Asymmetry After Breast Augmentation?

My natural boobs were a 34/aaa and 34/aa, one VERY noticably smaller than the other, though both breasts very small. My PS insisted on using the same size silicone implants (415cc), claiming because the breasts are so small the asymmetry would be minimal with that size implant, so I said ok. However it's clear to me the one bigger breast is larger and now my nipples are uneven. Why would he insist on using the same size implant!? I am honestly devastated, I saved up money for this for years.

Doctor Answers 8

Asymmetry after breast augmentation

Can you get asymmetry after breast augmentation? Of course that is possible even if there was only a small difference in breast size before the surgery. Most surgeons will put in temporary sizers and put the patient in the sitting position while asleep to check for contour and symmetry. However sometimes with swelling it's hard to detect subtle differences in symmetry. So it may take a few weeks for the differences to be noticeable after the swelling subsides and breasts settle. Your surgeon should be able to work with you to do a revision if needed

Tyler Plastic Surgeon
4.5 out of 5 stars 36 reviews

Breasts different after implants

All breasts are a bit asymmetric.  If the breasts did not have a big difference before, then placing large implants would minimize the asymmetry.  Review it with your surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Asymmetry After Breast Augmentation

Thank you for your question. I am sorry hear of your displeasure with the outcome so far. Without the ability to look at photos of the outcome and the pre-ops it is hard to comment upon the choice of implants. In my catalogs the only 415 cc implant is a Sientra product, and the closest sizes are 25 and 30 cc different. 

It is not an easy decision choosing implant for a patient who is asymmetric Sometimes using different implants may give more even volume, but with small breast the outline of the implant may be so dominant in final breast shape that the breasts may look more different than they might have with same size implants. 

Please consider posting photos. More important is to follow up with your surgeon, and make clear in a non-hostile setting the issues. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Breast asymmetry

Your question can only be answered by the plastic surgeon who performed your surgery.  A nice thing about saline implants is that they are adjustable during the surgery so you have more flexibility with them than with silicone gel implants.  Still, the silicone gel implants come in about 25-50 cc increments so you are pretty well covered with those too.  When I do surgery on patients with asymmetry and I am using silicone gel implants, I generally bring an assortment of implants with me so that I will have some leeway in case I need to adjust what I am planning to do during the procedure.  I also use an inexpensive, disposable sizer that I can put in the breast pockets and fill with saline.  This not only helps me in making my breast implant pockets but I can also get an idea about what a particular volume will actually look like in place before I open an expensive implant.  My suggestion would be to talk to your plastic surgeon.  Perhaps you can find a solution that will work for both of you.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 24 reviews

Breast Asymmetry Before and After

Thanks for your post.  I am sorry that you are not happy with your result.  Tackling breast asymmetry at the time of augmentation is a very tricky proposition.  Many times we like to use implants that are the same or close to the same base width in order to give a matching silhouette.  That being said, it is not uncommon to use implants that are one or two sizes up or down to try to match a breast asymmetry because for a given profile, it is a few millimeters for every 25-50 cc's of additional fill.  I would encourage you to talk to your plastic surgeon to see if there is anything that you can do to remedy the situation.  I would also encourage you to wait several months to allow the swelling to resolve and the implants to settle.

As stated before, there are many anatomic issues to consider for implant selection such as overlying thickness of the soft tissue, chest wall skeletal asymmetries, etc.  Perfect symmetry from breast augmentation or any breast procedure is the exception not the norm.  There will always be some degree of asymmetry with any bilateral procedure whether it is on the breasts, eyes, or face.


Stephen M. Chen, MD
Richmond Plastic Surgeon
4.8 out of 5 stars 34 reviews

Little Breast Tissue and Same Sized Implants

    Assuming that the breasts were markedly different in volume prior to surgery, there may have been an attempt to make the volumes more similar during the surgery.  However, depending upon the skin envelope and symmetry issues, the smaller breast may have looked strange with 50 to 100 more cc.  Had to say without pictures.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Asymmetry before and after augmentation

It is fairly common to be asymmetric before surgery. Most surgeons will try to achieve symmetry after surgery but need to weigh whether a larger size implant on the smaller side is the best option. As you increase implant size, the dimensions (width and projection) of the implant also change, so at times, with a minor asymmetry, the surgeon may determine that it is better to place the same size implant realizing that there will still be some asymmetry after surgery. I usually discuss this in detail with patients and a decision is made as to whether to use the same size implants or not. I am sorry you are not happy with your result but realize that it is not uncommon for women to have some asymmetry even after surgery if they were asymmetric before. Discuss this with your surgeon and see what he says. I would wait at least 6 months after the surgey to fully assess the situation to give the implants a chance to settle and make sure all of the swelling is gone.

Paul Wigoda, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Asymmetry After Breast Augmentation?

I'm sorry to hear about your concerns after breast augmentation surgery.

Although I do not know the details of your situation or the procedure performed, I can assure you that most plastic surgeons try very hard to end up with as much breast symmetry as possible after breast augmentation surgery. Our goal, after all is to end up with happy patients.

However, after all is said and done, the decision of what breast implant size and profile to use becomes a judgment call.  Every plastic surgeon has a different technique to help make these decisions; in my practice I use temporary sizers (intraoperatively), make careful measurements, and with the patient in the upright position try to match their outcomes with their goal pictures as much as possible.

 However, despite best efforts, it is unusual to end up with “perfect symmetry”;  for this reason, I tell all patients preoperatively that the breasts will be “sisters not twins” or  “snowflakes, each pretty but different”.

Sometimes, there are variables involved that patients do not appreciate externally. For example, patients may have chest wall (rib cage)  asymmetry that necessitates the use of a breast implant size/profiles that patients would not have anticipated (prior to surgery).

 I would suggest that you communicate your questions/concerns with your plastic surgeon in a calm/constructive fashion. He may have advice  to help you achieve improved symmetry (possibly at  significantly reduce cost).

Best wishes.


Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

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.