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.