A woman in her early 20’s who is bothered by breast asymmetry and would also like to have fuller breasts. She describes herself as a 34 B and is 5’3” and 150 lbs. She is shown before and again, 5 ½ months after bilateral partial subpectoral breast augmentation through an inframammary incision with a 300 cc smooth round moderate profile plus silicone gel implant on her right and a 200 cc smooth round moderate profile plus silicone gel implant on her left.
Discussion: The difference in her nipple position is not enough to justify the typical scar of a mastopexy (breast lift). Her right breast is the smaller and tighter of the two breasts and limits the size of the implant that can be used. So we choose the largest implant that will fit in her right breast based on her breast dimensions and that she also finds acceptable in clothing, and then work backwards with a smaller implant on her left breast to match as closely as possible. A larger implant on her right breast would have more fullness in the upper breast because it would be even more implant to breast proportionally and therefore not match the shape of her left breast as closely. She is thrilled with her result.
Update: At 11 months the right breast has settled and appears even closer in shape to the left breast. The key in a breast asymmetry case is the smaller breast, because that is the “tighter” of the two breasts and limits the size of an implant that can be used. If a larger implant had been used on the right there would be more fullness in the upper breast and because the relative size of the implant to the breast would be even tighter, the breast would have more of an “implant” look and not appear as natural as she does now.
Cosmetic & Plastic Surgery Specialist
"I treat my patients like I would treat- Jonathan D. Hall, MD, FACS
members of my own family."