Breast Blog

Is It Normal For My Breasts To Be Different In Size?

Posted by on Jun 17, 2019 in breast asymmetry | 0 comments

Correcting Breast Asymmetry: They’re Sisters, Not Twins

I got a private Facebook message from a young teen who was concerned that one of her breasts was bigger than the other. “It is normal for my breasts to be a little different in size?” she asked. She was wondering what she should do.

The short answer? I told her not to worry, to give it time. It’s not uncommon for breasts to develop unevenly during puberty, but by the time they stop growing they usually are more even. I also told her that there’s no such thing as perfectly identical breasts; most women have breasts that are slightly different sizes. It’s called asymmetry.

The long answer: In puberty, breast development can start first on one side or on both sides at the same time. It takes about 3-5 years for the glandular tissue to fully develop and for breasts to reach their full adult size. On average, most women are finished growing by age 18, although some might continue to grow into their early 20s.

That’s about the time the majority of women come into my office to find out about cosmetic breast surgery. They are still under the normal size breastsimpression that breasts are supposed to be identical. Actress Jennifer Lawrence made headlines a few years ago when she announced on Jimmy Kimmel Live that her breasts were uneven.

“Before I started to work in Dr. Eisenberg’s office, I had seen very few breasts,” said Pat Smith, my accounting coordinator. “I didn’t have any sisters. We didn’t get undressed in front of each other in gym class; we didn’t talk about our breasts or look at each other’s. This might be the case for most women. I never knew that girls had concerns – that one breast might be smaller than the other, or that one might point down and the other up.”

Time after time, when a woman comes in for a consultation and looks at dozens of before and after photos, she is relieved to find out that she isn’t the only one with breasts of different sizes.

Few women have identical breasts: Breasts are sisters, not twins. The difference might be slight or more obvious. Chances are one of their feet is slightly larger than the other one, too. That’s because the two sides of the body are not perfectly matched mirror images. They are asymmetrical. Watch our video on breast asymmetry here.

Nipple position, chest diameter, the amount of breast tissue, and the location of the breast on the chest wall all contribute to the appearance of the breasts. When one breast hangs a little lower than the other, it might give the illusion of being bigger. It might also look bigger when there is a longer distance from the nipple to the inframammary fold (the crease beneath the breast). With all these variables, it is no surprise that no one has identical twins.

While some women are bothered by a size difference that’s as small as a few tablespoons, others don’t notice or don’t care. Some women address their concern by adding padding – or a “chicken cutlet” – to one cup of their bra; others opt to for cosmetic breast surgery.

If there’s a difference in the volume of the breasts, I can make them closer in size by enlarging them with breast implants of different sizes, augmenting the smaller breast, or reducing the bigger breast. I have operated on women whose breasts varied by as much as two-cup sizes, and I was able to make a significant improvement. While I cannot transform sisters into twins, I can make them look like sisters from the same family.

The First Chicken Cutlet: In Victorian England in the mid-1800s, girls were considered adults at the age of 15. If they had not developed enough to fit into the women’s clothing they were supposed to wear, they were given bosom pads to fill out the bodices of their dresses.

Do Breast Implants Need to Be Replaced Every 10 Years?

Posted by on May 24, 2019 in breast-implants | 0 comments

Several times a week in consultation, I answer questions like these:

“I need to replace my breast implants after 10 years, right?” Wrong.

“You did my breast implants 14 years ago and I’m still happy with their appearance, but a friend just had her 10-year-old implants redone because her doctor said she had to. Is that true?” False.

Breast implants don’t have an expiration date. They only need to be replaced if they deflate (saline) or rupture (silicone), and they’re not fragile.

It’s no surprise that women believe that implants have a shelf life, but what causes the confusion? Breast implants come with a free lifetime product replacement policy. Manufacturers also offer a 10-year warranty to defray some costs of implant replacement surgery. When women hear this, some assume they have to replace their implants after 10 years.

breast augmentation

Vintage refrigerator ad: The new 1967 Admiral Duplex comes in 4 sizes and has the 5 features women want most!

Don’t be misled by the warranty. Your refrigerator comes with a warranty, too, but you don’t automatically replace it when its warranty expires. You’ll probably keep it until it breaks down, unless you are redoing your kitchen and want a bigger or smaller model.

Women sometimes opt to replace their implants for bigger or smaller ones after childbirth, weight gain or a change of heart. I recently removed saline implants from a woman who wanted to go bigger after 23 years, and her implants looked the same as the day I put them in.

About 1-3 percent of the 300,000-plus women in the United States who have a breast augmentation each year eventually have surgery to replace implants that have ruptured or deflated.

The most common reason that an implant breaks is because it develops a fold in one spot. Over time, that fold might move back and forth, weaken, and then break, in the same way that a paper clip might break after it has been bent multiple times. I’ve found that if an implant doesn’t deflate from fold failure in the first 6-7 years, the likelihood of this happening seems to decrease, not increase, over time.

Implant replacement requires time off from work, exposes women to the risks of surgery and anesthesia, and may require some out-of-pocket expense. As far as replacing implants every 10 years, my philosophy is: “If it ain’t broke, don’t fix it.”

What happens when a saline implant breaks:

When the implant shell tears, the saline solution leaks out quickly, usually within a few hours, sometimes in a couple of days. The implant deflates like a balloon, and the breast generally returns to its original size. Your body absorbs the saline and then you urinate it out. The saline cannot harm you: It’s the same concentration as the salt water that makes up about 60 percent of the human body.

What happens when a silicone gel implant ruptures:

When the implant shell tears, the cohesive silicone gel inside sticks together and is unlikely to leak. You might not notice a change in breast volume or have symptoms, which is why it’s called a “silent rupture.” There could be no problem, or the ruptured implant could irritate the surrounding healthy tissue and cause pain, hardness or capsular contraction. Either way, the implant needs to be replaced. To check silicone gel implants for rupture, the FDA currently recommends an MRI three years after surgery and every two years thereafter.

How Does a Breast Lift Work?

Posted by on May 9, 2019 in breast-lift | 0 comments

Are you a candidate for a breast lift? Should you also get implants? What can you expect during recovery? Here are seven things to consider.

Breast Lift Considerations

1. What a Breast Lift Can Accomplish
A breast lift, or mastopexy, raises and firms the breasts, giving them a more youthful look. I do this by removing the excess skin, moving the nipples to a new, higher position, and suturing the remaining tissue together to create a sling – essentially a natural support bra – that raises and reshapes the breasts. I use the I.D.E.A.L. Breast Lift technique, which I created and have been teaching to doctors from around the world.

2. What Your Nipple Position Reveals
To determine if you are a candidate for a lift, try the “pencil test.” Take off your bra and look in the mirror. Place a pencil horizontally along the crease under your breast where your bra band would rest. Does your nipple – not your areola – rest above, below, or at the pencil?

breast lift

In medical lingo, ptosis is the word for a drooping body part; breast ptosis is classified as mild, moderate or severe. Hint: The “p” is psilent.

If your nipple is above the pencil, relax. You are probably not a candidate for breast lift surgery. Use some of the money you save for new, uplifting bras.

If your nipple hangs below the pencil, your breasts would be considered moderately to severely ptotic (or droopy) and you would need a breast lift to raise and reshape your breasts.

If your nipple is at the pencil and your breasts are mildly droopy, it’s a borderline situation. You might get a good result with an implant alone because an augmentation can give the illusion of a lift. As the implant fills out the upper portion of the breast, it also fills out the lower portion, which makes it appear as if the nipple is located higher on the breast. After about 9 months, when the implant has settled, you’ll have a better idea if you are perky enough. You can always get a lift later if needed.

3.  Your Breast Size After a Lift
After a lift, your breasts will be the same size as they were before surgery, because only excess, stretched skin is removed during a breast lift; no breast tissue is taken away. You’ll look exactly how you look before surgery when you are wearing a good bra.

4.  Going Bigger
To determine if you need a lift and implants, put on your bra and look in the mirror. If you are satisfied with the size of your breasts, then a breast lift alone might be the right procedure for you. If you wish your breasts were bigger, you are probably a candidate for a breast lift and implants (an augmentation mastopexy).

5. Post-Op Discomfort
Women report minimal discomfort after breast lift surgery. That’s because a breast lift involves removing only loose, stretched skin. If implants are added at the same time, the skin and muscle will be stretched, which may cause a little more discomfort.

When a Philadelphia DJ came to me for breast lift surgery, she recorded her experience from start to finish. Watch her intimate video blog.

6.  Returning to Work
More than 90 percent of my patients are back to work on the fifth day after surgery if they work in an office setting. Women whose work requires lifting, pushing or pulling usually go back to work toward the end of the second week. They might be a little sore at the end of their workday, but by Week 3, they feel pretty much back to normal.

7. Breastfeeding in the Future
It’s very likely that breast lift surgery won’t affect your ability to breastfeed because your milk ducts, which run from the mammary glands to the nipple, are not disturbed. Only skin from the perimeter of the areola is removed, and there are no milk ducts there.

Titbit: In medical lingo, ptosis is the word for a drooping body part;
breast ptosis is classified as mild, moderate or severe. Hint: The “p” is psilent.

Saline vs Silicone Breast Implants

Posted by on Apr 25, 2019 in breast-implants | 0 comments

There’s an opinion asserted by breast implant manufacturers and by many plastic surgeons that silicone gel breast implants are better than saline breast implants.

In my opinion, “It ain’t necessarily so.”

I’ve performed more than 6,600 breast augmentation surgeries, many of them with saline implants. My patients who chose saline have reported a high degree of satisfaction; it’s been rare for a woman to request that I change her saline implants to silicone.

Silicone gel implants may be stealing the spotlight, but saline breast implants still have much to offer. Here are seven reasons why:

A Natural Feel and Appearance

When you hold a saline implant in one hand and a silicone gel implant in the other, the silicone gel implant feels softer, but that’s not where breast implants will be! When I place breast implants behind the muscle, saline and silicone implants feel the same. In slender women who have very thin skin, less breast tissue, and little or no muscle coverage around the side and underneath their breasts, there’s a higher chance that either implant can be felt in these locations.


Silicone gel implants are recommended by the FDA and the manufacturers for women 22 and older. Saline implants are available to women ages 18 and up. Although the majority of my patients fall in the latter range, young women who have not developed often tell me that they feel self-conscious when they are on the beach and that they can’t find clothing or swimsuits that fit. They don’t want to wait several years for surgery.

Incision Size

A saline implant, which comes empty, can be folded and placed through a smaller incision. It’s filled after placement. A silicone gel implant comes prefilled and therefore requires a larger incision.

Implant Size

There is a limit to how large an implant can fit behind the chest muscle, and it’s dependent on the width of each breast. A saline implant acts as a tissue expander, which means a woman can sometimes get a slightly larger size than she could with a silicone gel implant. Read: “How to Choose Your Breast Implant Size.”

Correction of Tuberous Breast Deformity

Saline implants, which are inserted empty and then filled, can expand and correct a constricted breast in a one-stage procedure. Silicone implants, which are prefilled, cannot. My surgical approach to correcting TBD has recently been published online in the American Journal of Cosmetic Surgery.

Implant Rupture

When a saline implant shell breaks, the body safely absorbs the saline (salt water) and it is urinated out. The breast returns to its original size. When a silicone gel implant ruptures, the cohesive gel inside sticks together. Women might not notice a change in breast size. To check silicone gel implants for rupture, the FDA and manufacturers currently recommend an MRI three years after surgery and every 2 years thereafter. This might not be covered by health insurance.


Silicone gel implants cost about $1000 more per pair than saline implants.

When you are choosing your breasts implants, consider all the facts. Although silicone implants get most of the attention, saline implants produce an equally aesthetic result.

What to Expect After Breast Implant Surgery

Posted by on Feb 20, 2019 in breast-augmentation | 0 comments

What Happens After A Breast Augmentation FAQ’s

When I call my breast augmentation patients the day after surgery or examine them at their first post-op visit, they want to know one thing: Is this normal?

They phrase that question in many different ways:

Is it normal for my implants to be so high?
When will my implants drop and fluff?
Will my implants soften up and squish together?
Is it okay that one of my breasts is up higher than the other?
Is it too soon to be judging my final shape and size?
Did you give me the implant size I asked for? 

My answer to all of the above: Yes!

At this point in your breast augmentation recovery, it’s way too soon to be evaluating breast implant size and position. When breast implants are placed beneath the pectoral muscle, the muscle happens after breast augmentationpresses the implant flat (like your hand could compress a sponge ball or a balloon) and the implant needs a place to go.

The implant’s space is limited on three sides – by the breastbone, the outside edges and the bottom of the breast – so it moves toward the area of least resistance: the collarbone and the armpit. That’s why your breasts are up “so high.”

One breast often heals at a different rate from the other, and one side might feel harder and be pressed up higher than the other.

Breast implants need time to “drop and fluff.” The term refers to what happens to your implants as your skin stretches and your muscles relax. The implants move downward and outward sloooowly – about 1 percent a day. Watching their progress is like watching your hair grow. You don’t see a difference in your hair growth daily, but all of a sudden you need a haircut. Watch our “drop and fluff” video.

It’ll be about six weeks before your breast implants even begin to settle down and take on a more natural shape. Your breasts will be close to 80 percent settled and softened at three months.

It’s best to wait at least eight weeks before making a major investment in new bras. It takes that long for your augmented breasts to begin to settle into their new size and shape. At that time, you will be able to more accurately determine your postoperative size and get a truer fit.

Read our blog: “What to Expect the First Week After Cosmetic Breast Surgery.”

Be patient after surgery. Think of it like those road signs you sometimes see: “Temporary inconvenience; permanent improvement.” Give yourself a few months to see the final result. The permanent improvement will be worth the wait! Till then, here are some comments from breast augmentation patients who have completed the journey:

  • “I used to hate lingerie and bathing suit shopping. Now I love it. In fact, all my old bathing suits looked brand new this summer.”
  • “I love my new figure. It is so nice to not have to worry about padding my bra anymore.”
  • “Now I can wear anything I want and feel comfortable, sexy and once again confident.”
  • “I look as good underneath my clothes as I do in them.”
  • “Friends know something is different about me but they can’t pinpoint what it is. They say things like, ‘You look great. Are you just back from vacation?’ or ‘That’s a cute outfit. Is it new?’ I like to keep them guessing.”