How Do Plastic Surgeons Make the Pockets Even on Both Breasts?

I had a revision where the surgeon had to bring the inframmary fold up to a better Position. I am 6 months post. I am being told by other surgeons that the left breast fold is 1mm lower than right breast. Is there a special surgical tool that you use during surgery so they are even on both sizes like leveling a picture on the wall?

Doctor Answers 9

How plastic surgeons make pockets even on both sides . . .

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In over 24 years of measuring breasts in women, I have found only two (2) who measured exactly the same, and both of them did not LOOK symmetrical. Others who looked perfectly symmetrical did not measure the same, and in fact often had really different measurements. Then again, even when I measure the same patient twice, the measurements often are "off" by 1 or 2 mm. (Of course, this is because skin is stretchy, not because I am inaccurate!)

The reality is that no woman starts out perfectly symmetrical, and after even the best surgical procedure she won't end up that way either--but I certainly strive to move in the direction of improved symmetry, especially when there is a larger discrepancy pre-operatively! With breast enlargement alone (no lift or other shaping incisions) my only surgical choices are implant size and profile, and pocket position, which should be chosen to accurately end up being directly behind the nipple areola complex. Then there are other details such as starting a bit higher to take into account scar softening, stretch, and maturation, and pocket size (a bit bigger than the implant) to take into account "normal" breast movement when reclining and to perhaps allow a bit of capsular contracture to occur without causing a hard breast. But . . .

Perfect symmetry is both unrealistic and impossible.

I suspect that no plastic surgeon would tell you that you are off by 1 mm. Either you misunderstood them, or you mistyped this--even a 1 cm discrepancy is less than 1/2 inch!

There is a special tool I use during surgery; it is a ruler--every OR has sterile ones available (but you have to use them). I also measure and mark each patient in the pre-operative holding area before surgery, and I do this while they are upright and not sedated, so the patient can tell me about any perceived size or position asymmetries she wants me to improve. Notice I did not say "correct," just improve.

Of course, careful surgical technique, attention to detail, and years of experience also play some role in how accurate a surgeon is in his pocket placement, and whether or not he or she takes into account how the healing process makes changes in every patient's final implant position. Most experienced surgeons learn over many years that virtually every patient's implant position "drops" over time after surgery--meaning that if you look "perfect" right after surgery, your implants will often end up "too low" by the time 6 months has gone by. Raising the pocket (and keeping it up) surgically is "way harder" than occasionally having to drop a pocket lower in the rare patient that does not drop as much as most patients do. But those preferences and surgical choices come down to training, habit, experience, and perhaps stubbornness in admitting there is still something to learn about this operation, even after doing hundreds of them over many years!

From a patient's perspective--YOURS--it's more about your look rather than measurements. Do you like how your breasts look? If so, forget the measurement difference. If you don't like how they look (even if the measurements are the same, but really regardless of the measurements), then talk to your surgeon about another revision, or see other expert plastic surgeons until you find one who seems on your wavelength, and whose work passes your critical gaze! Good luck.

How to make breast pockets even

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I have never seen breasts with perfect symmetry, either natural or surgical.  Typically a 1 mm difference in fold position would not be much to worry about.  Careful preoperative markings, attention to detail in the surgery, and evaluation of the patient with the back of the operating table elevated are maneuvers that are useful.  Minor discrepancies in implant position can often be adjusted after surgery with differential implant exercises, elastic bands, and support bras.

Symmetry following breast augmentation

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Achieving symmetry in breast augmentation is extremly difficult

The reason is that there are so many factors that need to be considered in order to achieve symmetry

These include

Pre existing breast size

Difference in base diameter

differencein breast shape

position of the breast fold

nipple position

chest wall asymmetry

Surgical technique

Curvature of the spine(scoliosis)

Adjustable implants are of great benefit in achieving symmetry,however only the saline adjustable is available in the USA.The adjustable gel implant is due to undergo FDA studies soon



Even pockets for breast augmentation

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Certainly the pockets should appear even after breast augmentation though in most cases there will be an adjustment due to dissimilarities in the breast. The pocket position comes with good judgment and experience as it must accommodate the implant size and shape, natural breast shape and skin elasticity, and of course natural asymmetries in the breast. Other surgeons have seen a 1mm difference, really? You did not say if you like the way you look, the goal for most.

Best of luck,


How Do Plastic Surgeons Make the Pockets Even on Both Breasts?

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Sounds like you fall in the normal ranges. But you did not post any photos so very hard to advise if there are differences. No special tool. 

Breast symmetry

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Remember a couple of things:

1. Most patients do not have symmetric breasts naturally. To expect human beings (plastic surgeons) to give perfectly symmetric breasts is ambitious to say the least, if not impossible.

2. 1mm difference is not only within normal limits, but hardly likely to be accurately assessed. Did you mean 1cm?

3. I find many patients tend to obsess about minimal asymmetries after surgery because they are scrutinizing their results more than they scrutinized their preop appearance.

If the asymmetry is very obvious, then revision can be performed.

We don't usually use a level, although I have seen plastic surgeons use a carpenter's level for preop marking before.


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A 1 mm difference in the breast folds is within normal limits. No one has folds exactly on the same level or shapes exactly the same.

Revision breast augmentation works.

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You do not need any special tool.  What we do is sit the patient up towards the end of the operation (you are still asleep, of course).  Then we can actually see if the shape and symmetry are great.  If not, we keep working, and check again.  Sometimes, these steps have to be repeated two or three times before we are satisfied and finish the procedure.

The other point is that one millimeter is very little difference.  There is no such thing as absolutely perfect symmetry.

The question is "Are you happy with the way you look?"  Sometimes it is best to consider leaving well enough alone.  Without pictures, that's all one can say.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Making breasts even--it's not easy but we do it...

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Hi there hyperchick.  First, your scenario is a common one.  Revisions after breast surgery are common and you shouldn't fault your surgeon for having to go back and "tweak" things.  There is no special tool that we use to make the breast pockets even.  It's simply using good surgical technique, having an aesthetic eye, and spending time preoperatively with markings and analyzing the patient's torso.  Even with all of this, the breasts can still turn out with one slightly lower than the other.  Unlike car mechanics, the machine we surgeons work on are living and breathing--so just because it looks good on the OR table, doesn't mean it's going to stay that way once the healing process begins.  With regard to your breast fold asymmetry of 1mm.  If you truly only have a 1mm difference, then you should be very happy.  This is near perfect and there's simply no way to improve on it.  Everyone has asymmetry preop and everyone has asymmetry postop--the goal is to just reduce the amount of asymmetry.  Hope this answers your question!  

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