It is extremely common for women to have some differences in both breast size and breast shape. These differences are usually relatively minor and can include differences in nipple position and location of the fold or crease at the bottom of the breast. In some cases, however, there is a noticeable difference in the size or shape of the breast. This can compromise clothing choices, especially swimwear, and often leads a woman to feel insecure or lose self-confidence. Breast surgery can minimize the differences and create a more symmetrical appearance.
Breast Reduction & Lift
Women who have a much larger breast on one side and want to match it better to their smaller side can be helped by performing a breast reduction on the larger side. Sometimes a breast lift (mastopexy) is needed on the smaller side to improve the shape to conform to the reduced side.
Augmentation is performed if a woman wants to balance the symmetry of her breasts by enlarging her smaller breast. In my opinion, this should be done along with a breast reduction on the larger side. Equalizing breast tissue on each side and placing implants offers the best opportunity to have the most symmetrical breasts with the best opportunity to maintain symmetry over the long term.
Although some surgeons may recommend placing a much larger implant on the smaller side to match the other breast, this leads to a continued difference between the two sides. One side has a large implant with little breast tissue while the other has a small implant with significantly more breast tissue. Although it may be possible to match the size on each side, it is almost impossible for this combination of large and small implants to create a matched breast shape.
Another problem with this approach is the changes that will occur to the breasts over time. Imbalance and asymmetry will worsen as the years go by since the natural breast tissue of each side will age and relax and change in a way that is different than the other because of the different amount of breast tissue. The breast will look more and more different as time passes. If the amount of breast tissue on each side is similar and the implant size on each side is similar then the same aging effects will occur on each side and the appearance should remain similar as well.
There are some cases where the smaller breast is extremely small. These are unique (although not rare) and reducing the larger breast to match the smaller side is not feasible. These cases are much more complex and generally require more of a breast reconstruction (such as after mastectomy) approach to achieve the most aesthetic results. These more complex cases should always be treated by a plastic surgeon with significant experience in breast surgery and breast reconstruction.