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Breast Asymmetry

Most women have some asymmetry between their breasts. Whether there is a difference in size, nipple position, areolar size, or overall shape, perfect breast symmetry is the exception, not the rule. Some women have significant breast asymmetry which can include not just a size difference, but also nipple position difference, or areolar difference. Breast asymmetry can be congenital, developmental (occurring during puberty), or due to weight gain, weight loss, pregnancy, or breastfeeding. Breast asymmetry may also occur in males as a form of gynecomastia. One other category of breast asymmetry is after breast surgery. This form of breast asymmetry may be due to a variety of factors and the treatment is based on the presentation.

Size Asymmetry

Size asymmetry can range from minimal to severe. The size difference and the patient’s goals will determine the best procedure. If the goal of the procedure is to decrease the size of the larger breast to match the smaller, then some form of breast reduction needs to be performed. Minimal scarring breast reduction is an excellent technique to reduce the size of one breast to match the other breast. This is a procedure that involves liposuction of the larger breast through one or two small incisions. The best candidate for this procedure is a patient with mild breast asymmetry who does not have breast ptosis (or droopiness) or if they have breast ptosis they do not mind that the ptosis is not corrected and only want a size correction. For patients with a size asymmetry who also have ptosis and want the ptosis corrected, performing a breast reduction on the larger side will reduce and lift the breast. The smaller breast, if droopy, would be treated with just a breast lift to match.

A patient in LA with size asymmetry who also wishes to go larger will need a breast implant procedure. If the size asymmetry is small to moderate then using different size implants will be enough to get better symmetry. If there is a large difference between breast sizes before surgery, then using implants alone will not lead to better symmetry. In these cases, the best technique is to remove some breast tissue from the larger breast and then use implants that are as close in size as possible to each other. The reason for this is that using implants that are very different in volume may make the volumes more similar but the shapes of the breasts will be different because a larger breast implant will also be wider and project more. In some patients, a breast lift may also need to be performed if there is a component of droopiness to the larger breast.

Nipple Position Asymmetry

Some patients have similar sized breasts but one nipple is higher or lower than the other. Typically if the difference in nipple positions varies by more than 1 cm, a lift can be performed on the lower side to match. This can be combined with a breast augmentation procedure. If the difference is only 1cm, a crescent lift can be performed. This involves an incision on the top half of the areola (from 9 o’clock to 3 o’ clock) and a crescent of skin is removed above that and closed, raising the nipple to the desired level. If there is a 2-3 cm difference between the nipples, a crescent lift will not be powerful enough and may distort the shape of the areola, making it oblong. In this case a circumareolar lift is performed with the incision going around the entire areola. This is commonly referred to as a Benelli lift. If the difference in nipple positions is even greater, then a mastopexy or breast lift will need to be performed using incisions that are no longer limited to around the areola.

Areola Asymmetry

Some patients present with differences in the sizes of their areolas. One areola may be significantly larger than the other. One areola may be round where the other is oblong. Areolar reduction or shaping can be performed alone or in combination with a breast augmentation. If performed alone this can be done under local anesthesia. If done in combination with a breast augmentation, general anesthesia is used.

There is some truth to the saying that your breasts are sisters, not twins. As a plastic surgeon, symmetry is the goal, but perfect symmetry is unrealistic. A specific plan is created for each patient based on their asymmetry and their goals. Communication is important to ensure that the patient has realistic expectations of the final result, but also that their goals of having the surgery are met.

Surgery and Recovery

Breast asymmetry surgery is performed as an outpatient. For most cases, general anesthesia is used. The surgery time is highly variable, depending on the nature of the asymmetry and what the procedure entails. For women, surgical tapes and a bra are used at the end of the procedure. For men, a compression vest is applied. Drains are rarely used and only in the case of moderate to large reductions. Patients are placed on antibiotics for a week and are given pain medications. Patients typically take one week off from work. For most cases, strenuous activity, such as exercising and running are restricted for 4 weeks. Your body needs time to recover and it is important not to be overactive too soon.

Schedule a consultation with our Los Angeles breast surgeon Dr. Babak Dadvand to learn more.

Dr. Dadvand

By Dr. Babak Dadvand

Dr. Babak Dadvand is a double board-certified plastic surgeon and portrait painter, providing a distinctive fusion of artistic and surgical skills to achieve exceptional outcomes, all while maintaining a robust ethical framework that prioritizes patient trust and satisfaction.

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