Breast asymmetry correction with periareolar lift - would it be enough or would I need implants? (Photos)

Question

I have noticeable asymmetry between my breasts and am wondering what my options are for achieving better symmetry. I am also wondering if my breasts appear tuberous and would require particular techniques. I am not as concerned about the size as I am with the shape. Would a periareolar lift alone be enough, or would I need implants?

Emre Guvercin, MD, FEBOPRAS · Answer

Based on what you’re describing (noticeable asymmetry, concern about shape rather than size, and possible tuberous features) and according to your photos, a periareolar (donut) lift alone is very unlikely to be enough.Why a periareolar lift falls short hereA periareolar lift can:Slightly elevate the nippleReduce areola sizeMake minor asymmetry look a bit betterBut it cannot:Correct meaningful breast asymmetryReshape the breast moundAddress constricted or underdeveloped lower pole (as seen in tuberous breasts)Reliably centralize breast tissueIn cases where asymmetry and shape are the main concerns, a donut lift often leads to under-correction and disappointment.Do you need implants?Not necessarily.If you are generally happy with your breast volume, implants are not mandatory.What actually corrects asymmetry and tuberous tendenciesThe appropriate solution is a Push-Up Lift (supportive mastopexy), which:Reshapes and redistributes your own breast tissueReleases lower-pole constriction if tuberous features are presentCorrects asymmetry by tailoring each breast individuallyImproves projection and roundness without adding volumeCreates a balanced, natural breast shapeThis is a structural operation &mdash; not just a skin tightening.When implants are addedImplants are only considered if:You want more volume, not just better shapeThere is insufficient native tissue to achieve your aesthetic goalIf you like your current size, a Push-Up Lift alone is often ideal.

Jeffrey M. Darrow, MD · Answer

Thank you for your photographs. It does not appear that you have any ptosis of your nipple/areolar complex.  Therefore, a periareolar lift may help you reduce the size of your areolar and improve your breasts shape without having to increase your breast volume with a breast implant.  The benefits and potential downsides of periareolar breast lifts should be clearly understood so have detailed discussion with your plastic surgeon about it’s benefits and risks.   Best wishes.

Jonathan Heistein, MD · Answer

I understand you are less concerned with the size asymmetry than the shape.  But it would be hard to create better symmetry without addressing both.  Breast lift would be a good place to start but periareolar approach may not be enough.  Implants can be considered but you don't have to have an implant if you don't want that.  Go to a board certified PS for an in-person consult to get a better idea of what the specific options would be in your situation.  Best of luck!

Ellen Ozolins, MD · Answer

Thank you for your question. You have visible asymmetry and features suggestive of a tuberous breast on one side. A periareolar lift alone won’t correct the shape. Reliable correction usually requires tuberous release, areolar reshaping, and augmentation with asymmetric implant sizes, possibly combined with fat grafting to improve symmetry and lower-pole fullness. You should be examined to assess nipple position; If either nipple is below the fold, a lift will be needed to achieve proper nipple placement. An in-person examination with a board-certified surgeon is essential to confirm the tuberous diagnosis, measure nipple-to-fold distance and base width, and plan for side-specific release, lift pattern, implant choice, and any additional fat grafting.

Donovan Rosas, MD · Answer

Tuberous breast is not, technically speaking, a "yes" or "no" question. There can be different points on the continuum. The typical hallmarks include a high, tight fold with "puffy" or distended areola, minimal breast tissue and potentially herniation of the breast tissue through a tightened ring thus the "tuberous" label. It is a congenital deformity which usually manifests at puberty. To what degree it manifests will vary from one patient to the next. Treatment of tuberous breasts varies depending on the degree of the breast architectural distortion. Surgical correction typically involves: -areolar reduction -submuscular augmentation -release of constricted breast tissue All of these techniques work in concert to correct the tuberous deformation of the breast. Based upon your photos alone, you don't demonstrate all of the classic features of a tuberous. Regardless, augmentation and lift can address volume asymmetry as well as areolar dilation. As always, discuss your concerns with a board certified plastic surgeon (ABPS). Donovan Rosas MD Board Certified by the American Board of Plastic Surgery Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons RealSelf Verified Member RealSelf Top 100 RealSelf Hall of Fame

Daniel Barrett, MD · Answer

Dear Imaginative718843,

it is hard to tell for sure without an examination. Based on your photos, there is a chance that one of your breasts is tuberous so you might need a small implant to correct it. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Georgina Nichols, MD · Answer

Hi there! 
Thank you so much for your question and for sharing this here.
Breast asymmetry is extremely common, and there are several options depending on the degree of difference and the underlying anatomy. From your description, you’re also wondering whether your breasts may be tuberous &mdash; tuberous breast characteristics can include a constricted lower pole, enlarged areolas, herniation of tissue into the areola, and overall breast shape that appears tight or “projected” rather than full.
In true tuberous breast anatomy, a periareolar lift alone is usually not enough to correct shape or lower pole constriction. These cases typically require techniques such as releasing the constricted tissue, lowering the inframammary fold, and sometimes adding implants or fat grafting to create a more natural, rounded contour.For asymmetry, the approach can vary &mdash; sometimes a combination of a lift, implant, or tissue reshaping on one or both sides is needed to achieve better balance.
Every patient is unique &mdash; anatomy, history, physical exam, tissue quality, goals, skin elasticity, and surgical risk profile all change what is indicated / recommended.Because of this, this should not be taken as personal medical advice. The next step is always an in-person evaluation with a board-certified plastic surgeon that can examine you and discuss individualized plan options.
Hope this helps!
&mdash; Georgina Nichols, MD FACS

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