Should I have two different sized implants? (photo)

Question

My breast are clearly not even. One side is fuller than the other and sits slightly different as well. My doctor does not think I need different sizes - says surgical methods can correct most if not all the asymmetry. But I worry the unevenness will just be much more magnified if same sized implants are used. Am I worrying for nothing? Or do my breasts definitely require two different sized implants to make them even? Help please!

Suzette Miranda, MD · Answer

Thank you for your question and pictures. Yes, you are right. You do have some slight asymmetry which is natural and common in everyone. No one person will have the same exact breast size, position etc. I would steer away from placing different sized implants because your difference is so minor and the outcome could be that you cause the smaller breast to become the bigger one, and vice versa. I think you are a great candidate for a breast augmentation. You should speak to your plastic surgeon and together you an make a plan that meets your goals(as long as you the risks and benefits of each). Good luck!
Best wishes, 
Dr. Suzette Miranda

John Diaz, MD · Answer

It is very difficult without assessing you in person to know if different implant sizes would be necessary for you. Keep in mind that implant size selection not only depends on your personal preference, but it also depends on your unique measurements. There are various types of implants that can help you attain the look you are going for. A thorough consultation with a board certified plastic surgeon will allow you to communicate what your desired result is and will inform you as to what is possible to achieve your goals. We have a device called the Vectra 3D imaging system that shows you what you will look like with any implant as well as calculate the volume difference between your breasts in order to determine if different sized implants would be necessary to improve your symmetry. Usually any volume difference that is less than 20cc is not normally visible and should not require a different implant size. Our patients are very happy with the choice of implant they make when using this system. To learn more about breast augmentation, you can read “A Comprehensive Guide to Breast Augmentation.

S. Larry Schlesinger, MD, FACS · Answer

From the photographs you sent, it does appear you have asymmetric breasts.  However, the difference appears minimal. Implants of the same size should give you natural appearing breasts.  This is because it is very natural to have breasts of slightly different sizes, and depending on the volume of implant you put in, the larger the implant volume, the less asymmetric they will appear.Obviously, it is difficult to make an absolute determination from a 2-dimensional picture.  However, based on your pictures and your plastic surgeon's comment, it seems reasonable that an implant of some volume would blur the minor differences your breasts display.

Tom S. Liu, MD, MBA · Answer

Thank you for your question! Your question is very common among breast augmentation patients. As we all have our own asymmetries, the slight differences you have noticed in your breasts are completely normal. For patients who want to try to correct any asymmetry in the size of their breasts with their augmentation procedure, it can be beneficial to use two different sized implants. For patients who feel that one breast sits a little higher than the other, your surgeon can lower your breast fold during the operation to alleviate this as well. It is possible that your surgeon feels that the differences in your breasts is so small that he may not recommend different sized implants. It would be important to address this with him or her before your surgery to ensure your satisfaction with your results! Good luck in your upcoming procedure! All the best, Dr. Liu

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate
for a breast augmentation.  If you trust your surgeon, then follow their recommendations for implant selection, as they have examined you in person and can tell much more about your asymmetry than can be determined from your images.  The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Austin Hayes, MD · Answer

It's difficult to tell from your photos, whether the size difference requires two different sized implants. It's important to know that small differences in volume are even less noticeable after placement of implants. I would say that you could go either way and use the same, or two different sized implants. Speak with your surgeon about your concerns.

Urmen Desai, MD, MPH, FACS · Answer

Yes, I recommend that you do use two different implants.  The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Donovan Rosas, MD · Answer

Asymmetry is the rule not the exception. Everyone will have slight variations from one side to the other. Ultimately, the decision of whether or not to address these differences is a decision which is made by both patient and surgeon together.A general rule of thumb is that if an asymmetry was present pre-op it will be present post-op (on an altogether larger canvas). In my practice if the patient presents with complaints of asymmetry it will likely need to be addressed. If they do not appreciate a mild asymmetry, I will typically point it out but will not necessarily encourage them to pursue it. Most mild asymmetries will be imperceptible to both patients and observersBased upon your photos alone, you do not appear to have any significant asymmetry (this does not mean you are symmetrical). It is unlikely that there is an implant differential available (outside of a saline device with an asymmetric fill) which could account for this difference.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Daniel Barrett, MD · Answer

Dear jenx3,Breast asymmetry is actually quite common. In fact most women's breasts are different from each other. A detailed consultation would be able to provide you better answers for your questions because there are several measurements that need to be taken first. I tell all of my patients that have asymmetry before breast augmentation to expect the same asymmetry after the augmentation so... No augmentation alone will not remedy the problem. However, it looks like you don't have any significant asymmetry so you should be fine.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

Richard Baxter, MD · Answer

In your case the difference appears to be quite small, so different sized implants might overcompensate and make the smaller one larger because of the increments of size in implants. VECTRA 3D simulations can help. Consider for example that 3D analysis determines that your breasts have volumes of 100 cc's one one side and 80 cc's on the other; the implants available might be more than 20 cc's of volume difference in the correct profiles. Consider also that your existing volume difference is 20%; if you use for example 300 cc implants, your sizes would then be 400 and 380, only 5% different, closer than most people would be able to detect.

Should I have two different sized implants? (photo)

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