A woman in her early 20’s with severe breast asymmetry. Her right breast never developed normally and she was an A cup on her right and a B+ cup on her left. She is 5’ 7 1/2” and 170 lbs. She wanted fuller breasts on both sides, but more even in appearance and still with a natural look. These cases can be complicated. It is not as simple as just putting a larger implant on the smaller breast. Because the skin envelope is smaller and tighter on the smaller breast, a larger implant can appear “bulgier” with unnatural fullness in the upper pole. So the trick is to find the largest implant that can be used on the smaller breast and still maintain a natural appearance, and then work backwards with a smaller implant on the larger breast to match. We spent some time sizing her in the office to get the proper range of implants, and then I had a large hockey bag of implants to bring to the operating room so that we would have enough choices to match. I started with a 450 cc smooth round moderate profile plus silicone gel implant on her right side, placed below the muscle through an inframammary incision. I needed to precisely lower her incision and create a new breast fold on her right breast to properly accommodate the base diameter of the new implant. We then worked backwards on her left breast using a temporary implant called a “sizer” with different sizes to see what was the best match. A 300 cc moderate profile plus silicone gel implant was selected and used on her left side, again through an infra mammary incision and below the muscle. She is shown before and again, 6 weeks after surgery. Of course the breasts are “sisters and not twins” and can never match precisely, but she is thrilled that they are so much closer now. She has a fuller but still natural look and much better symmetry of her breasts. If you look at the mole on her right upper abdomen you can get an idea of how much the breast fold needed to be lowered on her right side.