My Daughter Has a Size A Left Breast and a Size D Right Breast She is 19 What Surgery Should Be First Implants or Reduction?

Doctor Answers 15

A cup Breast on One Side, D cup Breast on the Other

    Whenever there is a great amount of volume discrepancy, there are several options including breast lift on the larger side and breast augmentation on the smaller side.  In other cases, a breast reduction on the larger side with breast augmentation on the smaller side may be appropriate.  There will always be some degree of difference in breast shape, because the smaller breast will always appear as though it has a tighter look.

Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Which operation.

Thanks you for posting this question. Surgery of this type, performed in order to create the best symmetry, typically involves operating on both breasts at the same time. Careful consideration of the amount asymmetry can only be evaluated appropriate during a consult with a physical exam. Best wishes, Dr. Aldo.

Aldo Guerra, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 201 reviews

Marked asymmetry.

IT would be helpful to see photos in attempting to provide a useful answer. Both a reduction and an enlargement will probably be needed for best symmetry.

It is unlikely that a A size breast can be made to look like a natural D size breast. On the same wavelength, a D size breast cannot be reduced to a A size without risking loss of nerve and blood supply to the nipple and areola.

Most surgeons would probably recommend doing both procedures at the same setting.

When your daughter is ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S.

Thank you for your question, best wishes.


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


tough to answer this without some photographs. The likelihood is she will need a combination of both augmentation and lift or reduction

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 14 reviews

Breast asymmetry

I think that an exam in person is essential to make a proper evaluation. If all things are normal anatomically except for the one breast being very small, she could possibly have an augmentation of the smaller breast and depending upon her desire and the appearance of the larger breast she coudl have something done to reduce the larger breast.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Treatment of Poland's syndrome (absent or small breast and normal breast).

This sounds like a variant of Poland syndrome, and surgery for this may be covered by insurance in some cases. The absence of normal breast development (and pectoralis muscle, also sometimes associated with hand abnormalities) on one side (A cup) with a normally-developed opposite side (D cup) is usually corrected by performing a (small) breast reduction/full breast lift on the larger breast to create the desired size and proportion, and at the same operation performing submuscular silicone augmentation of the opposite side to match as close as possible.

Exact symmetry is both impossible and unrealistic, but substantial improvements can be made that will give your daughter the symmetry in clothing and bathing suit she deserves.

Reducing the D cup breast to an A cup size and then subsequently augmenting both breasts only gives her two operations, and transforms one deformity to what many women still consider a deformity (both breasts too small). Doing two planned operations is also unnecessary, and if recommended may be for the financial benefit of the surgeon rather than the patient's best interest.

Touch-up or revisional surgery may be necessary anyway, particularly in more severe cases of asymmetry such as this young woman's, so please do both appropriate steps in one procedure. For a case similar to your daughter's click on the web reference link below). Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Treatment of breast asymmetry A cup and D cup

Hi,I am sorry to hear about your 19 years old daughter.She must be having tough times with herself and with boy friends.I am sure augmentation on one side and reduction at the other to aim to get C up can be performed as one stage surgery.This is just a suggestion and not a consultation without more information or images on her.I wish her good luck.

Ashok Govila, FRCS, MCh, MS
Dubai Plastic Surgeon
4.7 out of 5 stars 88 reviews

Size A left breast and size D right breast. Which breast do you correct first?

Breast asymmetry is very common  ranging from mild to severe. It would be helpful to see actual photos of your breasts but I would most likely perform both an augmentation of the left breast as well as the reduction of the right breast in 1 stage.Most cases lend themselves to very good correction of the asymmetry when performed by an experienced Board Certifiesd plastic surgeon. Good luck!

George Lefkovits, MD
New York Plastic Surgeon
3.8 out of 5 stars 46 reviews

Treatment of breast asymmetry

Developmental asymmetry is truly a complex problem. It is also a circumstance that insurance companies do not cover, which is tragic. The treatment plan will depend upon several factors including your daughter's inclination and your pocketbook. If reduction is covered by insurance, then you may want to reduce the larger breast first and then augment both. This can be performed either in one or in staged procedures. You must understand that it will never be possible to achieve identical appearing breasts and it is very important to accept the limitations of what we can and cannot do surgically.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 40 reviews

Breast Asymmetry

Both breasts should be done at the same time to avoid 2 anesthesias. I would reduce the larger side first and then, at the same procedure, augment the smaller size to match the reduced side.  I do this all the time in reconstruction after mastectomy.  Hope this helps.

Peter J. Simon, MD
Fort Lauderdale Plastic Surgeon
4.7 out of 5 stars 3 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.