Do I Really Need Mastopexy on Top of Different Size Implants For Asymmetry? (photo)

Hello, i have been to one surgeon who has suggested me to have a breast augmentation with mastopexy on my right breast, because of the position of my nipple, She says if i don't get it done, the assymetry will still be there with two different size implants, and it won't look nice and i won't like the result. i was against the mastopexy (which she plans to do around the aerola) because i am scared of having scars...she suggested 150-200cc but i think i am going for 200-300cc would it be too big?

Doctor Answers 24

Augmentation for asymmetric breasts

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From the picture it looks as though your asymmetry is due to differences in both volume and skin envelope. A periareolar mastopexy may be required. Using implants of different volume will improve volume asymmetry.  Your skin will stretch to accomodate the new volumes.  You could opt to wait until the skin stretches before deciding on the mastopexy.

Which is MORE important Asymmetric Breast Sagging OR Asymmetric Breast Size?

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You have a challenging set of breast deformities with different options. The path you choose must depend on your understanding of the options, their capabilities and limitations and your own personal preferences.

You have 
1. Widely disparate Breast sizes
2. Significant difference in breast location and sagging.
Since even in a dress or a bra the disparate breast dimensions is the most noticeable, most Plastic surgeons would first opt for decreasing the sze asymmetry as much as possible. That being said, WHICH of these two deformities bothers YOU the most? 

I DO NOT LIKE THE DIFFERENCE IN MY BREASTS' SIZES - This can be largely by not completely corrected with either one implant on the breast on the right OR if you like both breasts enlarged, by using temporary sizing implants in the operating room, the breast on the left may be enlarged to the desired volume following which the other one may be enlarged using a much larger sizer then an implant come close to that size. If the breast on the left of the photograph is enlarged, I do not think a lift needs to be done. 

I DO NOT LIKE THE SAGGING ON THE BREAST ON THE LEFT  (the most) - in this case, a breast lift would need to be done on the sagging breast on the left FIRST and then a breast implant would be placed on the right side. 

Before having a breast lift, especially an ineffectual periareolar breast lift (whose limitations are significant), I would use breast implant(s) to narrow the asymmetry as much as possible. I would recommend you wait a few months for the breast to settle and normalize before considering any additional breast procedures such as a lift.

Good Luck.

Peter A. Aldea, MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon


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Your question, Is a breast lift really needed? The answer is no. However, you will still have the nipple asymmetry which will change  minimally.  The breast volume can be closely matched.

You could have implants only by a surgeon who in comfortable doing so and a periareolar lift only if required at a later date.  Incisions are forever and i understand you situation.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 81 reviews

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Assymetric breasts and breast lift

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If you are afraid of the scars, then I would opt for the augmentation only.  It has been my experience that often times, (after a couple of years) that the breasts look very symmetrical once the volume discrepancy has been corrected.  You can always come back later and have a lift on the right side if you are unhappy.

Robert M. Jensen, MD
Medford Plastic Surgeon
4.8 out of 5 stars 46 reviews

Breast asymmetry

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Thanks for your inquiry.  I agree with your plastic surgeon that peri-areolar mastopxy would improve your result and symmetry.  The scar generally heals well.  Good luck.

Do I Really Need Mastopexy on Top of Different Size Implants For Asymmetry?

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The volume asymmetry can be lessened by bilateral breast augmentation with, of course, a larger implant placed in your left breast.  Placing implants only on one side does not, in my opinion, work very well, as the implanted breast feels different and has more upper pole fullness than the non-implanted breast.

If volume symmetry by implant augmentation is performed, your right nipple will still be lower and I believe the right breast will have more overhang.  The best option for obtaining better symmetry of nipple/areolar size and position and breast shape would be to lift the right nipple/areola, and I believe that this amount of lift could be accomplished with a periareolar (Benelli) lift without a vertical scar, but an examination would be helpful in order to confirm this.  The breast lift does NOT have to be performed at the time of the augmentation, and if you are unsure about having the lift, you can see what results you achieve over several months from the augmentation alone as things settle out and then undergo a lift later if desired. The lift is not that major a procedure, is not particularly painful, and if the implants are fine there is no need to re-operate on them.

One-sided circumareolar mastopexy for correction of asymmetry with implants

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The circular scar around the right nipple is necessary if you want the position of the right nipple adjusted. If you don't care that one nipple points in a different direction because you really don't want the additional scar, then no, you don't have to have it done. She is recommending to you what will help you look the best for size correction and asymmetry correction.

As far as the size of implant, it's up to you and depends on how big you want to be. 

If you want, you can see two or more board-certified plastic surgeons in your area to get other opinions as well.

Many women have breast asymmetry. It depends on if you are willing to have additional scars on your breast to fix that asymmetry or if you can live with the asymmetry of the nipples you have.

Best of luck.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Is breast lift required with augmentation for symmetry

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Your photo demonstrates a good deal of asymmetry on your breasts, with the right side being much fuller than the left side. I do feel that some degree of breast lifting on your right side might be required in order to be approximate symmetry. However, it is possible to undergo breast augmentation only and see what kind of asymmetry persists. It is not completely unrealistic to hope that matching breast size alone could provide you with enough symmetry at the moment that a mastopexy would not be required.   You could always have the mastopexy done at a later date if you did not obtain the symmetry that you desired.

Antonio Gayoso, MD
Saint Petersburg Plastic Surgeon
4.9 out of 5 stars 33 reviews

Fixing breast asymmetry

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There are a number of issues in your post. The photo posted looks like your arms are pushing into your hips distorting the breasts. The asymmetry though is obvious with the right larger and a different shape than the left. The nipples diverge out to the sides away from the midline and the breasts are widely spaced apart on the breast. Clearly if you just put in implants even if they are of different sizes with the smaller one on the right the asymmetry will be magnified. You will need a breast procedure to reorient the nipple direction and then have to decide between a number of options including placing different sized implants, placing implants whose size can be adjusted after surgery, etc.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Correction of asymmetry

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Unfortunately, it seems like once you have asymmetry, you will always have some asymmetry. Now you have a big difference in size between your breasts. An implant alone can make the volume more equal (in my experience an exact match is never achieved) and I would recommend to my patients to equalize the volume first and then see what the shape is like particularly if, like you, they are concerned about the scarring. Depending on whether you like the size of your right breast, you could just have an implant on the left instead of two different size implant which will have different dimensions. As you can see, there is no one right answer and another consultation with a different board certified plastic surgeon (or two) in your area may help you decide what is best for you. Good luck to you.

Margaret Skiles, MD (retired)
Sacramento 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.