Breast asymmetry correction with implants - over or under? (Photo)

Hello,
Thank you for the question.
Based on your photos, you appear to be a good candidate for breast augmentation.
Implant size discussion and implant selection is one of the most important steps during your consultation with plastic surgeon. The decision-making process depends on your desires, as well as breast and soft tissue dimensions of your chest wall. I also utilize Vectra 3D planning to further help with implant selection.
The breast implants are typically placed under the muscle to provide more soft tissue coverage using a small incision at the breast fold.
I would seek an in-person evaluation by the Board-Certified Plastic Surgeon, in order to discuss your goals and concerns for the best cosmetic results.
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Hello and thank you for your question. There are always risks, benefits and alternatives to every surgical procedure. I would highly recommend coming to see a board-certified plastic surgeon for more detailed examination and information. Nonetheless, based on your athletic nature and being into weightlifting I would recommend placing your implants above the muscle. Animation deformity can be a serious problem. I would not recommend teardrop anatomic implants. These implants can shift over time causing a secondary aesthetic deformity requiring another procedure.
Alex Zuriarrain, MD, FACSQuadruple Board-Certified Plastic/Cosmetic SurgeonCleveland Clinic Trained

In general, you have several options to achieve symmetry given your pictures. Your right breast is not only larger, but has more pseudoptosis (skin below the nipple) as well as a slight ptosis (low nipple). In my opinion, your best bet for true symmetry would be a staged procedure in which you underwent a subglandular or subfascial augmentation followed by a lift at a later time. Anatomic implants in the subfascial plane can look excellent, however can also lead to malposition. To decrease the risk of malposition, there are other cohesive smooth round implants that can give you a similar and reliable result. You could opt for a single stage subglandular augmentation mastopexy procedure on the right side, but the risk of asymmetry and revision surgery is slightly higher.

An appropriately done sub-muscular dual plane breast augmentation should not lead to an animation deformity. If you are able to take a break from pectoralis major work for the recovery (at least 6 weeks), this surgery would not be a problem in the future to resume your athletic lifestyle. The benefits of a submuscular pocket and risks of a subfascial/subglandular pocket are something you should extensively discuss with a board-eligible or board-certified plastic surgeon during an in-person consultation.

Either above or below muscle would be fine. I don’t believe in such a thing as subfascial because the fascia is so thin in that area that it’s practically non existent. Teardrop implants have been a disaster from day one. They feel like plastic through the skin and can get turn on their own so that they no longer are symmetrical. You are borderline as far as needing a lift. Specific measurements would need to be taken

Pre-existing assymmetry is difficult to correct with breast augmentation alone. This is true regardless of whether the implants are placed above or below the muscle.
Some options include choosing two different implant sizes (for mild differences only and often unsatisfactory), making the larger breast smaller (small reduction- downside is scars on reduced side), making the smaller breast larger (fat grafting).
The most predictable way to avoid an animation deformity is to place implants above the muscle in someone who is a very avid weightlifter.

Your breasts are asymmetrical in volume, shape and position. Implants alone will not solve your problem. The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, fat transfers or small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Love this question! you would be a good candidate for either over or under the muscle placement. But I agree with your concerns about animation deformity and loss of strength. For this reason, I believe your best option would be sub-facial placement.
Teardrop anatomic implants are a good option but might not be necessary, especially if high cohesive gel gummy bear implants are used, because I feel you have enough tissue on your upper pole.
As for asymmetry correction, depending on the size of implants, you might need a small lift on the right breast. This can probably be done with a lift around the areola only, commonly known as the Donut Lift. Plus, a Donut Lift on your right breast and a circumferential incision on your left areola will give you round areolas on both sides!
Best of luck,
Dr. Miguel Mota

Your risk of capsular contracture and implant visibility is far greater with implants in the over position than animation deformity or loss of strength in the under position. Further, your asymmetry issue will not be rectified well with a simple breast augmentation. Your larger breast has proportionately more skin for its size than the smaller one, which will leave you looking more asymmetric, even after using two different sized implants; the larger breast will look soft and underfilled, and the smaller breast will look tight and overfilled. Shaped implants do not impart a different result than round implants. This has been demonstrated time and time again. Additionally, shaped implants are textured, putting you at a very small risk for breast implant associated lymphoma. You will need a unilateral breast lift to get good symmetry, which will allow the surgeon to remove not only excess skin, but also some extra volume so that the implant size can be same for each breast.

Thank you for your question. A large portion of my practice is dedicated to breast surgery and revisionary breast surgery. After being in practice for 27 years, I have a significant experience with this. Generally, the long-term results associated with subglandular or subfascial placement of implants is poor. I have a whole gallery of poor results/revisions related to implants placed on top of the muscle. The animation deformity is mild trade-off for the benefits of going under the muscle. In your case, your breasts are somewhat low on your chest and you have ptosis in your right breast. You would benefit not only from a submuscular/dual plane breast augmentation but also a Donut or lollipop lift depending on the look and roundness that you want. The good news is that with a talented, board-certified plastic surgeon, you can have an excellent result. Best wishes to you.