Most women have looked in the mirror and had a moment where they believed their breasts were a reflection of self-image. Whether they’re small breasts, large breasts, or average-sized breasts, they can have many implications when it comes to a woman’s mental health. According to recent study published in the journal Plastic and Reconstructive Surgery, asymmetrical (uneven) or macromastia (abnormally large) breasts can lead to mental health problems, from lower self-esteem to eating disorders.

The right versus the left breast of any woman is very often different in size and shape, according to Healthy Women. It's common for girls to have different-sized breasts or nipples, especially as they develop during puberty. This is known as breast asymmetry and affects more than half of all women. Dr. Brian I. Labow, lead author of the study and ASPS Member Surgeon of Boston Children’s Hospital, believes breast asymmetry is more than just a “cosmetic issue” and that it can have negative psychological and emotional effects on women.

In the first study to analyze mental health implications of breast size, Labow and his collegues sought to measure the impact of adolescent breast asymmetry compared with macromastia and females with normal breasts. A total of 59 young women aged 12 to 21 years, who all had breasts differing by at least one bra cup size, were recruited to answer the Short Form Health Survery, Version 2 Short Form-36), the Rosenberg Self-Esteem Scale, and the Eating Attitudes Test. Similar tests were carried out on a group of girls without breast asymmetry.

The tests conducted among all groups of girls ascertained how well the participants functioned psychologically and socially. The females also did a series of tests to score their health-related quality of life. About 40 percent of the participants had tuberous breast deformity — a condition in which the breasts don’t develop normally.

The findings revealed there is a negative impact for women with asymmetrical breasts, extra-large breasts, and those with a relatively mild difference in breast size. Several aspects of mental health and well-being were lower for girls with different-sized breasts compared to those with normal breasts. They also had significantly lower scores for emotional well-being and self-esteem even after researchers adjusted for differences in body weight. Asymmetrical breasts were also associated with borderline issues in social functioning, eating behaviors, and attitudes.

“The observed impaired psychological well-being of adolescents with breast asymmetry may indicate the need for early intervention to minimize negative outcomes,” the authors wrote, according to the press release. The findings raise awareness that no provision currently exists for young women born with different-sized breasts. This means treatment is often not reimbursed by insurance because there is “no functional impairment.”

Labow and his coauthors emphasize this doesn’t necessarily mean surgery, especially for younger girls, "consultation and support" may be appropriate. For girls who have finished growing and still have breast asymmetry, surgical correction may reap emotional benefits for patients. Early interventions should include weight control and mental health counseling.

According to the American Society of Plastic Surgeons' latest statistics, there has been a 70 percent increase in breast lifts and a 37 percent growth in breast augmentation since 2000. Interventions and surgery could make the difference between poorer self-image and confidence for women with breast asymmetry. It could also prevent the onset of mental health issues.

Source: Cerrato FE, DiVasta AD, Faulkner HR et al. Psychological Impact of Breast Asymmetry on Adolescents: A Prospective Cohort Study. Plastic & Reconstructive Surgery. 2014.