Whilst it is true that no woman ever has perfectly symmetrical breasts, different degrees of asymmetry may cause enough concern for a woman to seek further treatment. These asymmetries may be in terms of volume, with a larger breast on one side and a smaller breast on the other, a difference in droop to the breasts, differences in nipple position or all of the above. In addition we all have various other asymmetries and differences between left and right halves of our bodies so an uneven chest wall with even breasts on top may result in an appearance of uneven breasts and unequal breasts where as there is actually an underlying chest wall (rib cage) issue fundamentally.

So what can be done to improve breast asymmetry?

The ideal situation from a plastic surgeon’s perspective is one in which the larger breast can be reduced to match the smaller breast. This is because the ability to achieve symmetry in terms of volume but also in terms of behaviour and character of the breast is far more predictable. However, of course, the patient may desire a final breast size that is larger than her smaller breast in which case at a later stage, a breast augmentation may be performed. This might also be possible at the same time.

Another situation may be encountered in which both breasts are somewhat empty or under developed and therefore a breast implant would be needed on both sides. In the past there was a vogue to use differential breast augmentations i.e. a larger breast implant on the smaller breast, however nowadays wherever possible, we prefer to lift or reduce the larger breast prior to using equal sized breast implants on both sides. This is so that the final breasts both have similar proportion of breast tissue and implant to ensure they behave as equally as possible. What we mean by breast behaviour may mean for example what happens to the breasts when you lie down, do they fall to the side or does one stay standing up? It also may mean how they behave on leaning forward or during exercise.

Nipple asymmetry and position of the nipple on the breast can also be an important factor to treat. Nipple position can be adjusted on a breast and this is normally in the form of lifting to a higher position, however, occasionally, nipples can be moved towards a more midline position or away from the midline if necessary.

At the end of the day, there are many potential options. The best option needs to be determined after careful clinical examination. If you have concerns about breast asymmetry or would like a professional opinion, please get in touch on 01892 619 635 or info@pacifico.co.uk

As a Plastic Surgeon we frequently see people who have lost a lot of weight and are left with redundant folds of skin in various areas of their bodies such as arms, tummy, legs and not to mention breasts. One of the challenges in this particular patient group that differentiates them is that their skin has been overly stretched when they were at their heaviest and has lost its elastic properties – it has thinned out and its supportive abilities as well as wound healing abilities are compromised.

This situation is combined with the fact that they have lost volume and have “deflated” and have a significant amount of excess skin. Therefore, we have to tread a fine line of compromise between wanting to tighten and lift the breasts, although not too much as this may impair wound healing whilst at the same time being careful not to enlarge the breast with too large an implant (if an implant is warranted) as the weight of an implant will be sitting within the existing skin that was stretched and doesn’t have the support mechanisms that it otherwise would have done.

From my point of view, I would therefore aim to avoid using an implant and perform a breast lift alone whenever there is enough volume to do so, as avoiding an implant avoids the introduction of further potentially complicating factors. A breast lift in someone who has lost a lot of weight requires different surgical techniques that necessitate significant anchoring and supporting of the breasts on the chest wall to try and minimise the recurrence of drooping that will inevitably occur to a degree.

In situations when an implant is needed, the breast also has to be secured firmly to the chest wall as there is a higher than normal risk of the implant migrating inferiorly into the wrong position which would require further surgical revision to place it back where it ought to be.

As a result of these limitations and necessary compromises, it is not uncommon for there to be a degree of disappointment during the initial consultation when the importance of this compromise is discussed, as many people might see the opportunity to undergo plastic surgery as one that may give them a breast that they wish for…but in reality might not be possible to achieve.

Therefore, as Plastic Surgeons we need to be honest and open about the breasts our individual patient has as well as explain the background of why we are making particular recommendations for them as an individual. We need to back this up by showing them examples of other patients who have undergone similar procedures from similar starting points to show what is realistically achievable.

At the end of the day, we would always rather under-promise and over-deliver to ensure we have happy patients, rather than allow our patient’s expectations to exceed what is realistically achievable.

There is a common misconception by many people I see in consultations that a round breast implant will produce a more artificial look, whereas an anatomical (teardrop) implant will look more natural. This is based on a combination of mis-information, but also the fact that a round implant on the office desk does not look very breast-like, but an anatomical implant has the appearance of a breast (in shape). Therefore the diagram below is actually not at all accurate!

In reality, the right implant must be chosen for the right breast shape and breasts, of course, come in all shapes and sizes. In addition, nipple position varies, as do chest wall shapes, position of the breast on the chest wall, distribution of breast tissue, breast volume and more. Therefore, there isn’t a “one-size fits all” approach when it comes to having a breast augmentation.

As a rule, if your breast width and height are about equal, and your nipple position is not low, then a round implant is probably perfect for you and can produce a really natural result. The main contribution to looking unnatural is the projection of the implant – that is, how far the implant projects from your chest. Therefore a moderate projecting round implant can often look a lot more natural than a highly projecting anatomical implant.

From my point of view, if the breast has a pleasing shape before surgery, then a round implant can help augment and increase the breast size, whilst maintaining the good shape. This is illustrated in the photo below – a natural breast augmentation using round implants.

If, however, it is desirable to change the breast shape – perhaps because of a slight droop, or because the nipples are lying low – then the shape of an anatomical implant can be utilised to re-shape the breast around the implant, thereby improving the shape of the breast.

So, for example, when I see someone with a wide breast, with a short height (so the breast “footprint” is a sideways oval), then using an anatomical implant can really induce a change of shape for the better.

So, when it comes to deciding on what shape of implant to use, the key is first of all to understand your own breast shape, and how that impacts on having a breast augmentation. For me, that is a key part of the consultation process. The implant must be chosen to suit you as an individual at the end of the day.

For more information, please get in touch on 01892 619 635

As plastic surgeons, we often here comments to the effect that the grass is greener on the other side! Women with less developed breasts see us about breast enlargement, whilst women with large breasts come consult about reducing the size of their breasts. Large breasted women will often tell me that they can’t understand why anyone would want to put up with the problems they suffer from as a result of having heavy breasts, including neck and shoulder ache, back ache, sores under the breasts, as well as the social implications of being large breasted.

Large heavy breasts cause functional issues, as well as the cosmetic concerns. This results in breast reduction maintaining its place as one of the most “worth it” procedures we perform as plastic surgeons. The instant relief that women feel on waking up with smaller breasts puts any post-operative discomfort into the shade, as they are overwhelmed with satisfaction!

There are a multiple ways to perform a breast reduction, and the right technique for you should only be determined after a thorough examination. The techniques vary in their scar pattern, their surgical technique and what is done to the nipple position.

Most breast reduction techniques result in a scar around the areola and a scar that goes down from the areola to the breast crease. There can also be a scar that runs along the breast crease. On occasion, I sometimes do a “scarless” breast reduction using liposuction on its own – but this is mainly for post-menopausal women whose breasts are mainly composed of fat.

Contrary to popular belief, most breast reduction techniques do not involve removing the nipple. The nipple is actually kept attached to the breast and repositioned higher up, keeping its original blood supply, and possibly its nerve supply. I say possibly, as whilst modern techniques in breast reduction aim to disrupt the nerves as little as possible, there is always the chance that nipples are numb or reduced in sensitivity after a breast reduction.

The surgery takes a couple of hours and liposuction can be done in selected cases to shape the outer part of the breast, especially if there is a fatty tail to the breast (“side boob”). The operation can be done as day case surgery, or with an overnight stay, and most return to work at around two weeks.

Breast reduction is an incredibly satisfying operation for patient and surgeon alike. There is instant gratification on waking up from the surgery by the patient who immediately notices the weight change. The aesthetics of the breast and the breast proportions are also improved, as there is also a breast lift and reduction in diameter of the areola (which is usually desired) providing a good shape and aesthetic outcome.

Breast reductions continue to be an ever popular operation, and righty so, due to the holistic benefits it can bring. For more information, please get in touch to find out more.

In each breast enlargement consultation, I ask every patient whether they are aiming for a “natural” result, or one that looks more augmented. Inevitably the majority ask for a natural look. But what does that really mean? After years of listening to the answers and then digging a little deeper, I can assure you that not everyone sees natural the same way!

To many, the concept of natural means that if they are undressed and their breasts are exposed, they don’t want to look like they have implants in. To a significant number of others, what natural means is that they don’t want to appear as if they are carrying bowling balls under their clothes, or they don’t want an obvious take off from upper chest to breast when in a bra…no matter what their breasts look like without a bra on.

You can therefore understand there is a challenge as a plastic surgeon, ensuring I am on the same wavelength as my patients when discussing implant choice and desired outcome!

I think that the best thing is to study before and after pictures together to see which breast augmentation results they like. This is only done after a careful clinical examination to ensure that the pre-operative breasts we are looking at in the gallery are similar to theirs. Only that way can patients tell me what they like and what they don’t like, which enables me to guide them towards the best implant size and shape for them. However, all my before and after photographs are very standardised clinical views, and none are in a bra or with clothes on. So this too is perhaps somewhat unrepresentative of exactly how the patients in the photographs breasts might look on a day to day basis.

There may also be a subjective disagreement between my patient and me regarding “naturalness”. I have had patients comment on how natural some breasts look in the photographs, whilst I feel they look clearly augmented, and on the other hand, some say that they think certain results look unnatural, which I feel look natural! Unless I understand what an individual desires, I will not be able to give them the result they want.

Breast implant sizing also has an important role to play. From my perspective, the bigger the implant, the less natural the result will be – this is especially true in those with little soft tissue cover (breast volume), as most of the breast volume after surgery will be composed of implant, rather than breast. So the more breast tissue there is before surgery, the more natural the result is likely to be.

The other aspect that has to be taken into account is breast implant profile or projection – this describes how far the implant sticks out of the chest. The higher the profile for a given implant width, the less natural it risks looking. So, a “moderate profile” implant has a higher chance of looking natural than a “high profile” implant; however in order to achieve this the desired volume or size increase may not be achievable.

In other words, the less projected an implant is (the lower the profile), the smaller that implant will be. Therefore a compromise needs to be settled on. For example, the choice may be between a moderate profile implant of 275cc volume or a high profile implant of 350cc. The patient may want to look natural, but they may also want the higher volume. This therefore has to be a choice by the individual as to what they consider the biggest priority – volume or “naturalness”. There is no right or wrong about this – it is very personal. I can guide them, but do not make the final choice – I leave that to my patients. If they ask me, I would usually go for a more natural, lower profile option.

Using the patient’s own fat – known as fat grafting or lipofilling – is perhaps the most natural way of enlarging a breast. As long as there is enough fat to find elsewhere (such as from the tummy, flanks or thighs) the fat can be removed using a liposuction type technique, processed in the operating theatre and carefully injected into the breasts. The great advantage with this is that there is no implant that will need replacing in the future. However, unlike an implant, there is no support provided, so if the breast skin is thin and has a degree of droop to it, whilst the breast will be enlarged, it won’t necessarily be more pert. However, it can be an excellent alternative. That said, fat grafting may require 2 or 3 operations to achieve the desired result, compared with one operation using an implant.

I wrote this piece more as food for thought, rather than for anything else. I hope it has been thought provoking, and useful in considering some of the reasons for making certain choices prior to a breast augmentation.