Breast Asymmetry, Classification, and Algorithm of Treatment: Our Experience

Roy de Vita, Ernesto Maria Buccheri, Amedeo Villanucci, Luigi Amerigo Ragusa

Research output: Contribution to journalArticlepeer-review


Background: In the literature, several classifications of breast asymmetries and treatment protocols have been proposed over time, which are mainly based on etiological or morphological characteristics of the deformity. The aim of this study was to present our new classification, based on patient’s self-consciousness of breast asymmetry, a simple and reliable treatment algorithm is also presented. Methods: The case series included 343 patients treated between January 2006 and January 2015. Only patients presenting with developmental breast asymmetries were included in the study. All patients underwent prior classification in three groups based on the patient's degree of awareness of their asymmetry. A specific treatment algorithm was associated with each group according to breast size, grade of ptosis, and patient’s desire. At the 48-month follow-up appointment, patients completed an anonymous questionnaire that addressed satisfaction with breast shape, size, and symmetry, scar appearance, body perception, self-esteem, perceived attractiveness, intimate life, and overall feelings about their breasts. Results: Mean patient age was 24.6 years (range 18–57 years). Mean follow-up was 54.4 months (6 months to 9 years). At the 48-month follow-up, 66.7% of the patients completed a visual analog scale (VAS) satisfaction questionnaire. An overall satisfaction rate of 77.0% was reported, and a statistically significant difference in the distribution of the overall satisfaction between groups was found. No patient expressed complete dissatisfaction. Conclusions: The proposed classification and the surgical algorithm is a simple, applicable, and reliable method to assess and treat breast asymmetries with a high satisfaction rate as confirmed from our results. Level of Evidence IV: 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 Table of Contents or the online Instructions to Authors

Original languageEnglish
Pages (from-to)1439-1450
Number of pages12
JournalAesthetic Plastic Surgery
Issue number6
Publication statusPublished - Dec 1 2019


  • Breast asymmetry
  • Classification
  • Outcomes
  • Treatment algorithm

ASJC Scopus subject areas

  • Surgery


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