Breast Augmentation with Breast Asymmetry

Almost all my Boston breast augmentation patients are surprised to learn during their initial consultation that they have breast asymmetry. I reassure my patients that 88% of women have different sized or asymmetrical breasts and it is normal to have breast asymmetry.

 I believe that most patients are not aware of their breast asymmetry because women do not study their breasts visually carefully.  However once patients have breast implants especially in the first weeks after surgery they study their breasts carefully in the mirror. It is important that they know ahead of time to expect to see the normal minor asymmetries that they had before surgery.

What are the most common breast asymmetries?

• Most common breast asymmetry is difference in the inferior level of the inframammary crease-the fold under the breast = 55%
• Nipple position asymmetry-53%
• Breast volume/size asymmetry 44%
• Breast base constriction causing a triangular shaped breast 29%
• Chest wall asymmetry 9%

When is minor modification of one breast needed during breast augmentation with breast asymmetry?

• When there is asymmetry of the level of the fold underneath the breast careful lowering of the higher fold can be done.
• Minor asymmetry of nipple position does not require modification. However, a major asymmetry may require lifting as described later.
• Breast volume asymmetry if significant for example one breast is 100cc smaller in some cases a larger breast implant is placed on the smaller breast side.
• Breast base constriction causing a triangular shaped breast can be corrected by a procedure to release constricting bands in the lower pole of the breast during breast augmentation. This allows the breast implant to expand the constricted breast and create a rounded breast shape.
• Chest wall asymmetry occurs usually when one side of the chest or rib cage is higher than the other side. This can push the implant more forward and make the breast on that side look larger. Usually if the patient agrees the same size breast implants are used on both sides. However, if intraoperative sizing with saline filled breast implant sizers demonstrates that a smaller implant on the higher side of the chest creates better symmetry then a smaller implant can be used on that side.

When is major modification of breast augmentation needed to correct a breast asymmetry?

Some patients present with a major breast asymmetry. In my experience this involves one breast sagging much further down on one side of the chest. The sagging breast is called mammary ptosis. In these cases the lower breast is lifted with a procedure called a dermal mastopexy and implants are usually placed on both sides. See below:

Most breast asymmetries do not require modification and same size breast implants are used during breast augmentation.

In most patients the degree of asymmetry is mild, and most patients are used to their minor asymmetry and the same sized breast implants are used.

However, I use saline filled breast implant sizers to check the position and adequacy of the breast implant pocket before inserting the final implant. With permission from the patient I can evaluate whether a larger implant in the smaller breast looks better and use the larger implant if it looks better if the patient requests that I make this judgement.