The decision to pursue asymmetry is a personal one. Everyone has some degree of asymmetry. Your breasts are "sisters" not "twins". Ultimately. the decision is a function of whether or not the asymmetry is significant enough that the patient chooses to pursue it and the surgeon believes he can account for it with your device of choice (small differences are easier to account for with saline devices).

Based on your photos, your asymmetry is significant enough that you could account for it with an implant size differential. They will never be identical but asymmetric implants can help. A 35 cc differential is subtle and unlikely to make a dramatic difference in the final result (less than the volume of a shot glass).

As always, discuss your concerns with a board-certified plastic surgeon (ABPS).

Published on Jul 11, 2012

Ask your surgeon for his opinion.

Published on Jul 11, 2012

Your breast on the right is one cup larger and contracture of the left lower pole. The left inframammary crease must be lowered and the inferior pole incised internally to allow the breast to splay. You need 150 cc's more on the left to make the the same. I would recommend saline hi profile 380cc on the left and 270cc on right to be close.

Published on Jul 11, 2012

You should get the implants needed to accomplish the goal of the breasts being the same shape and size after surgery. It is not uncommon to use different size implants when the breasts are naturally uneven.

Published on Jul 11, 2012

You can go with different sizes to try and equalize them, but no one is perfectly symmetrical.

Published on Jul 11, 2012

Based on your photo, I think two different size implants would give you the best result. However, I would ask your surgeon if he or she plans on using sterile sizers during surgery. I always place sterile sizers in prior to the implants, to make sure we go with the most symmetrical result. Hopefully your surgeon will do the same thing during surgery. Best of luck!

Published on Jul 11, 2012

You really should talk it over with your plastic surgeon. We are doing a unique imaging system where we put in your picture and then add the different sized implants to show you what it would look like.

Published on Jul 11, 2012

Thank you for your question. Looking at your picture, you certainly do need different size implants. The difference is likely more than what you have actually mentioned. I recommend Vectra 3-D imaging and simulation with the different size and style implants and, of course, using implant sizers in the operating room for a patient with a significant asymmetry like yourself.

Published on Jul 11, 2012

If your width is 10cm you should be looking at implants in the 200cc range. Before you worry about treating asymmetry you really need to go back and think again about how fake you want to look and how significantly you want to damage your tissue. I guarantee you with 100% certainty that if your width is really 10cm and you put implants of that size in them that within a couple of years your skin will thin, your own tissue will compress, and your rib cage will become bowed in under your implants. I have treated countless women who just a few years before started out looking like you with beautiful breasts (albeit smaller than they wanted,) but who developed severe and incorrectable deformities. Please go back and reevaluate your surgical plan from square one.

Published on Jul 11, 2012

Looking at your photos I agree there is a size difference that will need to be addressed. That being said, at the large volume of implant you have chosen, the slight size difference will be negligible- your breast is essentially going to be implants so the size difference will be diminished secondary to the volume of implnat you have chosen. If you had chosen a conservative implant size such as a 275, the implant size difference would be much more critical.

I am also concerned about your high riding breast fold on your left breast- be sure you have discussed the pros and cons lowering the breast fold with implant volumes of this nature with your plastic surgeon.

Published on Jul 11, 2012

Thank you for your question.
Best thing to do is communicate with your surgeon. I ask my patients to bring in pictures of breast sizes that they like and even dislike. I review these photos with the patient and discuss if it is reasonable with their body type, size,etc.. I take these photos to the operating room with me and when the patients is on the operating room table, I use temporary sizers to view how different cc's look on the patient. I sit the patient up on the operating room several times and compare them with the photos that they have chosen. When I see that I have achieved the patient's goals, I remove the temporary sizers and put in the implants. There is no guess work. I have all sizes from both manufactorers available to me at all times. This procedure takes more time BUT gives more exact results.

Published on Jul 11, 2012

The appearance of your breast symmetry is dependent on other factors than your breast size. It also depends on the POSITION of the breast on your chest as well as the symmetry of your chest wall right vs. left. Go over your concerns carefully with your board certified plastic surgeon to optimize results. And please remember that the breast are sisters, not twins. They may never be exact duplicates.

Published on Jul 11, 2012

I am so sorry, but I couldn't open your link to the photos on TinyPic. In general, I would need to assess you. Frequently, small differences in natural breast size should not be corrected with asymmetrically sized implants. Implants are very different in their physical qualities compared to natural breast tissue, and other issues can become apparent when trying to correct for size differences. If you want, please try another link to photos! Thank you.
POST SCRIPT: I was able to open your link. You have more than just a difference in size to your breasts, you have more skin on the larger on. You should know that you will have asymmetry to your breasts regardless of implants chosen, either the same size or different size. Additionally, you are way too small and thin for implants of this size. You should expect tissue thinning, rippling, and possible malposition of such large implants. I encourage you to reconsider.

Published on Jul 11, 2012

From the picture, there does seem to be quite a bit of asymmetry between your breasts with the left one being smaller and differently shaped, with what appears to be a higher IMF. Going with the two different implants can help improve some of the asymmetry that you have but I believe your two breasts will always look slightly different.
It sounds like your plastic surgeon has given this some thought with the implant choices based on his/her exam. I would trust his/her best judgment.

Published on Jul 11, 2012

Given the degree of differnce in size between your right and left breast, differnt size breast implants are warranted. Unfortunately, there is not only a differnce in size but a diffence in shape that is also significant. Specifically the lower pole of your left breast has a constricted/tight appearance. For whatever reason this side did not develop as fully as your right side. This will also be make it difficult to produce perfect symmetry between your breasts. You should undertand this going into surgery so that you have the appropiate expectations for what your breast augmentation can accomplish. Trying on implants in a sizing bra is and aproximation of how they will look not an exact science. I would trust your surgeons judgement given he/she has examined you.

Published on Jul 11, 2012

Unfortunately I was not able to open up your photo. As a general rule although sizing can help I prefer to use intraoperative sizing with sterile template sizers that can be placed in the submuscular location showing exactly what they would look like. Placing sizers on top of the skin and the muscle has not been helpful in my practice. We would make decisions based upon different sized implants based upon how they would look in surgery. I recommend the patient get some pictures of the look they are trying to achieve.this is what we try to achieve . I would recommend that you find a qualified board certified plastic surgeon in your area with expertise in breast surgery and be very specific in photos as the lool that you would like. best of luck.

Published on Jul 11, 2012

Thank you for the question. When it comes to size differences I usually go with what feels most "symmetric" to the patient. I don't think you can go wrong with using the same implants if your breasts feel symmetric with them (as sizers).

Published on Jul 11, 2012

Based on your picture, it does appear that you could use a slightly larger size on the one side to better balance you out. However, with only 10cm width, the implants that you are talking about are really toowide for your frame. At 10cm, those implants would really besticking out the sides due to the width. I recommend sitting down with your surgeon again or going for another consultation with a board certified plastic surgeon. Going past the nwidth of your natural tissue can lead to rippling and thinned tissues over time.

Published on Jul 11, 2012

You have a noticeable difference preop, so I would definitely use two different sizes! I use two different sizes in about 25-30% of patients, and it definitely helps achieve better symmetry in patients who have a noticeable difference preop. Yesterday I performed a first time augmentation on a patient and used 300cc on one side and 400cc on the other!

Published on Jul 11, 2012

Thank you for your question. After reviewing your photos it appears that your right breast is larger. I would recommend using two different sizes.There may still be a slight difference in size, but I feel the overall appearance and symmetry would be enhanced. Good luck with your surgery.

Published on Jul 11, 2012