Breast augmentation; Is a 35 ml difference noticeable? (Photo)

Question

Hello, my surgeon suggested that I have 295 ml in my right breast and 330 ml in my left one. I do have some slight asymmetry, with my left breast placed a little higher than my right one, besides being slightly smaller. Do you think that this difference of 35 ml will be noticeable once in my body?

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon' s experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Ramin Behmand, MD, FACS · Answer

The volume difference is relatively minor.  The intentions of using different size implants are good.  But, in a slender person like you, that difference is likely to become noticeable with time.  Best to sue the same size implants.

Your areolas are at very different levels. Print this photo out, and draw horizontal lines through the nipples across the chest, and you'll see the significant height difference between the two sides.  When you do an augmentation, this difference in areola height will become exaggerated, and more noticeable. Also, the larger areola is likely to expand proportionally more than the smaller areola.

Some options you have:

1. Don't do an augmentation, may be until after having children, and breastfeeding, if that is a consideration.
2. Have an augmentation with the same size implants, knowing that you will have symmetric breast mounds, but areolas at noticeably different levels.
3. Consider a periareolar lift (permanent soft Gortex suture paced) to make the areola the same size, and improve the position for better asymmetry.

Dr. B.

Daniel Barrett, MD · Answer

Dear Intuitive895363,
based on your photos, it looks like you have minor asymmetry so different size implants can help improve this. During the surgery your surgeon can use sizers to make sure that your asymmetry is resolved. 
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Tyler Frew, MD · Answer

Hi there,
Yes, 35cc/ml will be noticeable in your body as you and your breast are very thin. When the patients skin is thin the small differences are more easily noticeable. I would stick with your surgeons plans as they are trying to achieve the best symmetry possible for you.
Just an FYI, the smaller breast usually gets the larger implant. Since this area is smaller it takes longer to stretch out fully. So dont be alarmed if your left breast takes longer to drop and fluff
All the best

Ronald J. Edelson, MD · Answer

Unless there is significant asymmetry I usually recommend using the same size implants, and that’s what I would do in your situation. You need to accept some asymmetry anyway. Using different size implants is a game that usually doesn’t work out very well.

Camille Cash, MD · Answer

A volume difference of 35cc will not be visibly noticeable, however it may help to address the size asymmetry and may fit better in the pocket.  You are correct in that one of your breasts does sit higher than the other.  If this is not addressed during surgery this same asymmetry will be present afterward. Using differently sized implants will not correct it.

Connie Hiers, MD, FACS · Answer

Your right breast is larger now, so you will look more even if more is added to the left side. Let your surgeon do what is best for you.  Yes, you will notice that you are more even.

Mats Hagstrom, MD (license on probation) · Answer

For the implants your provider is suggesting a 35 mL difference it’s about 10%.
I don’t know how else to say it.
Breast augmentation outcomes are based on three variables.
The first is patient candidacy. The second is implant selection in regards to size shape, and type. The third variable is the surgeons ability to place the implant in the correct anatomic location.
Most people have a left breast that sits higher on the chest wall than the right side.
 This is normal and your anatomy is consistent with most people.
The discrepancy in breast position on the chest wall is slightly greater in your case but it’s pretty common for most people to have the left breast sit higher than the right side. This is true for both men and women.
Your breast sit slightly wide on the chest wall, and this will have an impact on the augmentation outcome as well.
Your nipples. Forward with minimal divergence and this is a very good Characteristic for quality outcomes You’re right breast has very slight divergence, but overall the nipple position is fairly good.
Overall, your candidacy for breast augmentation is fairly good.
The breast position on the chest wall cannot be changed and should not be changed.
I do not recommend lowering the IMF or infra mammary fold on the left side to compensate for breast position. 
Implant selection is a very important variable and different plastic surgeons will have different ways of guiding patients through implants selection.
The volumes, you are considering seem fairly conservative and appropriate.
Using excessively large implants, increases the chance of undesirable side effects, complications, and increases revision rates.
Provider selection is in the end, the most important variable.
There is nothing you can do to change your candidacy for the procedure.
Patients do have significant say in the choice of implants and this is best decided together with your provider.
Some plastic surgery just do a better job at implant decisions and guiding patients through this decision process than other plastic surgeons.
Each provider will have their own way of helping patient choose the right implant.
 Some providers will have patients make the final decision and other providers will make the decision on behalf of the patient.
My personal preferences always been to use before, and after pictures of previous patients with similar body characteristics.
I generally have patience, bring ideal outcomes of previous patients who had similar looking breasts 
I generally bring the ideal or wish pictures with me to the operating room and use temporary sizers during surgery to determine what size implants will create an outcome consistent with what the patient wishes.
I generally have a complete collection of implants available to me during surgery.
Finding the right provider is not at all easier or straightforward.
I generally suggest patient start the process by having multiple in person consultations with local provider system seem to have substantial breast surgery experience.
During each consultation, ask each provider to open their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar body characteristics to your own.
 I recommend patient have breast pictures printed and bring those pictures with you to use as reference during the consultation.
Do not rely on your memory or using mirrors during consultations.
An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients.
Highly experienced plastic surgeons should have access to hundreds or preferably thousands of before and after pictures.
I generally recommend people avoid virtual consultations whenever possible.
 Recommend patients schedule in person consultations whenever possible.
There’s no correct number of consultations needed to find the right provider.
The biggest mistake patients make is having only one consultation and then scheduling surgery.
Having only one consultation eliminates the ability to choose a better provider.
 Finding the right plastic surgeon is time consuming and requires effort.
This cannot be accomplished by sitting behind your computer, or using your cell phone.
The two biggest mistakes patients make is scheduling only one consultation, and assuming that being board-certified and plastic surgery with a few years of experience, and overall good reviews means they have mastered most plastic surgical procedures.
Never assume somebody is skilled at a procedure without getting confirmation by seeing numerous quality before and after pictures.
Ask each plastic surgeon during consultation with the most common indication of for revision surgery is, what their revision rate is and what their revision policy is.
All plastic surgeons do revision surgeries.
Typical revision rates for breast augmentation surgery is above 10%.
plastic surgeons, who claim to have very low revision rates are either not being honest or are not offering their patients the best possible outcome.
excessively high revision rates are also undesirable.
Revision rate is not nearly as important as understanding what the most common indication for revision surgery is.
You generally want to avoid providers who end up with implants that bottom out on a regular basis.
This is the most important outcome to avoid.
in relationship to all other variables, the difference in implant size is not particularly important.
I think 35 mL difference is perfect. 
Personally, I make the decision during surgery by using temporary sizers.
Each provider will have their own way of doing this.
In the end provider selection ends up, being the most important variable, and all other variables tend to follow.
Best,
Mats Hagstrom, MD

Breast augmentation; Is a 35 ml difference noticeable? (Photo)

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