Suspended breast asymmetry

Specialty: Gynecology and breast.

• Unilateral breast size change
• increase in breast volume
• acquired breast asymmetry

Why it occurs

• Large, rapidly growing nodule (giant fibroadenoma, phyllodes tumor)
• Simple breast cyst of large volume and rapid development
• Occult or delayed post-traumatic hematoma
• Diffuse infiltrating lobular carcinoma or breast sarcoma
• Unilateral juvenile breast hypertrophy (in adolescents)

Initial workup

Detailed breast ultrasound and bilateral mammography (in people over 35 years of age or if there is suspicion of malignancy). Breast MRI with intravenous contrast to accurately assess the limits of the lesion and rule out infiltration of the pectoral muscles. Core needle biopsy (CNB) of any solid mass detected to differentiate fibroadenoma, phyllodes tumor or carcinoma.

Standard management

• There is no medical treatment available for new-onset structural asymmetry. If a benign or malignant phyllodes tumor is confirmed, the treatment is wide surgical excision with free margins. If a giant simple tension cyst is confirmed, fine-needle aspiration is performed under ultrasound guidance, which usually resolves the asymmetry immediately.