Unequal breasts may be due to an underdevelopment of one breast or over-development of the other. Basically the decision is of matching the two. Depending on the size the patient wants, one breast can be reduced or the other augmented, - in most cases, it is the combination of the two to give it the right size and aesthetic shape. In most cases, where a reduction is deemed, I tend to carry out a peri-areolar reduction which gives the best cosmetic results.
Usually the hypoplastic breast is often associated with a condition called tubular breast. Here not only is the breast hypoplastic, but also the base diameter is very narrow. Though there are some one stage operations to correct this primarily, the results are not very good. In these cases volumetric increase of the size would not give best aesthetic result. The aim is to increase the base diameter. This can be achieved by a expander-prosthesis as a Becker or expand the breast in the first instance and later insert the right sized prosthesis to balance the contra-lateral side