Breast asymmetry is a common concern expressed by patients seeking aesthetic breast surgery. Breast asymmetry is the rule rather than the exception, meaning virtually all patients have clearly visible differences. Minor breast asymmetry is considered normal anatomic variation in most patients. Patients frequently voice concern that their clothes do not fit well as a result of breast asymmetry, especially when wearing a low-cut garment or a bathing suit. Although minor asymmetry is not commonly observed by other people, patients are still self-conscious about breast size disparity. Many patients seek consultation for aesthetic breast surgery specifically because of breast asymmetry. In most circumstances, breast asymmetry can be improved with a breast augmentation.

There are many variations in breast anatomy that can result in asymmetry. The most obvious is differences in breast size. Breast size refers to breast volume, which is typically estimated in cubic centimeters (cc). To visualize breast volume, one can think of the volume of a soft drink can, which is approximately 350 cc. In most patients with size asymmetry, the difference in size is minimal, usually less that one cup size. Less common is the patient that has a large difference in breast size. A patient may have a D cup size on one side and an A cup size on the other side. If asymmetry is severe enough, different procedures may be required to get the best symmetry. In the D cup – A cup patient, a breast reduction may be needed on one side, and a breast augmentation on the opposite side to achieve symmetry.

Another common cause of breast asymmetry is difference in breast shape. The breasts can have similar volumes but appear quite different because of differences in shape. For example, one breast may be more conical shaped, and the other breast may have a more rounded shape. Both of these breast shapes are within normal limits, and volume of the breasts are similar, but the differing shape alone causes the breasts to appear asymmetric. Ptosis, or breast sagging, could be considered a subcategory of the shape asymmetry. When one breast sags more than the other, by definition, there is breast asymmetry. In this circumstance, the breasts might both be a round shape, but do not match simply because of differences in sagging.

The nipple-areolar complex is asymmetric in most patients. The areola can differ in size and shape, resulting in general breast asymmetry. The nipple is often asymmetric, with one being larger than the other, and in some patients one nipple may be inverted. (New onset of nipple inversion should always be checked immediately by a qualified physician.) Again, asymmetry of the nipple-areolar complex is the rule rather than the exception. The nipple-areolar complex can also be in different positions when comparing the breasts. For example, one nipple-areolar complex may be in the center of the breast, and the other may be more lateral on the breast.

The inframammary folds are commonly asymmetric. This anatomic entity is the fold at the bottom of the breast. It is very common to have these folds at different levels, and most patients do not notice this asymmetry unless it is severe. Related to this is the breasts resting on the chest at different levels. In this circumstance, the breasts could be of very similar size and shape but appear asymmetric because the breasts rest at different positions on the chest wall. One breast may be higher, lower, more lateral, or more medial than the opposite breast.

Chest wall asymmetry is very common in patients seeking breast augmentation. One side of the chest may have more projection than the opposite side, which can give one breast more projection than the other. The chest wall may also a different angle on one side, which can make the breasts appear to point inward. Minor chest wall asymmetry is considered normal anatomic variation in most patients.

In most patients, minor asymmetry of the breast does not affect breast augmentation In many patients; minor asymmetry can be improved by breast augmentation.

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