Fixing Uneven Breasts Without Implants

The breast lift operation allows for correction of asymmetry from left to right.  In fact it is a much more powerful operation in this regard than breast implants. The areolar reduction is an integral part of the lift operation, so that would be accomplished at the same time.  You probably should be fine after lift with pregnancy, although it is impossible to guarantee 

If you're looking to correct uneven breasts without implants, there are several surgical options:
Breast Lift (Mastopexy): A breast lift can improve the shape and position of your breasts, including addressing asymmetry. This procedure can lift and reshape the breasts, reduce the size of the areolas, and restore a more youthful appearance. It can be particularly effective if one breast is sagging more than the other. For more pronounced asymmetry, some reduction in size of the larger breast may also be performed to achieve better symmetry.
Regarding pregnancy, while a breast lift and areola reduction can provide long-lasting results, pregnancy and breastfeeding can alter the shape of your breasts over time. Hormonal changes, weight gain, and breastfeeding may lead to some changes in breast size and shape. If you're planning to get pregnant in the future, it may be worth discussing timing with your surgeon, as future revisions may be necessary depending on how much your breasts change after pregnancy.
Consulting with an experienced plastic surgeon is crucial to determine the best approach for your specific needs and goals.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Most women actually have some degree of asymmetry of the breasts. If you also experience ptosis, or sag, you may be a good candidate to undergo a breast lift. As part of that operation, I do often correct breast asymmetry. Also as part of a mastopexy, I can trim a portion of the areola to decrease its size.
In the future if you become pregnant, it could unfortunately affect your result. Pregnancy weight gain / loss and breastfeeding often lead to permanent changes in breast shape and structure. Patients who may become pregnant in the future have undergone surgery with me to correct their aesthetic issues now, but I make sure that they understand that future pregnancies can compromise their result.

Thank you for your question.  Photos would be helpful to best answer your question.  A breast lift will bring the breasts up and reduce the size of the areola.  The type of incision needed is best determined by physical exam.I perform a liposuction breast lift/reduction known as Breast LipoLift®. This specialized technique spares more nerves and blood supply as well as removes tissue from the areas you don't want such as near the armpit and the lower portion hanging near your stomach. Once I use this to shape the breast, I then remove the excess skin to tighten the breast and create a more proportional silhouette with better cleavage. This procedure is also more accurate than traditional breast lifts or reductions since I use 3D measurements to uncover size asymmetries. During the procedure I remove exactly whatever is more from the larger side to get as close to symmetry as possible. Since I perform this less invasively the recovery time is faster and drains are not necessary. Over 90% of my patients are out to dinner the next evening taking only Advil and Tylenol if even needed. The size would depend on the proportion with your body versus going for a cup size.  It has been proven to have less complications than traditional breast reduction (please see my Breast LipoLift® page web page) and should not affect nipple sensation, mammograms, cancer risk or breast-feeding. The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in breast plastic surgery.  Best of luck!    Dr. Schwartz Board Certified Plastic Surgeon#RealSelf100Surgeon #RealSelfCORESurgeon#RealSelfTopContributor

The best treatment for asymmetric breasts depends upon your own anatomy.  Significant breast asymmetries do make getting good results more complicated so it's important that you go through all your options with your surgeon beforehand to come to the best decision for you.  It is certainly possible to improve the symmetry without implants by using a combination of reduction and uplift surgery, provided you are happy with the size of the smaller of your two breasts. Whether or not this would be suitable for you is impossible to say without examining you in person though. If you would like a degree of augmentation as part of your symmetrising surgery then an option would be fat transfer or lipofilling as an alternative to an implant.  This is usually the best way of increasing volume if you want to avoid silicone implants and can often be done as part of the same operation, though it may well require additional procedures.  If you get pregnant after an areola reduction then it is possible some of the benefit may be lost, depending on how much your breasts change with the pregnancy, but it is rare to lose all of the benefit of your previous surgery.  Indeed if your areolas do stretch a little, they would almost inevitably have done so more without surgery.  Do your research well, chose a surgeon that you trust and good luck with it all!