Frequently Asked Questions (FAQ's) Concerning Breast Augmentation
Correcting breasts that are extremely different sizes or shapes
Q: I have one breast that is much smaller and different shape than the other? What is the best way to correct the difference. Do you just put a larger implant in the smaller breast?
A: First, be sure that you understand two important concepts: 1) No woman has two breasts that are the same, and 2) no surgeon can produce two breasts that are the same. Perfection is not an option, only improvement.
Asymmetry is the medical term for different size or shape breasts. If the difference in the breasts is very slight, different size implants may give a satisfactory result. In moderate to marked breast asymmetry cases, it is virtually impossible to achieve optimal results using differential implants alone. The best symmetry is achieved by attempting to equalize the three components of the breast- the skin envelope, the parenchyma, and the implant. Placing an implant at the time of mastopexy or reduction is illogical- the weight of the implant combined with the surgically mobilized tissues at the time of mastopexy will undo the mastopexy (bottoming), and the base dimension of the implant is limited in order to achieve closure without complications. A two stage procedure has the best chance for the best correction.
The first operation should be a reduction and reshaping of the larger breast (mastopexy)to make it match the smaller breast as closely as possible.
At a second operation 6 months later (allow the tissues time to completely heal and soften), both breasts are augmented with a moderate size implant (around 240-270cc) to avoid future bottoming- the skin has already shown you (especially in the left breast) that it won't support the weight of the existing breast tissue. Any larger implant will undo what you have tried to accomplish in the reduced breast! With the tissues healed and less mobile than at the time of reduction or mastopexy, and with a limited pocket for the moderate size implant, you have the best chance of success.
Preoperatively, the patient must be aware of and accept the following:
Symmetry is not achievable- improvement is the goal.
At least two stages, and possibly a third stage operation will be necessary to achieve the best possible symmetry.
Regardless of what is done, it will be difficult or impossible to maintain fill in the upper breast long term (with or without an implant), because in most cases, the skin of the larger breast has already shown you that it will stretch, allowing the larger breast to sag. With the slightest amount of stretch of the skin in the lower breast, the breast will lose fill in the upper breast, with or without an implant. If an implant is placed, the larger the implant, the greater the stretch in the lower breast over time, and the greater the certainty that the breast will lose upper fill. Repeatedly replacing the implant with a larger implant to try to maintain upper pole fill is totally illogical. As the patient ages, the tissue quality declines, and a larger implant will inevitably cause more thinning of the lower breast skin envelope, with more stretch and repeated loss of upper pole fill. Permanent damage to the tissues can occur from repeated replacement of excessively large implants.
Top of page / Home / Steps to the Best Breast