Breast atrophy is the partial or complete loss of glandular and adipose volume within the mammary envelope, most frequently encountered after substantial weight reduction, menopause, prolonged hypo-oestrogenism, or post-operative/radiation changes. Recognition is based on objective volume loss rather than subjective patient perception.
- Decrease in breast projection and circumference
Measurable reduction in bust circumference (> 2 cm compared with baseline) and loss of upper-pole fullness produce a flattened or “deflated” contour. - Excess, lax skin envelope
The mammary skin becomes redundant, often with fine wrinkling and loss of elasticity; the inframammary fold may descend or efface. - Nipple-areolar complex changes
Areolar diameter often decreases, and the nipple may assume a more pendulous position relative to the chest wall; true nipple retraction is absent unless malignant scarring co-exists. - Asymmetry when unilateral
Following surgery or radiotherapy, the affected side appears visibly smaller, with contralateral compensatory hypertrophy accentuating disparity. - Loss of breast tenderness and cyclical variation
Post-menopausal involution abolishes the premenstrual fullness and mastalgia previously experienced; sudden recurrence of pain merits investigation for pathology. - Associated systemic stigmata
Generalised thinning of scalp hair, dry skin, and hot flushes accompany physiological or premature menopause; concurrent loss of axillary/pubic hair suggests pan-hypopituitarism. - Psychosocial impact
Significant distress, avoidance of fitted clothing, and altered body image are common; some patients request reconstructive augmentation or autologous fat grafting. - Absence of underlying mass
On palpation and imaging, only fatty replacement and fibrous strands are evident; any discrete nodule within an atrophic breast requires malignancy exclusion.
| Symptom / Sign | Typical Presentation |
|---|---|
| Volume loss | > 2 cm bust decrease, flattened contour |
| Lax skin | Redundant envelope, fine wrinkles |
| Nipple-areola | Smaller diameter, lower position |
| Asymmetry | Unilateral shrinkage post surgery/RT |
| Cyclical loss | Absence of premenstrual fullness |
| Systemic signs | Hair thinning, hot flushes, dry skin |
| Psychosocial | Clothing avoidance, body-image distress |
| No mass | Only fatty replacement on imaging |