In fact, about half of women who present for breast augmentation have breasts which are asymmetrical in size and about half have nipples that are at different levels. Including asymmetry in the shape of the chest, nipple/areola size, and level of the crease under the breast, 88% of women have asymmetrical breasts before surgery! Women are often unaware how common this is. We have all seen women's breasts portrayed in the visual media in various poses and amount of cover. But, most of us are not in the habit of critically inspecting large numbers of naked, unretouched women's breasts. And, I am at a loss to think of anybody who is in such a habit, apart from a medical doctor or mammographer!

As part of the examination, plastic surgeons look for asymmetry before surgery. One reason we do this is to bring any existing asymmetry to the patient's attention. She may have never noticed it before. But, she will look more closely at her breasts after surgery and, unless she knows about it beforehand, she may notice for the first time that one nipple is slightly lower or higher, or points outward more, than the other.

Nipples naturally point slightly outward due to the curved contour of the chest. A breast augmentation will not change this. It will not alter nipple placement on the skin. Sometimes, an optical illusion is created after surgery by the low position of the nipple on the breast mound - it appears that the implant is too high, when in fact the implant is correctly positioned on the chest, but the nipple is too low. Patients wonder, "Can't you just put the implant lower?" But to lower the implant in such a situation, would make the whole breast appear too low. It would sit lower on the chest, look unnatural and would displace the natural crease under the breast ("inframammary crease") downward. The implant has to be in the right position for the breast, not for the nipple. The logical way to correct a lowered nipple position is to elevate the nipple with the saggy lower breast tissue, and a breast lift is the operation that does this. Women cannot expect breast implants alone to significantly raise the nipple position on the breast.