Severe asymmetry - wondering what my options could possibly be. (photo)

Hello and thank you for your question.
Based on the photographs provided, the folds look fairly symmetrical. It does appear that you have some bottoming out with an elongated nipple to imframmary fold distance. You may benefit from revisional surgery with removal of excess skin along the lower poles and possible mesh placement for improved support. Good luck.

It does look like you're experiencing bottoming out on both sides. This happens when the implant drops below the natural fold, creating too much fullness in the lower pole and stretching the nipple-to-fold distance. If you're planning to remove the implants without replacing them, keep in mind that achieving symmetry can be a bit more complex — especially if one side had a larger implant and more tissue thinning. That said, a natural, balanced result is possible.Depending on your goals, options may include:A stabilizing mastopexy revision (lifting and reshaping the breast without moving the nipple)Fat grafting to restore volume and improve symmetryOr implant exchange with improved support, if you still want upper pole fullnessYou can absolutely achieve a natural result — whether using your own tissue or implants, but you might need more than one surgery.

Without a history/physical exam/in-office ultrasound, it is challenging to make official recommendations. Just from the photos, it appears that you have some pocket malposition, potentially too wide of a breast implant, and breast tissue/skin laxity. At the minimum, I would recommend breast revisionary surgery that would include tightening the internal implant pocket, placing a new implant, performing a breast lift.