Despite the tremendous popularity of breast augmentation, and the relatively common occurrence of differences in most women’s breasts, there is little public knowledge about what occurs when both are mixed together in a surgical enhancement. All plastic surgeon’s made a good effort to point out a patient’s breast asymmetries beforehand, and that breast asymmetry is likely to continue to exist after surgery, but I have found that most patient’s still have misconceptions in this area.
First and foremost, I have found that many women don’t even know that their breasts are not ‘even’. Many do when the differences are more significant but in small differences it is often not even perceived until it is pointed out.
Secondly, breast augmentation may either improve or worsen the breast asymmetry dependent upon what type of asymmetry it is. In my Indianapolis plastic surgery experience, if the asymmetry involves different positions of the nipples before surgery, it is quite possible an enlargement of the breast will make it worse. In this cases, a superior nipple lift may be considered in the more ‘southern’ nipple if it is the one not at the right height. If it is a more ‘northern’ nipple, then there is no real solution to that problem short of keeping the implant higher on that side and living with mound asymmetry but with the nipples centered on the breast mound. (either choice is not great). If the nipples are fairly even and the differences are mainly in mound size (amount of skin, level of the inframmary crease), then an implant enhancement may improve the asymmetry by different fill volumes or sizes between the two sides. This is a more desireable situation and , while some asymmetry may still exist, it is likely to be better than dealing with nipple aymmetry.
With all of the options available in breast implants today, saline vs silicone and different projections, it is tempting to get too clever by making changes not only in implant volumes but in styles or projections as well. While this may work in some cases, it is equally possible that you may merely create a different asymmetry problem. I have found it best to usually keep it simple using some differential volumes of implants is some cases but generally not mixing implant projection styles.
In short, if breast asymmetry improves after augmentation that is a bonus but is not assured. It is not possible with any degree of certainty to predict final breast shape outcomes in asymmetry. The goal is improvement in shapes, but not perfection. To use a great quote (to whom I cannot remember to give credit), ‘this is sister surgery not twin surgery’.
Dr Barry Eppley
Indianapolis, Indiana