Breast Enlargement for Asymmetric Breasts?
I don't think that you would fall into the "extremely" difficult category but you do have a couple of issues that make situation somewhat more challenging. You photos indicate that you have at least two components of asymmetry. First, your left breast appears larger and you have more ptosis (sagging) on that side. Also, as you mention, your left areola is larger. The size difference can likely be addressed by using two different sizes of implants. The increased sagging and enlarged areola could be addressed with some type of breast lift. This would help change the shape of your left breast to better match your right breast, but it will require putting additional scars on your left breast and you do not appear to need any sort of lift on the right. Doing a lift on just the left side will introduce a different type of asymmetry. In some situations you are better off accepting your original asymmetry rather than introducing extra scars and creating a different sort of asymmetry
Augmentation and Lift for Asymmetric Breasts
The position of the nipple on the right side is esthetically normal and perfect, so an augmentation to the desired size would be indicated. Then a breast lift to match nipple position and areola diameters on the left would be indicated as well as an augmentation with the appropriate size for volume symmetry. It is not particularly complicated.
Breast augmentation seems to be a simple procedure, with even breasts use the same size implant, if you have unequal breasts use two different implants. However, breasts often (especially in your case) respond to augmentation differently. Your left breast has more laxity in it and it will relax more after augmentation. A lift will help but now you will have different scarring on each breast. After 24 years of surgery the one thing I am sure of is that nothing is 100% predictable. Find a board certified surgeon that you like and have multiple discussions about your desires and be prepared to maybe have a touch up surgery on the left side after every thing heals. Good luck you should do fine.
Breast enlargement is simple
but if you are desiring perfect symmetry, you must have additional procedures done on the more droopy side that will elevate the areola, make it smaller, and possibly diminish the amount of tissue so same size implants can be used. Any experienced plastic surgeon should be able to do this but you cannot expect perfection... only an improvement.
Asymmetries are fairly common and in your case it appears that you would probably want to consider a lift on your left side, then two potentially different volumes of implant. It is best to discuss expectations and options in person with a board certified Plastic Surgeon.
All the best
I do not think that it would fall into the difficult category, but you would need a lift as well on the left
3-d imaging simulation
thank you for your question by viewing your pictures I believe you were the ultimate candidate to use a 3-D imaging system called the Vectra to determine whether or not you will require a lift for proper symmetry depending on the volume of implants you use. I think you're great candidate for breast augmentation and will have very natural and aesthetically pleasing breasts. In my practice I believe preoperative planning is essential to get good results consistently.
Asymmetric Breast Augmentation & Lift
For an experienced plastic surgeon, correcting both the asymmetry and left droop. You will need different sized implants and a lift on the left side. The lift should also correct the difference in the areolae. I wield personally place the implants sub glandular since this makes correcting both the asymmetry and doing the lift easier. Because of this I would use textured implants to retain a low risk of capsular contracture. Make sure you discuss your exact desires with your surgeon.
Breast enlargement for asymmetric breasts
It is more complicated to do breast enlargement on asymmetric breasts, but not extremely. You will need a lift (possibly a small reduction) on the left side. This will get your nipples at equal heights and diameters. Then perhaps slightly asymmetric implants. I think you could go over or under the muscle with the implants but you need an in person examination to determine the final specifics. Good luck!
Thank you for your question and photos. It appears that you would benefit best from a lift or modified lift on the left breast to match the right breast. Then you can have either saline or silicone implants to give you the fullness you wish to have. Make an appointment with Board Certified Plastic Surgeon who performs a lot of breast surgeries.