It is unusual to measure a patient to determine their implant options and get identical measurements on both sides. Some degree of asymmetry is normal; perfect symmetry is rare. Most differences do not require any special attention since often the patient was not even aware. However, when there is a significant and visible difference, correction can be very rewarding.
In some patients one breast sits visibly higher on the chest wall, more often the left. This can result in the implant sitting higher too since the ideal pocket exactly follows the pre existing breast fold and serves as the “shelf” on which the implant rests in the body. There are techniques such as biplanar pocket formation which allow the lower pole to expand better and the implant to sit lower on that side for a better match. Sometimes with a very highly defined breast fold with tissue hanging below the fold (“descent” of the lower pole), attempts to lower the implant below the fold can lead to a double bubble deformity. In these cases it is often best to accept some differences in breast position and try different sizers during surgery to get the best match along the upper breast, the part seen in outfits. Most patients enthusiastically agree that it’s better to have a slight visible difference when the breasts are completely exposed than one which is always apparent even in outfits. Intraoperative sizing involves using temporary implants to get the best match during surgery (remember silicone gel implants are prefilled and not adjustable). Once the ideal sizes are determined, the temporary ones are replaced with your new, permanent implants, often of slightly different size.
Nipple areolar asymmetry can be improved in many cases with a vertical repositioning of the lower nipple using a crescent mastopexy. This leaves a very fine scar along the border of the upper half of the areola and can usually move the position up as much as 1 cm. More extensive mastopexy procedures can move the position to any position desired.
As with positional asymmetry, breasts of significantly different size can be greatly improved with the use of intraoperative sizers, trying different prefilled silicone gel implants until the best match is achieved. Since breasts of different size frequently have shape differences too, often the best possible result is a great improvement but may not be perfect. It’s very important to have realistic expectations set before surgery and we use a very extensive collection of before and after pictures to demonstrate realistic outcomes. Corrective breast surgery may involve creative reshaping of the breast with a variety of mastopexy and pocket sculpting techniques in addition to differently shaped implants, making these challenging and interesting for the surgeon. This is a special passion of mine and we have a tremendous number of pictures showing almost every variable imaginable!
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