Your Questions
Your Questions
Q: Dr. Eppley, I have breast asymmetry and am interested in breast augmentation/lift surgery. I am 18 years old and have had two children. My breasts are significantly different by at least two cup sizes and have been so for six years. I have Tricare insurance. I am wondering if my being 18 years old is ok for breast surgery because I have already had two children so my body is done growing. I’ve spoken with my family doctor about wanting to have this done because its already done a lot of physiological damage to me.
A: Significant breast asymmetry is always a challenge in any form of cosmetic or reconstructive breast surgery. Having had two children and being two cup sizes different almost certainly speaks to the potential of needing some form of a breast lift on at least one the breasts (usually the larger one) and perhaps implants for both. Until I can see some pictures of your breasts I can not be any more helpful in recommending a specific plastic surgery treatment plan as there is great variability in many cases of breast asymmetry.
What is known now, however, is that insurance is not going to cover this type of breast surgery. Unless it is a case of reconstruction after breast cancer, breast reshaping surgery will be considered as a cosmetic procedure by any insurance provider today. The fact that you may have developed this through no fault of your own and it has a significant negative impact on your self-esteem is something that I have learned carries little weight with insurance companies.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast augmentation. One of my breasts is bigger than the other. I would like to even them out and go up a couple of sizes. I would like to do the “gummy bear” implants. My goal would be to get the most natural look possible.
A: Generally when breast asymmetry exists, it is very rarely adequately corrected by two different sized breast implants. This is because the amount of skin, nipple position, and any degree of sagging is often quite different between the two. But for the sake of a starting point (and perhaps this will be all that is needed) I will assume that it is just a matter of two different sized breast implants for now. Otherwise the concept of a natural breast augmentation result can mean different looks to different people. While implant size is certainly one factor that goes into a ‘natural’ result, there are other factors that can also play a role in creating that outcome including the use of round vs. shaped (tear drop) breast implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am wanting a breast lift and augmentation. I am 24 years old and my left breast is a cup size larger than my right. After having a baby a year ago and breast feeding for 6 months, the all around shape and liveliness has headed south. I want to get some information about a lift. I am interested I’m how much of a difference just a lift would make, is it better to do both augmentation and lift, and what is the likeliness of breast feeding if I were to have children in the future and would it bring the breast back down. Thank you
A: Breast asymmetry is always one of the most challenging of all breast reshaping surgeries to do. In interpreting your question, it sounds like you are just interested in doing something with the original larger left breast. That may be a reasonable approach if a lift can approximate the position or shape of the opposite right breast. In many cases of breast asymmetry, before or after pregnancies, it usually takes treating both breasts to get the best result. Whether this is done with implants, lifts or combinations depends on the size and shape of the initial breasts and their degree of asymmetry. Regardless of what is done, future pregnancies and breast feeding will negatively impact the surgical results that are obtained.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have severe breast asymmetry. Left is a D cup and right is an A cup. I also have very large areolas and my breasts are pendulous. Because they are so uneven I have had upper back soreness and other aches and pains. Would insurance cover me at all? It is just as disfiguring as other birth defects and even cancer. I am not at all exaggerating.
A: Whether your medical insurance would cover the reduction of your larger D cup breast is a determination of the insurance company. No physician can say with any certainty whether they will or won’t. This requires a written letter with photographs by a plastic surgeon to your insurance company. This is known as a pre-determination process. Once they have this information, they will then make either an approval or denial in a written response. They will definitely not cover any form of a breast lift such as may be needed on the smaller right breast and this would not even be submitted, lest it jeopardize any potential approval of the left breast reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q:I had a combined breast augmentation with a lift about 3 weeks ago. It seems like my implant on the left side is below my breast. It has been like that from the beginning so I should have asked the doctor aboutthat when I last saw him. I was just wondering if it is like that because of swelling still or is it going to stay like that. I know it has only been 3 weeks and my doctor said you really can’t critique it for 3 months, so I’m not overly concerned just wondering about it. Maybe my left one required more work, it’s still a little bruised. I didn’t know if I should try to do something to push it up? I guess I was wondering if this is normal. I probably wouldn’t think as much about it if both of my breasts did the same thing. I have attached some pictures for you to see.
A: Based on the pictures, the left breast implant is below your original inframmary fold of which some of that crease still exists. It is often necessary to lower an inframammary crease, particularly in cases where there is breast asymmetry. I would suspect that your original left breast was smaller with a higher imframammary fold prior to surgery. This made it necessary to achieve better symmetry during surgery by lowering the crease on that side so the implant will match better with the original larger right breast. This is an issue in which more time is going to be needed to see how the whole breast shapes out over time. Combined breast augmentation with lifts are always more complicated than when implants are placed alone, particularly when there is significant prior differences between the the breast mounds and the level of the inframammary folds. I think it would be alright now to begin wearing an underwire to give that left breast better support as healing progresses.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have one breast that is quite a bit larger than the other one. I am way too embarrassed to wear a bathing suit or even go out with men for more than a couple of weeks. (I don’t let my relationships, go to the next level so to speak, in fear that the guy will totally freak out and embarrass me even more if that is possible because I already feel pretty bad about myself!) Anyway I was wondering if you could enlarge just one of my breasts?
A: While few women have breasts that are perfectly symmetric, congenital or developmental breast asymmetry is another matter. In this condition, one breast is significantly larger than the other often by several cup sizes. In its most severe form, there is a medical condition known as Poland’s syndrome where the breast and the underlying chest muscles on one side fail to develop much at all.
All forms of breast asymmetry can be significantly improved through modern breast surgery methods. In some cases, the smaller breast may be merely enlarged by the placement of a breast implant. In other cases, differential enlargement of the breasts will different implants sizes may be better.
Often times, however, the differences between the breasts is more than just that of volume. The larger or more normal breast will have more skin and a different size and position of the nipple on the breast mound. Optimal correction may require adjustment of the more normal breast as well through a lift or nipple elevation.
Dr. Barry Eppley