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Balancing Breasts With Breast Augmentation

I think there are a lot of subtleties about breast augmentation that the public is not aware of. The operation is not just about increasing the size or scale of the breasts.

It’s also about balancing each breast so that they look full and naturally equal. Breasts, by their very nature, are never exactly the same before or after breast implant surgery. It is common for patients to have asymmetric breast volume and shape. It is also common to have different degrees of droop in individual breasts. 

For example, many women have one breast that is slightly higher on the chest wall than its counterpart. In these patients, the fold of the breast and the nipple are slightly higher than the other. Often the underlying muscles are structurally different as well, with the dominant hand’s pectoral muscle often thicker.

What I do in breast augmentation is attempt to find the best balance of all these opposing forces. 

Different Types of Implants for Balance


Saline breast implants offer some flexibility because I can change the volume of the implant at any time. I will often adjust the size of saline implants intraoperatively to find the best overall balance of shape versus volume. When you change the volume of saline, you also change its shape. 

If the dominant pectoral muscle is thicker than the non-dominant, I may back off the volume slightly. If a patient is droopy, I may keep the volume to give lift and projection even if the upper pole is fuller.  In some situations, I will use a larger breast implant on one side. The larger implant will have a greater diameter but may keep a better shape as opposed to just overfilling the same size implant, which would make it pointier and more torpedo-like. In cases of extreme asymmetry, I may use a high-profile implant on one side and moderate or low on the other to achieve optimal balance between the augmented breasts.

If one breast is higher than the other I may have to drop the fold of the higher breast down so that the upper portion of the implants will be symmetric.  This is a balance and trade-off as well. Often the higher breast will have a higher nipple.  Dropping the fold can make the higher nipple even higher—again a trade-off for the goal of overall symmetry of the entire breast.


In contrast to saline, silicone gel breast implants look and feel more natural.  The smooth round implants, which I prefer, are technically not teardrops, but when upright and placed, they take on a teardrop shape within the breast. To me, they are the preferred implant in very slender patients with little breast tissue to cover over the implant itself. 

In patients with droop, a saline implant may be preferable. While technically less natural, saline implants are fuller in the upper portion, give more breast elevation in the patient with droop, and their volume can be modified easily to best deal with the imbalance. With each patient and each case, the procedure is different and augmentation is about finding the best balance based on the current positioning and shapes of their breasts and what the patient hopes to get out of the operation.

Considering Breast Augmentation & Want A Natural Look? Get In Touch

Contact my office today at 301-656-6398 to schedule a  consultation and meet with me. I have helped many patients get the breast size they have always desired by aligning their goals with my professional advice and analysis of their breasts.

Together we can determine the best implant size and type that will meet your needs. I guarantee we can find an option that best suits you.

August 30, 2023 6:22 am
Categories: Blog, Breast Augmentation

Written by Dr. Adam Tattelbaum

Dr. Adam Tattelbaum is a highly skilled and compassionate plastic surgeon with over two decades of experience.

Double-certified by the American Board of Plastic Surgery and the American Board of Surgery, Dr. Tattelbaum believes in providing personalized patient care and customizes his treatment plans to suit the individual.

Dr. Tattelbaum's candid and realistic approach has earned him recognition, not only with his patients but in the Top Doctor lists of the Washingtonian and Bethesda magazines. He is also a member of the American Society for Aesthetic Plastic Surgery, a mark of distinction in the field of cosmetic surgery.

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