Not every breast augmentation procedure requires the use of two breast implants of the same size. For patients with a concave chest wall, breast asymmetry, or differences in breast tissue characteristics, the surgeon may consider selecting two different implant sizes to improve symmetry and achieve a more natural breast shape.

The case of Ms. B, born in 2001, 1.68 m tall and weighing 49 kg, is one example. After directly assessing her chest structure and tissue characteristics, the surgeon selected a 275 cc implant for the left breast and a 300 cc implant for the right breast instead of using the same implant size on both sides.

Preoperative Breast Condition

Ms. B desired breast augmentation with the goal of achieving a natural, harmonious, and proportionate appearance, without prioritizing an excessively large size.

During the direct examination, the surgeon noted several characteristics:

• A concave chest wall with asymmetry between both sides.

• The breast tissue showed signs of fibrosis.

• Poor tissue expandability.

• Anatomical and volumetric differences between both breasts that needed to be considered when selecting the implants.

These factors directly affected the selection of implant diameter, projection, and volume, as well as the process of creating the implant pocket.

Why Can’t Breast Implant Sizes Be Selected Based Solely on Height and Weight?

Height and weight serve as reference data, but they are insufficient to determine the exact implant volume (in cc) that is appropriate for an individual.

The surgeon must simultaneously evaluate multiple factors, including:

• Breast base width.
• Chest wall and thoracic skeletal structure.
• The degree of asymmetry between both sides.
• The thickness of the glandular tissue and fat layer.
• Pectoral muscle characteristics.
• Tissue expandability.
• Implant diameter and projection.
• The patient’s desired breast shape.

Particularly for individuals with a concave or asymmetrical chest wall, if the implant is selected based solely on the volume (cc) without considering the anatomical structure, the postoperative result may not achieve the desired symmetry.

Why Did the Surgeon Choose Two Implant Sizes, 275 cc and 300 cc?

In Ms. B’s case, the two original breasts were not completely identical.

After direct assessment and actual evaluation during surgery, the surgeon selected:

Left breast: 275 cc CLASSIC DNTBC implant

Right breast: 300 cc CLASSIC DNTBC implant

The 25 cc difference was selected based on the actual condition of each side to help correct the asymmetry and create a more harmonious overall appearance.

This shows that the two breasts do not necessarily need to receive implants of the same size. In some cases of asymmetry, using two different implant volumes may be part of an individualized surgical plan.

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How Does a Concave Chest Affect Breast Augmentation?

A concave chest can alter the breast base, the direction in which the breasts develop, and the distance between the two sides. The extent of impact varies from person to person.

Therefore, before surgery, it is necessary to evaluate not only the breast glandular tissue but also the thoracic skeletal structure and the soft tissue covering the implant.

In Ms. B’s case, the concave chest combined with fibrotic tissue and poor tissue expandability required more careful implant selection. The goal was not to attempt to place an implant with a large volume, but to select a size within the anatomical limits and consistent with her desire for a natural breast shape.

Breast Augmentation Surgery Using an Ultrasonic Surgical Scalpel

In Ms. B’s surgery, the surgeon used a new-generation Ultrasonic Surgical Scalpel during dissection to create the implant pocket.

The implant pocket needs to be created based on the actual structure of each breast, especially in cases with an asymmetric chest or unfavorable tissue characteristics.

The implant size and implant pocket need to be considered simultaneously. A breast implant with an appropriate volume but placed in an unsuitable pocket can still affect the postoperative breast shape.

Post-Breast Augmentation Care for Ms. B’s Case

After surgery, Ms. B:

• Wore a surgical bra as instructed.
• Had her postoperative breast condition monitored.
• According to the postoperative protocol specifically applied to this case, she did not use painkillers or antibiotics after surgery.

Does Natural-Looking Breast Augmentation Mean Choosing the Smallest Implant Possible? No.

A natural breast shape is not determined simply by whether the implant is large or small. The result depends on the relationship between the breast implant – implant pocket – soft tissue – pectoral muscle – chest wall and overall body proportions.

An implant size that is suitable for one person may not necessarily be suitable for another, even if both have the same height and weight.

Therefore, the important question before surgery is not only “How many cc should my breast implants be?” but rather:

“Based on my chest structure and tissue characteristics, what implant size and projection would be appropriate to create a natural and proportionate breast shape?”

Should Different Breast Implant Sizes Be Used When the Two Breasts Are Asymmetrical?

It is possible, but not all cases of asymmetry require two different implant sizes.

The surgeon needs to determine whether the asymmetry originates from the breast glandular tissue, chest wall, pectoral muscle, inframammary fold position, or a combination of multiple factors. Based on this assessment, the surgeon can then decide whether two different implant volumes are needed or whether the asymmetry should be adjusted through implant pocket creation techniques.

In Ms. B’s case, using a 275 cc implant on the left and a 300 cc implant on the right was a choice based on the patient’s individual anatomical assessment, not a general formula for individuals who are 1.68 m tall and weigh 49 kg.

Conclusion

Ms. B’s case shows that breast augmentation needs to be individualized according to the patient’s body structure, especially when the patient has a concave chest, asymmetry, or limited tissue expandability.*

Instead of routinely using two implants of the same size, the surgeon selected a 275 cc CLASSIC DNTBC implant for the left breast and a 300 cc CLASSIC DNTBC implant for the right breast, with the goal of improving symmetry while maintaining a natural breast shape that is proportionate to the patient’s body.*

Natural-looking breast augmentation is not determined by a fixed number of cc. What matters is selecting the appropriate implant and creating an implant pocket that matches each patient’s individual anatomy.