Asymmetry present before surgery will remain if you add identical implants to each side. Volume asymmetry, that is. If you have positional or anatomic asymmetry, this too should not be changed by adding identical implants to each side, assuming they scar, heal, drop, soften, and settle the same on each side. But let's do a little mathematical exercise regarding size discrepancies, the most common concern when someone asks about asymmetry.BTW, thank you for spelling asymmetry correctly--you would be surprised to see how many physicians even spell it "assymetry!"For example, let's say you have breasts whose natural volumes are 90g on one side, and 100g on the other. This is a 10% volume discrepancy, right?! Now, add identical 400cc implants to each side, for a total of 490g (1cc = 1g) on one side and 500g on the other. This is now a 2% difference! However, there is still an absolute difference of 10g, the same as you started with.Still, with breast augmentation, natural differences often seem magnified--especially since healing differences are usually much more noticeable. Also, remember that your chest and ribcage exhibit differences between sides--your left chest has a heart that causes more rib protrusion on that side, and this usually means a slightly narrower ribcage and breast base with slightly more (apparent) breast projection. The right chest does not contain a heart, so the ribs are flatter, breast base is slightly wider, and breast projection is less, meaning that absolutely identical breasts (and who has that?) already LOOK different because of natural chest wall anatomy asymmetry! Plus you might have more muscle bulk on the dominant hand side, etc.Positional asymmetry (one dropping faster than the other) can be improved by use of an elastic bandeau positioned above the higher implant and below the lower implant ("Mexican gun belt style") at night. You will need to wear a T-shirt over the elastic bandeau and safety pin the elastic band to the T-shirt to keep it in place as you sleep. Ask your surgeon about this option.I'm not sure why you or your surgeon went above your muscles. You do not have much ptosis at all, and the slight submuscular compression on implants can easily be accommodated-for by adding 10-15% volume to the chosen implant size. Implants don't shrink OR swell as time goes by, either above OR below the muscles. Below-muscle placement minimizes risk of bacterial biofilm on the implant surface, and thereby reduces the risk of capsular contracture. Above-muscle placement exposes the implants to the intraductal bacteria from the base of your breasts. But I wasn't there for this discussion you had with your surgeon, and I don't know his/her thinking on this. I do know the vast majority of experienced breast surgeons go below the muscles for the very important reason noted above. Regardless, as healing progresses, tissues stretch, and scar capsules soften, so your breasts will develop a more teardrop shape with slightly more projection. If you had lots of post-op swelling, this goes away over time, and the end result is the perception of "smaller." If your surgeon uses careful tissue handling and precise technique that results in less swelling post-op, as tissues stretch and scars soften, implant projection increases can be perceived as slightly "larger." Either way, implants don't swell or shrink, so there's that!The important take-away here is that at 1.5 weeks post-op you are far from your final result. Complete healing can be determined by looking at your external scars. Once they have completely faded, softened, and flattened to (hopefully) a thin white line, you know your internal scar capsules have similarly completely matured. This take all patients 6-12 months, during which changes can occur by activity, bra pressure, gravity, and ongoing scar stretch or contracture. This is also why SOME women who look fantastic at 3 months post-op end up looking pretty funky (now there's a medical term we all recognize!) at one year post-op. And then they march right into the office wanting to know what the darn surgeon did wrong!If you are "too small" at 6-12 months post-op, you can always go back for larger implants. Any residual asymmetry can also be addressed at that time. Breasts are NOT twins, they are sisters. Perfect symmetry is virtually never seen (go back to basic anatomy lesson above!). You may be interested in more information which you can access by clicking on the web reference link below for my Comprehensive Guide to Breast Augmentation. Best wishes! Dr. Tholen
