Breast Asymmetry

While most women have some asymmetry between their breasts, for a few this is more pronounced with a difference in either the volume or shape of their breasts.

They may describe their breasts as tubular breasts (tuberous breasts deformity), small (hypoplasia), or that they just have a weird shape. Women may be able to camouflage these asymmetries by wearing padded bras or loose fitting clothing. However, this is not always possible and many feel self-conscious and even embarrassed to seek help with their concerns.


A breast implant can be positioned on the smaller breast to improve breast volume and improve overall breast symmetry. If a woman would like the overall breasts to be bigger on both sides, there are two options. The first is to use different sized breast implants to create symmetry. The second and preferred method is to use the same sized breast implant on both sides and perform a breast lift or reduction on the larger side or both. This will give the best result in terms of volume and shape.


A reduction mammoplasty (breast reduction) may be performed only on the larger breast in order to match the smaller breast in shape and volume. However, if they desire both breasts to be small overall, we can perform a reduction mammoplasty (breast reduction) on both sides, with customisation of the amount of breast tissue removal to achieve breast symmetry.


In women with one breast that is slightly larger, often with the nipple / areolar lower than the contralateral breast (frequently after breastfeeding), then a breast lift on one side only is frequently performed. However most commonly, especially in patients with tuberous breast anomaly we perform a breast lift combined with a breast implant, plus the addition of fat grafting to improve both breast volume and shape.


In women with severe breast asymmetry we often need to modify the breast glandular tissue to allow the breast implant to expand an often tight or constricted breast. This has historically been done by cutting and reshaping the breast tissue – glandular scoring with excellent results.

However using the latest fat grafting techniques, we can expand the deficient aspects of the breast tissue by carefully using your body’s own fat tissue and re-injecting it into the breast tissue at the same time as we perform the breast implant surgery. If the breast asymmetry is extreme, to give a more reliable and safe outcome we may elect to stage the breast reconstruction by using a breast tissue expander prior to performing the final breast implant surgery.


Tuberous breast anomaly or deformity has had many names, including constricted breast, tubular breast deformity, snoopy breast, herniated areolar complex and lower pole breast hypoplasia. Many patients do not know they have tuberous breast deformity, having lived their lives thinking their breasts are not quite right. They don’t realise how common this condition is, and there are many effective surgical techniques available to correct and restore a natural breast shape.

Tuberous breast deformity has a wide range of severity and is defined by conditions such as the following:

  • A breast that is small or underdeveloped
  • A high or tight breast fold
  • Deficiency of skin in the lower half of the breast
  • A large areola with herniation of breast tissue
  • Droopy breast with nipples sitting low or downwards pointing


Correction of tuberous breast deformity is one of the most challenging aspects of cosmetic breast surgery and may require a multi-staged procedure by a Specialist Plastic Surgeon to get the optimal result desired.

  • In mild cases of tuberous breast anomaly,  a breast augmentation with an anatomical breast implant can solve the problem and restore a natural breast shape. As the breast is constricted or tight in the lower pole of the breast, scoring of the breast gland or more commonly fat grafting is often performed. This releases the tight breast tissue to allow the implant to fill and expand the lower aspect of the breast. A mastopexy or breast lift, may be required at the same time as the breast augmentation to correct the breast herniation and enlarged areola at the same time.
  • In more severe cases of tuberous breast anomaly, when the patient has little breast skin / volume, a staged procedure may be required. Here a tissue expander is used to recruit extra tissue along with fat grafting to the breast during the initial procedure. In the second procedure a breast implant along with a second round of fat grafting and mastopexy is performed.


One of the biggest advances in the correction of tuberous breast anomaly has been the addition of fat grafting. The ability to combine fat grafting to enhance and restore the volume deficiency of the breast, especially in the lower aspect of the breast with a breast augmentation has allowed a much more natural breast shape to be created. Utilising the latest fat grafting techniques has allowed greater fat graft survival with improved cosmetic outcomes.


Women with Poland’s Syndrome have very obvious asymmetry in their chest wall with significant under development of the breast on the affected side. Poland’s Syndrome has a wide spectrum of abnormalities that affect the chest wall and upper limbs, in addition to the underdeveloped breast these may include:

  • Absence of the pectoral component of the pectoralis major muscle
  • High nipple position or absence of nipple
  • Narrow chest width on the affected side
  • Absent ribs or sternum
  • Hand abnormalities on the affected side

While mild cases can be treated with a breast augmentation procedure alone. In more severe cases, extensive reconstruction is necessary. The options include tissue expander with breast implant, fat grafting, latissimus muscle reconstruction or transverse rectus myocutaneous (TRAM) flap reconstruction.


Women with significant rib cage abnormalities can present with breast asymmetry. If the ribs are deficient or very prominent, this in turn can affect the size and projection of the breast, such that in women with a prominent rib on one side can have a breast that appears much larger and vice versa.

This is a very common variation that needs to be identified during your consultation as women may not be aware of her rib cage asymmetry and it has significant implications in the selection of your implants and the final results of any breast augmentation procedure.


Breast hypoplasia is due to lack of development of the breast during puberty; characteristically the breast is either absent or very small. This is the most common form of breast asymmetry and is usually corrected by breast augmentation of the affected side. However many women seek augmentation of both sides by using different sized implants to gain fuller, more natural looking breasts to complement their body shape.

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