In short. What is measured on each side, what imaging adds, and how each result narrows the options. The examination is mostly numbers rather than impressions.
Key points
- Where the fold sits on each side.
- A fold that is higher on one side explains a difference that volume cannot account for, and it changes the operation from one that adds tissue to one that repositions the fold.
- It is also the measurement most often omitted when an assessment is rushed.
An assessment for a difference between the two sides is short, and almost entirely measurement. Its point is not to judge how noticeable the difference is but to establish which of the four causes is present, because that decides what can be offered.
The history, before anything is measured
When the difference first appeared, whether it has been stable or changing, and whether it changed after a pregnancy, a period of breastfeeding, a weight change or an earlier operation. A difference that has been stable since the breasts finished developing and one that appeared last year are assessed quite differently, and the history is what separates them. Any previous imaging and its reports are reviewed here as well.
Both sides measured, not only the smaller one
The width of each breast where it meets the chest, the height of each fold from a fixed point on the breastbone, the distance from the fold to the nipple on each side, and the distance from the notch at the top of the breastbone to each nipple are recorded. Describing a difference by eye is unreliable; comparing numbers is not, and the numbers are what a result is later judged against.
The shape of each breast, and its base
Whether the lower half of the breast is full or tight, whether the base is wide or narrow, and whether the tissue is spread or crowded forward. This separates a small breast from a constricted one, and it is the finding that most often changes what is offered.
The finding that changes the most plans
Where the fold sits on each side. A fold that is higher on one side explains a difference that volume cannot account for, and it changes the operation from one that adds tissue to one that repositions the fold. It is also the measurement most often omitted when an assessment is rushed.
What the chest wall is doing
The chest wall is examined for a curve of the spine, a rib that projects further on one side, or a breastbone that is not level. Where the frame holds the two sides at different heights, that is recorded, because it changes what an operation can achieve. Recognising it is the difference between a plan that works and one that produces two breasts of equal volume sitting at different heights.
Imaging, and the record
Imaging is arranged where the history or the examination calls for it, or where age and family history mean it is due. Standardised photographs are taken with the measurements, so the starting position is documented, and they are kept in the clinical record rather than published.
Findings that stop the cosmetic conversation
- A lump, a thickening, or skin that has puckered or dimpled.
- A difference that is new, or that has changed over weeks or months.
- A newly inverted nipple, a new discharge, or redness over one breast.
What each of the four causes looks like on examination is set out in Volume, Shape, Fold or Chest Wall. What the ladder of options looks like once the cause is named is in The Treatment Ladder for Breast Asymmetry.
Frequently asked questions
Why are both breasts measured when only one is a concern?
Because a difference is a comparison, and a comparison needs two numbers. Measuring only the side that prompted the appointment describes that breast in isolation and says nothing about how far it differs from the other. Both sides are measured, and the difference between the two sets of numbers is what a plan is built from.
What does imaging add that an examination cannot?
An examination describes the surface and the shape; imaging looks at the tissue inside the breast. Where the history or the examination calls for it, or where age and family history mean it is due, imaging is arranged and its result is read before an operation is planned, because a cosmetic plan built on an undiagnosed change is a plan built on nothing.
Can the assessment be done from photographs?
No. Photographs are useful as a record and for comparing a result with a starting point, and they cannot show the base width, the height of the fold, what the chest wall is doing or how the skin behaves when the breast is lifted. The measurements that decide the plan are taken in person.
Risks & Limitations
- No operation makes the two breasts identical. Balance in and out of clothes is achievable; a matched pair is not, and any plan that offers one should be questioned.
- A difference that has appeared over weeks or months, or that comes with a lump, a skin change or a discharge, is assessed as a medical matter before any cosmetic plan is made.
- Scars are permanent. They mature and fade over months but do not disappear, and sensation may change, sometimes in a way that lasts.
- Where the difference comes from the chest wall, surgery on the breast alone does not correct it, and the two sides may still sit at different heights afterwards.
When to Seek Care
- A difference that has appeared over weeks or months rather than years — seek prompt diagnostic assessment.
- A lump, thickening, or skin that has puckered, dimpled or reddened on one breast — prompt assessment.
- A nipple that has newly turned inwards, or a new or blood-stained discharge — prompt assessment.
- After surgery: rapidly increasing swelling, spreading redness, fever, bleeding that does not stop, or a wound that opens.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.