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Psychological Impact of Breast Asymmetry on Adolescents: A Prospective Cohort Study

Nuzzi, Laura C. B.A.; Cerrato, Felecia E. M.P.H.; Webb, Michelle L. P.A.-C.; Faulkner, Heather R. M.D., M.P.H.; Walsh, Erika M. M.D.; DiVasta, Amy D. M.D., M.M.Sc.; Greene, Arin K. M.D., M.M.Sc.; Labow, Brian I. M.D.

Plastic and Reconstructive Surgery: December 2014 - Volume 134 - Issue 6 - p 1116–1123
doi: 10.1097/PRS.0000000000000736
Breast: Outcomes Article
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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.


Video Discussion by Patrick Garvey, M.D., is available online for this article.

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.

Received for publication March 12, 2014; accepted June 6, 2014.

Disclosure: The authors have no financial interest to declare regarding the content of this article.

A Video Discussion by Dr. Garvey accompanies this article. Go to and click on “Video Discussions” in the “Videos” tab to watch.

This work was supported by THE PLASTIC SURGERY FOUNDATION.

Brian I. Labow, M.D., Department of Plastic and Oral Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Mass. 02115,

©2014American Society of Plastic Surgeons