Differences in breast size have a significant mental health impact in adolescent girls, affecting self-esteem, emotional well-being, and social functioning, reports the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

More than just a “cosmetic issue,” breast asymmetry can have negative psychological and emotional effects, according to the study by ASPS Member Surgeon Dr. Brian I. Labow and colleagues of Boston Children’s Hospital. They suggest that early intervention may have mental health benefits for young women with even relatively mild breast size differences.

Mental Health Impact of Breast Asymmetry in Adolescent Girls

The researchers evaluated psychosocial functioning and health-related quality of life in 59 adolescents and young women (12 to 21 years) with breast asymmetry. In all patients, the breasts differed by at least one bra cup size. Similar evaluations were performed in a group of girls without breast asymmetry, and in girls with macromastia (overlarge breasts).

Mean age was about 17 years in all groups. About 40 percent of girls with breast asymmetry had tuberous breast deformity, a congenital condition in which the breasts don’t develop normally.

Several aspects of mental health and well-being were lower for girls with breast asymmetry, compared to those with “normal” breasts. After adjustment for differences in body weight, breast asymmetry was associated with significantly lower scores for emotional well-being and self-esteem.

The differences were similar to those in girls with macromastia–another common condition with a known mental health impact. Breast asymmetry was also associated with “borderline” issues in social functional and eating behaviors and attitudes.

Not Just a Cosmetic Issue–Intervention May Have Mental Health Benefits

Differences in breast size are common, especially in early adolescence. The breasts usually even out over time, but in some girls the difference persists after puberty. The new study is the first to focus on the mental health impact of breast asymmetry.

“These findings suggest that patients suffering from breast asymmetry have poorer emotional well-being and lower self-esteem than their female peers,” Dr. Labow and coauthors write. They note that the mental health impact is similar for girls with mild versus more severe breast asymmetry.

The psychosocial effects of breast asymmetry are similar to those in girls with overlarge breasts–as well as in boys with enlarged breasts and even women with differences in the breasts related to breast cancer surgery. The researchers note that although federal provisions ensure insurance coverage for surgery to correct asymmetry in breast cancer survivors due to the known psychological effects, no such provisions exist for younger women with congenital breast asymmetry. As a result, treatment for breast asymmetry in adolescents is often not reimbursed by insurance, with the justification that there is “no functional impairment.”

“The observed impaired psychological well-being of adolescents with breast asymmetry may indicate the need for early intervention to minimize negative outcomes,” Dr. Labow and coauthors write. They note that this doesn’t necessarily mean surgery–especially for younger girls, “consultation and support” may be appropriate.

However, for girls who are finished growing and still have breast asymmetry, surgical correction may have important emotional benefits. “Though substantial barriers to care exist, early evaluation and intervention for these patients may be beneficial, and should include weight control and mental health counseling,” Dr. Labow and colleagues conclude.

In this month’s introductory video on the Plastic and Reconstructive Surgery website, Editor-in-Chief Dr. Rod J. Rohrich discusses the new findings. Rohrich comments, “This important study was able to conclude that breast asymmetry–which, unfortunately, is often classified as a cosmetic issue–is truly a condition which has lasting psychological and emotional effects, just like macromastia.”