Disproportional breasts - over the muscle implants? (photos)

I had surgery to remove a large benign tumor from my right breast and since then my breasts have been noticeably uneven. I wear 32 DD now, but only my left breast fits the cup correctly. I am considering implants to even out my breasts. My assumption is that over the muscle implant will look more natural on me, since I already have "loose" skin and some droopiness in the area. I would like to stay similar size, but with more volume. Would you recommend going over the muscle? What size?

Doctor Answers 10

Disproportional breasts - over the muscle implants? (photos)

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To summarize, you have DD cup breasts but because of a biopsy in the past in the right breast, your right breast is slightly smaller. Your question is, what size implant do you need in the right breast for symmetry and should it go over or under the muscle?

All studies demonstrate that under (behind) the muscle has a lower encapsulation rate. This is a huge advantage of behind the muscle implants. However, in your case because you have such large breast and you need such a small implant, I doubt if you would even notice an encapsulation. Still, my recommendation would be to place a small implant, about 100 to 150 mL, in the right breast to make it more symmetrical with the left. Because of needing such a small size, I feel confident that it would be very close in shape and contour to your left breast.

To determine the size implant for your right breast, you should see a plastic surgeon and have "Sizers" placed in a bra with a T-shirt, and look at yourself in a full-length mirror at various angles. Between you and your plastic surgeon, you should come pretty close to the size that will make you symmetrical.

Thank you for your question and photographs and best of luck to you.

Breast assymetry

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I much prefer implants below the muscle .  I would recommend saline implants with a diameter equal to your breast diameter. The final result will be more symmetrical because you have a lot of freedom adjusting the volume with saline implants. Try on some implants for size in the office.

Talmage Raine MD FACS


How to correct uneven saggy breasts

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I would not recommend breast implants in your case. You need a breast lift. Placing an implant over the muscle will not stay in place for very long. The weight of an implant will only pull/stretch your breasts down further. Lifting them will make them more aesthetically pleasing and allow the surgeon the opportunity to remove the same amount to achieve symmetry. You may have enough volume to create nice results without implants. You are welcome to take a look at my gallery to look for someone with your dimensions to see what kind of results can be achieved with more current techniques. I have attached an example of a woman who did not require implants nor the vertical incision.

Best wishes,

Asymmetry fixed by implants?

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There are many reasons for asymmetric breasts; your asymmetry may not only be a result of the tumor removed, but also where you breast originates on your chest, the width of your chest wall, etc.  Implants can help to assist with adding volume, but it may not affect the overall shape.

These are difficult to assess online with pictures; it is advisable to seek a consultation with a plastic surgeon certified by The American Board of Plastic Surgery.

Over or Under the Muscle for Uneven Breasts

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As you know most women's breasts are uneven.  Adding volume I think is a reasonable thought and may be done without an uplift depending upon your goals and your recognizing that "volume" makes your breasts larger.  A larger implant on the operated smaller side will increase your volume and size but to achieve equal size with uneven skin you may have different shaping.  If you're wiling to accept a compromise between contour and size then consider implants as long as you are okay being larger.  If not, then you may need to consider uplift incision lines to permit uplift and skin and breast tissue removal on the larger side with an uplift and tightening on the smaller side only.  You and your plastic surgeon will need to review photos of the incision lines and your goals very carefully before you make any decision.  Also, my strong preference is nearly always to place implants below the pectoral muscle rather than subglandular.  There's more information in the video that I've linked to above.


Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

What you need is a lift to even the breasts. Not necessarily implants.

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From the pictures posted it appears that you need to have a breast lift. This will even out the position of the breasts. Implants would only be added to increase your upper pole fullness. Implants alone will not make your breasts more even. In fact they may make it worse. I hope this helps.

Itzhak Nir, MD, FACS
West Palm Beach Plastic Surgeon
4.9 out of 5 stars 40 reviews

Disproportional breasts and over the muscle implants?

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 Thank you for your question. I respectfully personally disagree with your assumption about over the muscle. The submuscular placement of breast implants reduces the risks of some of the the unwanted side effects such as capsular contracture, late "bottoming out" of the implants, thinning of your native breast tissue, visible rippling  and several others. When placing implants beneath the pectoralis muscle, its fibers along the lower breast fold are released so that the implant settles down into the fold nicely and does not remain high riding. Your breast implant sizing would be based on your goals as well as breast and chest measurements. I don't realistically think that it is possible to provide more volume in the form of  breast implants yet stay within a similar size as you suggested. The breast implants you receive would need to be of adequate width to generally match your existing breast foot prints. Whether or not a breast lift would be recommended would certainly require an in office examination. As a final thought, in order to minimize size increases you also could consider a fat transfer procedure to one or both breasts as apposed to breast implants. Best of luck!

Disproportional breasts - over the muscle implants?

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Thank you for your surgery, It is normal for most woman to have uneven breast, a Breast Augmentation and lifting would be needed.

Over the muscle is a bad option

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Implants placed over the muscle have a lot of issues -- more interference with mammography, higher visibility and palpability, thins the tissues, and most of all a higher risk of capsular contracture.  I have fixed MANY implants placed over the muscle and the solution is to put them under the muscle.  The recovery is nearly identical! Don't make the mistake many have made before you -- discuss it with your surgeon. I feel a dual-plane technique for placing the implant under the muscle is best.  Good luck!

Disproportional breasts - over the muscle implants?

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Thank you for the question. Keep in mind as you are making your decisions, that you may be a good candidate for breast lifting surgery as well as breast augmentation surgery.  This operation will address the "loose skin and droopiness"  and help improve symmetry as well.

 Generally speaking, there are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well. 

I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes). The submuscular positioning  also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  they can be seen with breast implants placed in these sub muscular position.    Best wishes.

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.