Breast enlargement issues. Any solutions to this? (Photo)

Help please. I am a few weeks from my breast enlargement and my surgeon has suggested not completing this as my breast bone would cause the breasts to effectively point in different direction. Basically one will point straight and the other to the right as I have one flat/sloped breast bone. Any solutions to this? Or has anyone experienced this?

Doctor Answers 9

Breast enlargement issues. Any solutions to this?

Hello and thank you for your question!

Yes, in some cases asymmetry in the chest would be a challenge in breast surgery. As you can understand, one of the breasts can be evened out. In that case, from my experience, the best option is a Mastopexy with implants, where I can remove some of the tissue and make sure they look as asymmetric as possible. As you can understand, it is practically impossible for them to be 100% equal, however we can do measurements of the base of your chest and breasts, allowing us to have a predictive result in terms of projection. You can also use a scanner, called Divina, which allows us to perform a previous simulation of the result and that way know if we need different sized implants or another approach.

Please visit a board certified plastic surgeon for further advice and the best, safest results.

Good luck!

Dominican Republic Plastic Surgeon
5.0 out of 5 stars 3 reviews

Breast enlargement issues

Thank you for your question and photographs.  Asymmetry between one's breasts is quite normal.  I see no reason why you would not be a good candidate for breast augmentation.  Best to consult with a board certified plastic surgeon.

Breast Augmentation For Asymmetrical Ribcage

So far as you are prepared for asymmetry, have realistic expectations, and are in good health you can proceed with breast augmentation. Discuss with your plastic surgeon a strategy to help minimize asymmetry as much as possible. 

Millicent Odunze-Geers, MD, MPH
Sacramento Physician
4.6 out of 5 stars 5 reviews

Be prepared for asymmetries after surgery

Dear Kerry, it is very common to have asymmetries between your breasts and underlying chest wall deformities are also not that uncommon.  It is good that this has been pointed out to you beforehand to allow you to prepare for what you can expect.

My approach to asymmetries such as yours is to consider using implants of different shapes and sizes to try to get a balance, although because of the way that the implants come, sometimes I use the same size implant in both sides despite the asymmetry as this could be the best match if the difference is mild.

You do have an asymmetry of your nipples and they are pointing in different directions and I would suggest leaving this, as to correct it would give more obvious scarring.  However, you would have to accept that they would remain asymmetrical postoperatively.

It is all about being aware of what can be achieved with implants and to be prepared for the results of surgery with realistic expectations.

When there are asymmetries and chest wall deformities, you may want to see a plastic surgeon who specialises in breast surgery.  Our professional organisations, BAPRAS and BAAPS have websites with a list of members with their speciality interest.  Good luck.

Augmentation and Asymmetries

Breast augmentation is often performed to increase the size of the breast for aesthetic reasons. The size, shape, and position of these implants are often based on the patient’s anatomy, the type and size of the implant, and the patients goals. 

As your surgeon has indicated, however, implants can magnify problems with nipple position or breast and chest wall asymmetry, such as yours.

To correct these issues, an asymmetric augmentation is often recommended. In addition, a mastopexy is often performed to remove skin and reposition the nipple to further shape the breast around the implant.

See the link below for more info on breast augmentation.

A detailed examination will help delineate the best surgical option. Consultation with a surgeon certified by the American Board of Plastic Surgery would be the next best step.



Thank you for your question and photos. There is often not a way to make the breasts a perfect match or create symmetry where the was asymmetry, so it is important that you understand the limitations of the procedure for you and accept that some differences may appear greater afterwards. Having said that, for chest wall asymmetries I have found that different sized implants or different implant projections placed on each side and careful surgical placement, can provide a pleasant outcome. Sizing in the office, trying implants on to see what feels like a balance for you will be helpful. Clear, frank discussion about your expectations and likelihood of remaining asymmetry is important. Certainly, many women with these chest wall asymmetries have BA surgery and are pleased with their results. You could seek a second opinion if your surgeon does not feel they can give you a good results in their hands.

All the best

Breast augmentation in patients with chest wall asymmetry

Dear Kerry,

Thank you for your question. I have performed an number of breast augmentations on ladies with chest wall asymmetry, and most recently on someone with a marked scoliosis of her spine causing one side of her chest to be much more prominent than the other (in fact I believe she has written a review of her experience on Realself). The best solution I have found is to use breast implants of different sizes. The smaller implant goes under the breast on the side of the chest which is more prominent, and the larger on the other side. I use inflatable sizers at the time of surgery to calculate what sized implant to put on which side, such that at the end they both match. This does mean the surgery lasts a bit longer, and I also have to order up a larger range of implant sizes. However the outcomes have always been very good through this approach. Looking at your pictures this should be very achievable with you.

Best wishes,


Anthony Barabas, MBBS
London Plastic Surgeon

Breast enlargement issues. Any solutions to this?

Thank you for sharing your question and photographs.  It is not uncommon for patients to have some asymmetry in breast volume or chest wall discrepancies that can be accounted for with differing size and differing profile of implants.  The use of Vectra imaging can help preoperative planning to account for volume differences as the profile and cc amount on your right implant will need to be greater than your left.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 38 reviews

Breast enlargement issues. Any solutions to this?

Thank you for the question and pictures.  Based on your photograph, I think that you are starting out at good place and should have a very nice outcome with breast augmentation surgery.  It is not at all unusual for patients to present with some degree of breast and/or chest wall asymmetry.   Skillful execution of the breast augmentation procedure, including selection of appropriate breast implant size/profiles can improve chest wall/breast asymmetry significantly. Often, it is  helpful to use different sizes (or even profiles) of breast implants; this differential use of breast implant volumes and/or profiles can really help to camouflage any pre-existing asymmetries. Some of our happiest patients are patients who started out with chest wall asymmetry and/or pectus excavatum concerns.

Generally speaking, the best online advice I can give to ladies who are considering  breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This communication will be critical in determining  breast implant size/type/profile will most likely help achieve your goals. 

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as  “natural” or "C or D cup”  etc means different things to different people and therefore prove unhelpful.

 Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup  size may also be inaccurate.  Again, the use of computer imaging has been very helpful, in our practice.


3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery,  after the use of temporary intraoperative sizers.

I hope this (and the attached link, dedicated to breast  augmentation surgery concerns) helps.  You will find separate pages, on the same website, dedicated to breast asymmetry as well as chest wall concerns ("pectus excavatum").  Best wishes. 

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.