A woman in her mid 20’s with back pain, shoulder pain, grooving and irritation of the shoulders from her bra straps, difficulty exercising because of the size of her breasts and a rash in the warmer months. She was wearing a 34 DDD Bra. She is shown before and again, 4 ½ months after bilateral breast reduction with the removal of 743 grams from her left breast and 561 grams from her right breast to bring her down to a C cup. Her symptoms have resolved and she is thrilled with the new shape and size of her breasts.
A nursing student in her early 20’s who is bothered by breast asymmetry and macromastia. She is a D cup on her left and a triple D cup on her right. In addition to having problems in a bathing suit and in clothing from the difference in size of her breasts, she also has problems with back pain, shoulder pain, difficulty exercising as well as a rash under her breast in the warmer months.
She is ‘ 4” and 156 lbs and is shown before and again, 9 months after bilateral breast reduction with the removal of 146 grams of tissue from her left breast and 536 grams from her right breast to bring her down to a full C cup to match her frame.
Her symptoms have resolved and she is thrilled to have breasts that match in her clothing.
An 18 yo woman of color with severe macromastia and breast asymmetry. She describes herself as a 38G cup and has problems with grooving and irritation of the shoulders, back pain, shoulder pain, difficulty exercising and intertrigo. She is shown before and again, 5 months after bilateral breast reduction with an inferior pedicle Inverted T scar technique with the removal of 1538 gms from her right breast and 961 gms from her left breast to reduce her to a full Cup. Scars will typically fade and improve over the next two years. She is thrilled with her result. She no longer has symptoms due to the size of her breast and is able to exercise now. She is confident now, and showed me photos of her being able to wear beautiful dresses now from a recent trip to a bridal shop that she could never have been comfortable in before.
A 17 year old woman with severe breast asymmetry. She is larger than a DD on her right and a full C cup on her left. She has had problems with right shoulder and back pain due to the size of her breasts. She had first developed breasts at the age of 13 and has not had any changes in size over the past year.
She is shown before and again, 7 ½ month after a J breast lift on her left side and a short T scar technique on her right. Gortex Round block sutures were used to prevent spreading of the areola. 40 gms of tissue were removed from her left and 252 gms from her right. Her symptoms have resolved and she is thrilled to have breast which match. Scars typically get thicker and redder for 6 weeks and then fade and improve over the next 2 years or longer. She is using topical silicone to help with the scar maturation.
A mother of 3 in her late 30’s who feels like her breasts are too small to balance her frame, and is also bothered by breast asymmetry in a bathing suit and in T shirts when she is not able to wear a padded bra to camouflage. She has selected the ideal structured saline implants because she didn’t want to worry about silent rupture but wanted an implant that feels more natural than the traditional saline.
She is 5’6” and 138 lbs and is shown before and again, 9 months after bilateral partial sub-pectoral breast augmentation through and inframammary incision with a 300 cc Ideal structured saline implant on her left filled to 320cc which is above the “high” but below the “100%” fill volume, and a 440 cc Ideal structured saline implant on her right filled to the “high” of 440 cc. Tattoos have been blurred for her privacy.
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.
A woman in her mid 20’s who is interested in having fuller breasts. She is 5’ 3 ½” and 138 lbs. Her breasts are a different shape and size. Nipple position is close enough that it does not make sense to place a scar around the nipple with a mastopexy (breast lift). A good rule of thumb is to consider a mastopexy if the difference between the sternal notch to nipple distance is more than 1 ½ cm.
Different size implants can be used. The issue here is that the smaller breast is relatively “tighter” and will bulge more if a significantly larger implant is used. She is shown 3 years after surgery with round smooth moderate profile plus cohesive silicone gel implants placed in a “dual plane” position below the pectoralis muscle through an infra mammary ( at the breast fold) incision. A 350 cc implant was placed on her left breast and a 375 cc implant was placed on her right breast. The 375 cc implant was the largest implant that could be used on her right breast without an “implant look”. A larger implant may look overly round or bulge in the upper part of the breast. Of course her breasts are still “sisters and not twins” and remain different but are now closer in appearance
A 19 yo student who is shown before and again 18 months after a breast reduction using the short periareolar inferior pedicle reduction (SPAIR) technique. Her case is challenging because her areola is large and the typical “Wise” or anchor pattern would not allow us to get around the outside of her areolar without removing too much skin. The SPAIR technique I a perfect choice for her case, with the benefit of a shorter scar as well. This technique works best for smaller reductions in patients with excellent skin elasticity, because there is some “gathering” of the skin that has too be able to have enough elasticity to smooth out with time. She had 350 gm of tissue removed from her right and 200 from her left to correct her asymmetry.