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I have one breast that is three times the size of the other. What procedure would be...
Having two different size breasts gives you the unique opportunity to see which size you like better. You could need an augmentation on the small side, a reduction on the large side, or both to arrive somewhere in the middle with respect to size. Often the best procedure is determined as much by shape issues as they are by size. Usually the best results are achieved with surgery on both breasts.
Many women considering breast augmentation surgery are seeking to not only enhance the volume of their breasts, but to also enhance the shape and/or improve the symmetry of their breasts. Essentially all breast shape and symmetry issues can be improved during breast augmentation surgery, and with most of them it is possible to make significant improvements and produce an aesthetically desirable breast profile. Accurate preoperative evaluation, appropriate surgical planning and attention to detail during the surgery are all crucial elements in achieving this goal.
Breast asymmetry is extremely common, and in fact essentially all breasts have some identifiable and measurable asymmetry. So the goal of surgery is not really perfect symmetry, as that does not exist in nature, but rather to produce the closest approximation of symmetry that is possible. In some cases it is possible to improve size asymmetry by using breast implants of different volumes and/or profiles. To do so one must patiently evaluate a wide variety of breast implant sizers intra-operatively with the patient in the upright sitting position. In some cases the breasts appear to be similar in volume, but asymmetries in the projection of the chest wall may mandate the use of different size implants in order to produce the closest approximation of symmetry.
For some patients it is actually quite important to reduce the volume of the larger breast (hence the somewhat confusing term 'reduction augmentation'), which in turn allows the surgeon to use breast implants of the same or similar size. If there is a significant difference in breast volume, and one attempts to address that difference solely by using breast implants of different size, then the result may be acceptable early on but as time passes the breasts will age very differently. The smaller breast with the larger breast implant will tend to remain youthful and perky-appearing, while the larger breast with the smaller breast implant will gradually become droopy-appearing and may eventually assume the appearance of a breast hanging off of a small implant. Not a pretty picture.