Expertise in Breast Asymmetry?

I lost a considerable amount of weight naturally and have breast asymmetry (A & B cup). I have been told that I need some form of a mastopexy (from crescent to benelli to lollipop). I have consulted with several PSs, but haven't found one that I have full confidence in. I am thus seeking two things: (1) some sort of uniformity in diagnosis/recommendation, and (2) an expert in breast asymmetry who is invested in their results and the Hippocratic Oath. I am willing to travel.

Doctor Answers 11

Breast Assymetry and disagreement on treatment

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Congratulations on your healthful weight loss. Now what to do about the subsequent breast assymetry?

Your photo strongly suggests that you would benefit from a lift on the right side. On the other hand, as far as one can tell from the single photo, you don't appear to need a lift on the left if you would like to be a C-cup or larger. But if you lift just the right side then you introduce another type of assymetry i.e. the scars of a lift.

There is no easy or perfect solution for your situation which helps explain why you are getting a variety of recommendations.

I do not think that a crescent or binelli type lift is applicable to your situation as you need to reposition your breast tissue to match the right sight, and not just change the nipple position. You could consider possiblity of just doing an augmentation with different sized implants, but the right side might not look too great and you would still have some type of assymetry, just no additional scars.

In addition, your breasts are space quite wide on your chest and that will also not be significantly corrected.

Based on what I have stated so far you need to think about which type of assymetry you would find most acceptable.

Correcting Breast Asymmetry with a Breast Implant and Breast Lift

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Breast asymmetry is very common and should be corrected with relatively the same operation on both sides in order to match incisions and breast shape. Extreme asymmetry (not you) may not follow this recommendation, but for your breasts, bilateral breast implants with a periareolar mastopexy would be ideal. Consider a high profile implant because that lift technique can flatten the breast and i have found that a high profile implant can help with improving the breast shape. You want to match the incisions on both sides because if one side is left without the "around" the areola incision it will will draw more attention through things off which defeats the purpose of this operation. Let me know if you have questions. Dr. Trussler

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 52 reviews

Breast Asymmetry?

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Thank you for the question and pictures?

It is not uncommon to get different advice from different plastic surgeons. You will find that however after you do your due diligence it will become clear which surgeons have significant  experience with patients with breast asymmetry. In today's age of Internet information,  you will be able to view thousands of before and after pictures on physicians websites and come away with a good idea of who does quality work. Online reviews may also be helpful.

It is clear based on your pictures  that breast augmentation with some form of mastopexy will help improve the symmetry of the breasts,  keeping in mind that absolute symmetry cannot be achieved despite best efforts.

I applaud your efforts as you do your research;  finding a plastic surgeon will be the biggest decision you make at this time.  At that time, in person examination to discuss your goals in detail will be invaluable.

Best wishes.

There is No Single Ideal way of dealing with Deflated, Sagging breasts

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Dear Ms. Sunshine,

Your frustration is palpable. You have a challenging problem. One that has MANY potential solutions. Such variability of opinions is honest and it has NOTHING to do with an ethical failure on the part of the surgeons you have seen.

In the nearly 2,500 year old Hippocratic Oath taken by most physicians upon graduation doctors swear to maintain patien confidentiality, to  hold the patient's interest above all and to not willingly perform abortions or assist in suicides (as well as  to honor ourt teachers and teach their sons the art of medicine without charge, to not perform THEN risky surgery as removing bladder stones). I seriously doubt that any of these were violated by the surgeons you consulted with.

Unlike other surgical professions, Plastic Surgery attracts and fosters independent, problem solving and self-reliance. We often solve problems differently and are used to comparing different solutions without seeing them as somehow flawed or wrong much less in violation of the Hippocratic Oath.

In my opinion, you have breast asymmetry with deflated, minimally constricted breasts. I think you may best benefit from bilateral Breast augmentation done via a periareolar approach which would allow for release of any constriction. Both breasts would benefit from a lift. The Lift procedure would depend on the nipple position AFTER the implant placement. The "Benelli" lift is limited in its applications and you may require a different lift technique on each side.

Keep looking for a Plastic surgeon you are comfortable with. The search will be worth it.

Good Luck.

Peter A Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon

Not satisfied with recommendations for breast surgery

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Breast asymmetry is the rule, not the exception. Your photos are very helpful, revealing in a few ways a challenging undertaking. This also explains the disparity of recommendations which is also very common.

You need to seek one or more additional consultations with board certified plastic surgeons and then decide whether or not what they are recommending makes sense, you can feel comfortable with them and they have a good probability of delivering reasonable results. Unfortunately, there is never any guarantee as regards results.

Reputable board certified plastic surgeons should have your interests in mind.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Breast asymmetry and treatment

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When I look at your photo I think along with the asymmetry would have mild version of the tubular breast on the right side. I think you're inframammary fold on the right side is higher than the left and your breast tissue is herniated under the nipple on the right side with breast tissue on the left side is closer to the chest wall.

If you want to match the breast without an implant then a list on the right side to be needed to match the left side. This is a common procedure in patients who need breast reconstruction where the normal breast is usually larger and more ptopic in the reconstructed breast. Usually once done is measuring the dimensions of the left breast and then reproducing them on the right side. in my hands I would need a short scar type of lift which is a scar around the nipple and a vertical scar no horizontal scar. If you want the larger then a breast augmentation would be necessary.  I think the best thing to do would be to do the surgery in 2 steps. Augmenting Both sides 1st then come back later and lifting the right side to match the left. After the augmentation depending on the size of the augmentation you may need less surgery to match the size is the implant may even out  the difference between the breast.

Wendell Perry, MD
Miami Plastic Surgeon
4.8 out of 5 stars 234 reviews

Truth about breast asymmetry

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With careful study we find that everyone has a degree of breast asymmetry which may be reflected by breast volume, skin envelope, or both. If you feel that you would like a fuller breast appropriately sized implants can soften volume discrepencey. Breast lift is about nipple position, and the pattern used depends on the amount of lift the nipple requires, and how the projection and shape are influenced by the lift. Round block, and vertical are both good, and a careful assessment and 'tailoring' will give the best result. Implants and lifts are imperfect, so expect some compromise in reaching a decision.

Best of luck,

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Breast Asymmetry

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Hello Sunshiiine,

I know that when a prospective patient with a difficult issue sees multiple surgeons, typically many different remedies are recommended, providing little comfort to the patient.  There is no textbook or scientific article that can guide you (or us) towards the best way to address these issues.  So, it is left to the experience of the surgeon to guide him, based on what has worked best in the past.

I am surprised, and a little embarrased, that a surgeon recommended either a crescent or benelli lift.  Either of these procedures would be so woefully inadequate, and leave you with significant residual asymmetry.  I can only hope those doctor(s) were not certified by the American Board of Plastic Surgery.

I will try to give you the logical reasoning behind what would be best for you.  Using your smaller breast as a model(in the photo you provided it looks like your left breast), let's compare your right/larger breast to the left.  Your right breast has an excess of skin both vertically and horizontally, much more than either a crescent or binelli lift could reduce. Although a lollypop or vertical lift may be able to remove excess skin horizontally, it too fails to address your vertical excess, which is the amount of skin between the bottom of your areola and the inframammary fold.  Currently, there is much more vertical excess on the right, and yet the right nipple areolar complex is lower, and would need to be placed higher to match the left, making that vertical excess even greater.  Therefore a full anchor lift would be required to address the significant vertical excess skin.  In addition, a full anchor lift allows the surgeon to remove breast tissue that is excessive to match the left in volume.

Your left breast does not appear excessively saggy or ptotic, but a physical examination would determine if it too could benefit from a small lift.

The explanation is best understood while looking at a diagram.  On my website there is a button you can push called 'YOUR PROCEDUE IS NOW IN 3D' under Our Tools section of the home page.  this might help you visualize my explanation.  I hope this has been helpful.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Treatment of breast asymmetry

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Breasts can be asymmetric for a variety of reasons, skin differences, nipple position, volume differences, muscle and bone differences, etc. The first thing that a plastic surgeon needs to do is document the differences and their causes.

The next step is to determine the various options for correcting the differences. In this consideration one must also consider the downsides associated with the corrections and really get into the patient's motivations and what the patient is willing to trade off for better symmetry. 

One of the reasons you are getting different answers is because there are many ways to achieve symmetry in the breasts even when there is only one cause. For example, if the problem is more skin on one side vs the other, you could correct this with adding volume or reducing skin.  

The best thing to do is find a plastic surgeon who can go through all of this with you and then offer several different options. Personally, I would recommend breast augmentation with a 6 month follow up to determine if a lift of some sort is warranted or desired by the patient.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 37 reviews

Breast ASymmetry

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Your asymmetry is probably not related to your weight loss, but is more likely just asymmetric development of your breast.  Often with loss of breast volume, the asymmetry becomes more obvious.  You have not said whether you were interested in breast enlargement or just making your breast more symmetric.  Either way, you will need a lift on the right breast, and possibly on both breasts, though the right will obviously require more lifting.  It may be difficult for you to find uniformity in opinions on this site just from pictures.  I certainly do think that you should find a surgeon that you are comfortable with before proceeding.  Good Luck.

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.