Aim: To assess volume management in patients presenting with breast asymmetry and ptosis. Methods: Retrospectively collected data was analysed. The patients were divided into 3 groups. Group A included patients who had volumetric difference alone and had different size implants alone. Group B included patients who had volumetric difference with breast ptosis requiring mastopexy with different size implants. Group C included patients who presented with breast asymmetry with ptosis and had same size implants on both sides with different volume breast reduction. Results: Subgroup A1 included 145 patients who had larger implants placed on right side. Subgroup A2 included 95 patients who had larger implants on the left side. Subgroup B1 included 7 patients who had larger implants on the right. Subgroup B2 included 13 patients who had larger implant on the left side. Subgroup C1 included 7 patients who had larger reduction on right side. Subgroup C2 included 11 patients who had larger reduction on left. Conclusion: When different volume implants are used, the vast majority of the patients do not require a volume difference of more than 60 mL. When the breast is larger on the right then larger mean volumes are used on left side to offset the larger right breast.