While a slight difference in breasts is normal, a difference in size, shape and the position of the nipple can be quite different in each breast for some women. Surgical intervention is most likely recommended when one breast is a cup size or more different from the other breast. Breast size and shape is genetic to a large extent although asymmetry can occur at random. Breasts begin to grow at puberty and continue to grow for another two to four years. It is during this phase that a difference in size can become apparent.
If breasts are uneven at age 21 it is unlikely that their size and shape will change or improve significantly after that time. Surgery is not recommended on patients younger than 18 except in some special situations. Surgery for breast asymmetry may require: augmentation of one or both breasts, reduction mammoplasty of one or both breasts, augmentation of one breast and reduction in size of the other, and lifting of one of the asymmetrical breasts.
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