Why Do PS Opt to Do Different Sized Implants for Lift and Aug Vs. Removing Excess Tissue?

I had a lift w/ aug, I was assymetrical prior to surgery (about a cup) my PS chose to put a 270 implant filled to 300 on lg side and 330 filled to 360 on small. I am still assymetrical enough that I have to wear a padded bra, why don't PS remove the excess tissue since the lift is being done anyway, then fill to size with less cc's to try to match? He said he would replace one or both, but I'd have to pay implants and surgery fees, it doesn't seem like I should have to, since that was my concern

Doctor Answers 8

Breast Augmentation and Breast Lifting?

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Thank you for the question and pictures.

Breast augmentation and lifting done together poses challenges that  either one of the procedures done separately do not pose. The surgeon does his/her best to achieve as much symmetry is possible by altering/removing tissue and/or using different sizes or volumes of breast implants.

Despite our best efforts, absolute symmetry is not achievable.

Your surgeon's policy of not charging a surgeon's fee to return to the operating room is quite standard.

Best wishes.

Breast asymmetry: remove tissue from the big or add tissue from the small

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It all depends on what your goal is.  One or both of the methods you describe can be used to help with breast asymmetry.  If the breasts end up symmetric and they are generally the size that you wanted them most patients would not care which method is used.  It is a little easier recovery and likely a little safer from the complication standpoint to just choose different implants.  I think the issue in your case is that the symmetry was not corrected to the extent your desired.  Have a discussion with your plastic surgeon about this.  Another option would be to just remove some of the fluid out of the larger breast.  This can be done in the office under local anesthesia thereby saving your facility fee and implant cost.

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Why Do PS Opt to Do Different Sized Implants for Lift and Aug Vs. Removing Excess Tissue?

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Thanks for the posted photos. Great question, the best advise is to discuss these issues with your chosen operative surgeon. If unsatisfied with the responses than seek in person second opinions. Yes, you will need revision surgery. 

Surgery to correct asymmetrical breasts

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Correction of asymmetrical breasts is not as straightforward as you would like it to be. There are a host of different reasons why wa woman's breasts could be uneven and a big range within each of theose reasons. It is not right to think that one strategy of surgery will be the right one for every woman. Most plastic surgeons who perform a lot of breast surgery will be able to pick and choose which operation would be best for their specific patient. Clearly you still have some asymmetry remaining and you should discuss this with your plastic surgeon. It is fairly customary for the patient to have to pay for facility costs for revision surgery but most surgeons will waive their professional fee. Your surgeon might alos be able to speak to the implant representative about the possibility of being able to "comp" you new implants. The companies also would like you to have a good result so that you recommend the procedure to your friends. If your surgeon has a good relationship with the company they should be able to work together. Good Luck.

Uneven breasts after breast augmentation

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Putting different sized implants or removing breast tissue deep to the breast skin alone will not fix your current problem. You are bottoming out on the right. That would be best addressed by removing an ellipse of skin from just above the fold on the right. I think you will be much less asymmetric after that and it could make you happy enough that you do not want or need additional surgery.

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

Use the same size implants in doing a lift and adjust the tissue

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It makes the most sense to me when dealing with an asymmetric lift to use the same size implants and just adjust the tissue to make them most equal.  The implants are like the frame of a house, so why would you use different ones if you wanted the two sides to look the same??

Breast asymmetry can be corrected with revision breast augmentation.

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1)  It is fine to correct asymmetry by reducing the larger breast and doing a lift on both sides without implants.  Or you can put different size implants in each breast, as you had done.  But you tend to feel less symmetrical if there is an implant in only one breast.  We do that only when the patient really likes the size of the larger breast.

2)  The probable reason that you are still asymmetrical is that you need a larger implant in the smaller breast.  We recommend using sterile disposable implant sizers during surgery before opening the permanent implants.  That way, the surgeon can see for sure which sizes produce symmetry, without any guess work.

3)  For revisions, we charge for implants, operating room and recovery room, and anesthesiologist but we do not charge a surgical fee.  It sounds like there was a mis-communication between you and your surgeon.


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

Resection an Option.

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When a patient is very asymmetric, and I am performing one of the larger lifts, I actually prefer to try to create symmetric breast mounds and place a similar volume implant. This gives a similar shape and projection on each side. This can sometimes be best addressed by doing the procedures in two stages. If the unevenness if relatively small, two different size implants can be placed with good results. Good Luck!

Brian Klink, MD
Vacaville Plastic Surgeon
5.0 out of 5 stars 100 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.