Breasts are like snowflakes – no two are alike. I have seen a lot of breasts in my lifetime, and I have yet to meet a woman who has a right breast that is identical to her left breast. Some degree of asymmetry is normal and expected. This may be a slight difference in the volume, shape, nipple position, or breast fold height. They may be similar, but never identical. This is why I tell my patients that their breasts are like cousins, no sisters.
Certainly, the women who have very large asymmetries (such as a C cup on one side and a small B cup on the other) come to my office aware of the difference. However, most women with smaller differences seem surprised when I point them out. I find it hard to believe that a woman had never noticed that her left nipple is 1 inch higher than the right, or that her left fold is 2 inches lower than the other side. It amazes each time, but I have come to expect it. These asymmetries are pointed out by using a large mirror and also taking pre-operative photographs.
Pointing out the asymmetries serves a few different purposes. First it protects me. If breasts are asymmetric before surgery, then they will remain asymmetric after surgery (hopefully less asymmetric, but asymmetric nonetheless). After cosmetic breast surgery, women will stare all day long at their breasts and I can guarantee that the asymmetry that was not obvious to them before surgery will be painfully obvious to them after surgery. Pointing it out beforehand helps to establish realistic expectations about the results.
Second, it helps me and my patient get on the same page regarding the surgical plan. If I need to raise a fold or lower a nipple, I want them to understand the specific surgical techniques involved so that they can appreciate the complexities of the scheduled surgery. In some cases, I need to perform a totally different operation on the left and right breast. For example, sometimes one side needs a lift, while the other does not. Also, sometimes I place different size implants in order to account for volume asymmetries. If different operations are needed on each breast, my patients must understand that this may result in different scars and different recoveries.
So breast asymmetries are almost a given. Cosmetic breast surgery is designed to minimize the difference, but achieving 100% symmetry is impossible and my patients need to understand this.