.05). Asymmetry patients had a higher mean body mass index percentile than controls (83.36 versus 73.52) but did not differ from that of macromastia patients (83.39).
  
  
  CONCLUSIONS
  Breast asymmetry may negatively impact the psychological quality of life of adolescents similar to macromastia. Breast asymmetry is not just a cosmetic issue. Providers should be aware of the psychological impairments associated with asymmetry and provide proper support.
authors.affiliation: Boston, Mass. From the Adolescent Breast Clinic, Department of Plastic and Oral Surgery, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital and Harvard Medical School.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Nuzzi
authors.forename: Felecia E
authors.initials: FE
authors.lastname: Cerrato
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Webb
authors.forename: Heather R
authors.initials: HR
authors.lastname: Faulkner
authors.forename: Erika M
authors.initials: EM
authors.lastname: Walsh
authors.forename: Amy D
authors.initials: AD
authors.lastname: DiVasta
authors.forename: Arin K
authors.initials: AK
authors.lastname: Greene
authors.forename: Brian I
authors.initials: BI
authors.lastname: Labow
mesh_terms: D000293:Adolescent; D001828:Body Image; D001940:Breast / Q000002:abnormalities*; D016022:Case-Control Studies; D002648:Child; D005247:Feeding Behavior; D005260:Female; D006306:Health Surveys; D006801:Humans; D006984:Hypertrophy / Q000523:psychology; D016014:Linear Models; D008603:Mental Health; D011446:Prospective Studies; D012649:Self Concept; D011795:Surveys and Questionnaires; D055815:Young Adult