- Symmetry is something of a myth when it comes to breast size.
- All breasts, including those that are symmetrical, fluctuate in size during ovulation, pregnancy, and menstruation.
- Surgical options for uneven breasts include fat transfer, mastopexy, and breast implant surgery.
Maybe one of your breasts appears perkier than the other, or perhaps one sags a bit more or one nipple protrudes further than the other. Sound familiar? If so, you are not alone.
What is breast asymmetry?
“Very few of us have perfectly symmetrical breasts, says Miles Graivier, MD, a plastic surgeon in Atlanta. “In my primary breast augmentation patients, one in eight will need different sized implants for each breast,” he shares.
“Basically, asymmetry of breasts refers to a difference in form, position, shape, or volume,” Dr. Graivier explains. This is usually not cause for concern, although some women can be self-conscious about their uneven breasts.
If the asymmetry is severe, it can be disfiguring. Women can have trouble finding bras, bathing suits, or tops that fit.
There are many causes for uneven breasts including hormonal changes, fallout from breast cancer treatment, traumatic injury to the chest wall, genetics, and underlying medical or skeletal conditions.
Postural issues and weight gain or loss can also contribute to the look and feel of uneven breasts.
Breast asymmetry and cancer
While uneven breasts aren’t necessarily an indicator of underlying medical issues, any sudden change in breast symmetry should be investigated. Fibroids or non-cancerous breast tumors can cause unevenness. And some research suggests that breast asymmetry, as seen on mammography or breast x-ray, is a marker for increased risk of breast cancer.
Sometimes a complication from breast augmentation with implants can drive the asymmetry. For instance, capsular contracture occurs when internal scar tissue forms a tight or constricting capsule around a breast implant, which can become misshapen and hard.
Still, the most common cause of uneven breasts is really just a roll of the dice. “There can be some unevenness in how the ribcage is formed in utero, and, as a result, one side projects more than the other,” Dr. Graivier says.
“Your breasts are sisters. They are not twins, so they can develop differently,” agrees Frederic H. Corbin, MD, a plastic surgeon based in Beverly Hills, California.
Not every woman will realize her breasts are uneven, Dr. Corbin says, but it can be an issue before breast augmentation surgery. “This is often something I have to point out beforehand, as we plan the operation, so we are all on the same page,” he says.
Breast augmentation can accentuate differences, which is why managing expectations is a key part of the planning stage.
Breast asymmetry correction
There is no one-size-fits-all fix for uneven breasts. Scheduling a consultation with a board-certified plastic and reconstructive surgeon to discuss your concerns is the best way to start the process. He or she will conduct a thorough exam and tell you what is or isn’t possible with surgery.
The first step is to determine the ideal size of breasts for your frame, taking your aesthetic goals and concerns about symmetry into account.
Reduction or augmentation?
Your surgical plan might involve increasing the size of one breast or reducing the size of the other. Some women require different-sized breast implants and/or a breast lift (mastopexy) on one side to shore up the size difference, Dr. Graivier says.
“We try and match things up as closely as we can,” he explains. “If I have to choose upper pole fullness as even or lower pole fullness as even, I usually choose upper pole, as you see that more in low-cut clothing.”
(The upper pole is the upper part of the breast, and the lower pole refers to the bottom half.)
There are times when performing the same procedure in both breasts does the trick. This could mean reduction in both, with one breast reduced more than the other, or augmentation in both, with one breast enlarged more than the other.
Sometimes fat grafting can even out breasts if the difference is only one cup size or less. This involves taking fat (via liposuction) from a part of the body where it is plentiful, say the abdomen or thighs, and injecting it back into the breasts, where it will establish a blood supply to survive and thrive in its new home.
In the wake of a breast cancer diagnosis or treatment, surgery for uneven breasts can include tissue rearrangement.
“We can move tissue around on the breast that we performed a lumpectomy on, or we may use fat or a tissue flap if the defect is big enough,” says Dr. Graivier. Flap surgery involves taking a section of tissue from one area of your body, such as your abdomen, and relocating it to create a new breast mound.
“We may need to operate on the other side as well to create symmetry,” Dr. Corbin adds. Contralateral surgery for symmetry after breast cancer is covered thanks to federal law.
Recovery and side effects
All breast surgeries confer their own share of risks and benefits. Recovery is often longer for more involved surgeries, such as lift plus augmentation or flap surgery, than for fat grafting, for example.
The best way to maximize your results and minimize the risk of side effects, including cosmetic dissatisfaction, is to follow your surgeon’s pre- and post-operative advice carefully.
“If an uneven breast is something that truly bothers a woman, this surgery can dramatically improve her self-esteem,” says Dr. Graivier. “The good news is that we have a lot of options, all of which produce very natural-looking results.”
» Connect with our medical review team to find out more about cosmetic breast surgery.