Breast asymmetries represent the most challenging part of the aesthetic breast surgery, dealing with a large variety of situations. There are three main groups of asymmetry etiology, namely, congenital, developmental, and acquired. Focusing on errors in growth and development in terms of breast asymmetry, Reilley (Aesthetic Surg J 26(5):596–600, 2006) includes absence of structures, excess structures, variations in size, and variations in shape. Connecting the breast asymmetry with the type of operation needed, Araco et al. (Aesthetic Plast Surg 30(3):309–319, 2006) propose a morphologic “working” classification of breast asymmetries to guide treatment planning. Since we have separate chapters for tubular breast and breast augmentation on chest malformation, we will present our classification for breast asymmetry focusing mainly on implant selection. The author presents a series of eight cases with breast asymmetry, from minor to severe ones, corrected with anatomical implants. Sometimes it’s more difficult to do a small refinement than a surgical correction for an obvious breast asymmetry. Only the accurate patient examination with a precise diagnosis will lead to an appropriate surgical plan and good results.