Understanding breast asymmetry and its relation to AIS

Study design: Literature Review. Objective: Review the pathophysiology, causes, and treatment of breast asymmetry in patients with adolescent idiopathic scoliosis (AIS), as well as postoperative patient assessment and health-related quality of life. Background data: Female breast development begins at 35-day gestation and continues 2–4-year post-thelarche to achieve final volume and shape. During the post-pubertal period, errors in growth and development may result in breast asymmetry. Breast asymmetry typically attenuates with time, but can be pronounced in individuals with AIS. During adolescence, there is rapid development and, thus AIS patients are increasingly sensitive, physically and emotionally, to breast changes. While breast asymmetry can be monitored through radiographic measures and surface topography, pre- and postoperative patient assessment is also critical in determination of optimal patient treatment. Methods: A comprehensive literature review was performed on the pathophysiology, causes, and treatment of breast asymmetry. The advantages and limitations of various treatment options based on patient satisfaction were also investigated. Results: Various treatment options exist for breast asymmetry correction in AIS patients. Surgical correction involves an aesthetic outcome, as well as social, physical, and psychological impact on the patient. Despite the benefit of correction surgery, in terms of function and self-image, patient-reported outcomes still appear lower postoperatively in the domains of pain and mental health. Conclusion: Breast asymmetry is very common, especially among AIS patients, and is often corrected with surgical augmentation. AIS correction surgery has been shown to aggravate breast asymmetry and negatively affect patient-reported outcomes. Other treatment modalities should thus be considered when presented with an adolescent patient. Understanding patient concerns and their relation to quality of life will help guide surgical and medical interventions in correction of AIS deformities. Long-term follow-up studies are necessary to determine whether such interventions are successful and if patients remain healthy. Level of evidence: N/A.