Breast augmentation with symmetric breasts is a fairly routine procedure.  The plastic surgeon must take account of asymmetries which are very common.  Careful measurements of the sternal notch to nipple distance and breast diameter are part of a thoughtful preoperative plan.  These asymmetries must be pointed out to the patient.  Often, patients are unaware that there are differences in the breasts will be disappointed as augmentation may magnify these differences.  Augmentation alone may not overcome asymmetries.  Even with breast volume asymmetry, getting the exact volume correction is very difficult.  Asymmetric nipples will not be equalized in many cases and sometimes require mastopexy.  Many women exhibit asymmetries of the contour of the chest wall.  One such abnormality is the pectus excavatum deformity also known as funnel chest.  In this deformity the sternum has a concavity which can be quite severe or more subtle.  In the absence of surgical correction of this, it is difficult for a breast augmentation to mask this abnormality. Other chest wall deformities such as pectus carinum (or pigeon chest) are characterized by a prominent sternum with the ribs sloping away. Patients with this variant can have nipples and breast mounds that are pointing outwards. Even subtle rib abnormalities can cause depressed areas or raised areas with asymmetry.

These conditions can affect the final result.  

This 25-year-old woman desired modest improvement in her breast size.  She did have pectus excavatum deformity as well as breast asymmetry with the right breast being smaller. She underwent bilateral submuscular breast augmentation with silicone gel implants. The right side had a 275 cc moderate profile device.  The left side, which was larger, had a 210 cc moderate profile device.  The patient was very happy with the improvement.