Dr. Neavin’s breast “relative” diagram, by Beverly Hills plastic surgeon, Dr. Tim Neavin
Women, are your breast identical twins, fraternal twins, sisters, or distant cousins. When women approached me for breast surgery, most often, women fall into the category of having sister breasts. What I mean by this is while their breasts are very close in resemblance they are far from perfect or identical. It is very rare to find breasts with near perfect symmetry. When we look at the breast architecture, there are several things that would need to match on both breasts for perfect, symmetrical “identical twin” breasts. That would include breast volume, breast shape, nipple position, areolar complex size, shape and position, breast shape, and breast fold position. Almost always one if not more of these components are different among two breasts. It is interesting how few women know which breast is bigger. When I asked this question in the office, I would say less than 50% can point out their larger breast when asked without looking. Once they look into the mirror and inspect their breast anatomy, they realize they indeed have asymmetry in some aspects of their breasts. Additionally, ask yourself now what nipple is lower on your chest wall. You may not know now. However, after you have your breast enlarged you will know. This is because breast augmentation or enhancement is like putting a magnifying glass on your breasts. After a breast enlargement, one generally becomes more critical of their new additions because chances are they paid some good money for them. When it comes to breast augmentation, I always explain to patients that almost everything could be corrected including areola size, nipple position, fold position, breast shape, and breast size; however, they should also have realistic expectations as to what to expect, and what kind of scars they want to put on her breast to achieve such goals. More often than not, breast size between both breasts are perceivably different. When it comes to breast size differences, saline breast augmentation to correct the breast discrepancy is generally more accurate than silicone breast implant augmentation because the saline breast implants can be inflated per cc whereas the silicone breast implants come in pre-filled sizes sometimes to the tune of 25 cc discrepancies. Thus, some guess work is involved when augmenting significantly asymmetrical breast and thus a large array of implants must be available to the plastic surgeon to make this correction on the table.
Regarding areola size: The areola often enlarged after pregnancy when the breast engorges for lactation. It generally does not retract back to its original position from before pregnancy. The ideal aesthetically appearing areola could have a diameter anywhere between 20 and 42 mm. Generally if the areaola are greater than 42 mm, the areola is considered rather large and can be reduced with a breast augmentation or lift. It is less common to reduce the areola with a breast augmentation without a combined breast lift (mastopexy) because: #1, it requires putting a scar around the entire areola which can either darken or lighten making the scar more visible and #2, larger reductions of areola have the effect of flattening the breast.
Regarding fold positions: The breast fold height discrepancies generally can alter between 5 mm on each side. Often, even mild scoliosis with even subtle spine curvatures will change breast fold height and position making one breast or breast implant appear slightly higher than the opposite after breast augmentation. Sometimes lowering the breast fold to create symmetry can be performed; however, it does have its limitations and negative consequences such as a double bubble formation or bottoming out. Thus, very mild breast fold level discrepancies are best treated with the breast massaging with surgical lowering of the fold.
Regarding nipple position: Unless there is an obvious difference in position greater than 1 cm or 1.5 cm, I often do not find it necessary to alter nipple position because again, this will leave additional scars on the breasts alternating the scar for a repositioning of a nipple that may not even be noticeable through the common observer (if anyone is closely observing your breasts).
Breast shape: This is interesting because this is probably one of the most difficult things to correct with breast augmentation. Size, nipple position, and breast fold differences can quite easily be altered to modify these components. However, shape of the breast is a bit more difficult to modify surgically. Some breasts are just different shape. In some cases, one breast may be tubular, one may be wider, one may be more projective, or one may be more narrow. When addressing breast shape and breast width, choosing the most suitable breast implant
shape becomes important. Correcting different shaped breasts can be achieved by enlarging the breasts with larger implants such that the proportion of implants to native breast tissue increases. This would obviously reduce the native breast shape asymmetry as the implant fills out and becomes more of the breast – and the implants are the same shape and size, presumably.
In conclusion women,your breasts are probably sisters. If they are distant cousins with significant asymmetry more internal and external work may be required to get them looking more related. And this may not be worth the price of the additional scars. This is something you want to talk to your practice surgeon about.