Asymmetry Still Present After Breast Augmentation

I had breast augmentation to fix asymmetric breasts. I asked my surgeon if I should have breast reduction first since the right breast is over a cup size bigger, but she assured me that this wasn't necessary. I ended up with smooth saline implants, 400 cc on the left and 280 cc on the right. I am 4 weeks post-op, and I still feel like the right is fuller, especially at the bottom where it's already fuller to begin with. It sags more.

Was this the right decision to fix the problem? The doctor said I might want a breast lift on the right breast to make them more even, but how can they look even when the other breast will have a lot of scars? What can I do if it's still uneven after a year? Help!

Doctor Answers 5

Persistent breast asymmetry after augmentation with implants; use of liposuction

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In some instances, mild amounts of breast asymmetry can be managed with suction assisted lipectomy (liposuciton)

This can be achieved with relatively little scarring.

There is a potential for implant rupture but it should be realtively low if perfomed by an experienced surgeon. I would advise that you wait 6-9 months to allow for normal settling from surgical changes.

The video below shows some examples of asymmetry treated with liposuction

Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

There is no perfect option

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The surgery to have really depends on what you are trying to achieve. If you liked the size of the larger breast then maybe an augmentation of the smaller breast is all that is required but the will "always be sisters, not twins" as my office staff says. You may decide after a year if it bothers you enough to have the breast lift on the side you percieve as larger or fuller. I would recommend that you continue your follow-up with your plastic surgeron and allow at least a year before making a decision. Best of luck.

Dr Edwards

Be patient after breast augmentation, two surgeries often necessary

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First of all, it is very important for all patients to know that EVERYONE has some degree of breast asymmetry. Sometimes, it may not be apparent to the patient, but often careful analysis and counseling by the plastic surgeon can help educate the patients about breast asymmetry. It is important to go over this and discuss this PRIOR to surgery. Other patients have more significant assymmetry that is very noticeable and can be very debilitating to patients.

I literally just had a patient in surgery today with a very similar anatomic description to yours.

I carefully explain to my patients what they can expect with surgery and also that they will always have some degree of asymmetry. Breasts are not ever mirror images of each other, and it's important to know that before surgery.

When one breast is significantly larger than the other, it is often more "ptotic" or droopy and the nipple position is also usually a bit lower than the smaller side. The smaller breast as you describe usually doesn't have any droop to it. In order to make the breasts more similar with implants, the first goal is to create similar breast mound volumes between the two breasts. The larger, ptotic breast will require a smaller implant and the smaller breast will require a larger implant; HOWEVER, it is important to understand that that alone will not make the shapes of the breast similar to each other. The smaller breast will have more projection and "look tighter" because the volume is composed of less breast tissue and more implant, while the larger droopy breast will still look droopy with a small implant in place. That is really all that any surgeon can do with implants alone.

There is one more thing that I do that I think helps a bit. I do a "dual-plane" technique that helps do some degree of internal lift on the larger droopy breast that has the smaller implant. I think this helps a bit but won't prevent you from needing the right sided breast lift. In a mild case, it might prevent the lift, but in more severe cases I don't think it will.

In my patient today we discussed all of these issues as well as the NEAR CERTAINTY that she would need a subsequent one sided breast lift to give her better symmetry; however, we both elected to just do the implants first and wait until they are fully settled into position which is usually 3 months, and then likely proceed with a one sided mastopexy (breast lift) on the larger breast at that time. I also tell my patients that they may be happy just the way they are. You may decide to hold off and come back and get the lift in several years, or never at all, but that is a decision you can make and don't have to feel rushed about making.

I think the breast lift scars are not a big deal and in patients with this type of asymmetry I have never had a patient regret having the procedure with the trade off in the positive being having much more similar shape and "uplift" to the breasts which displays well in clothing, etc. I think there are a variety of techniques with breast lift.

The other thing that is nice about waiting 3 months and then "doing part II" of the procedure at that point is that sometimes the surgeon needs to further adjust the implants. There is only so much the smaller breast can stretch in any one surgery and sometimes it is necessary to remove the implant from the smaller breast and place a slightly larger implant to "catch up" to the other side. However, in any breast lift, the breast oftentimes will be slightly smaller as well.

I think it is most often necessary to do the the best asymmetry correction in severe cases in two steps. Even then there will still be some degree of difference, but this will be substantially better than it was before and most patients are very happy. Yes, there are some incisional scars on one breast for the one side breast lift but that is a small trade off that is necessary to get the shape of the breast more similar.

I have never had a patient regret incisions if that was necessary to improve shape. The only scar that you will likely see will be the vertical limb in the central lower breast. The periareolar incision fades well into the areala and the inframammary crease incision is hidden below.

I hope this helps!

A complex issue

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As Dr. Yuan nicely stated, breast asymmetry is more normal than is perfect symmetry. I find that it is rare to be able to correct a significant asymmerty with differential implants alone. The problem is that significant asymmetries are usually partly volume plus drooping on the larger side. The best treatment is to use the same implants so the platforms are equal and make the breast tissues match as best as possible. Sometimes that involves a lift on only one side and this adds a new asymmetry because of the differential scars. So this is a complex issue.

Analysis of breast asymmetry

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Most women, if not all, have breast asymmetry to varying degrees. Most are noticeable but not disagreeable. If you had surgery specifically to address this problem, a careful analysis is important. Often, you must expect some residual asymmetry. The final treatment depends of many factors including the tolerance for certain post-op asymmetries and risks and the need to manipulate the breast shape, form, or size. Asymmetry comes in many varieties and in many dimensions. The most rationale solution would be to start with the same breast and put in the same implants assuming the chest wall is symmetric. Usually, putting in different implants of different dimensions and volume will make for different breasts even though they might make certain asymmetries less. For example, volume can besimilar but the width might be different. Or the width might be better but the degree of sagging might be worse. I usually start with the question of how to make the breasts similar before implants. Sometimes you have to do a lift, sometimes a reduction. Once you make the breast as similar as possible, it is easier to determine what implant to use to get you what you want. On occasions you have to do a reduction, a lift, and an augmentation on the same breast to get a better match. If you really needed a lift to make the breast sismilar but only did an augmentation, you might need a lift post-op. If you need a lift anyways, you might look into the approach I outlined above. Good luck.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.