Introduction <p>The approach to addressing tuberous breast deformity has evolved significantly, with a wide array of procedures now available. The aim of this study is to analyze the outcomes using same or different projection implants in patients with asymmetry grade A or B and tuberous breast type I, II or III.</p> Material and Methods <p>Eligible patients met the following criteria: (1) primary surgical procedure for correction of tuberous malformation; (2) breast asymmetry, (3) follow-up for at least 2&#xa0;years; (4) standard pre- and postoperative photodocumentation; (5) proficiency in Italian language; and (6) signed consent for study participation. All procedures were performed by the same surgical team, using a singular or double superior glandular flap for the correction of the tuberous breast, using retroglandular round implants and circumareolar incision. All patients completed Italian versions of the BREAST-Q, which were issued by e-mail approximately 2&#xa0;years postoperatively. We compared levels of patient satisfaction with the breast postoperative module by group, using the Chi-squared test for unpaired data. Two plastic surgeons reviewed all postoperative photographs of treated patients and rated outcomes on a VAS scale of 1–5.</p> Results <p>A total of 63 patients were enrolled, aged between 20 and 35&#xa0;years. Patients were retrospectively divided into 2 groups: group 1 (28 patients), same implants and gland resection of the bigger breast; group 2 (35 patients), same base and height but different projection and volume implant using the bigger and more projecting implant in the smaller breast. The BREAST-Q showed higher scores in group 2 in all the scales (psychosocial well-being <i>p</i> = 0.039; Sexual well-being <i>p</i> = 0.043; satisfaction with breasts <i>p</i> = 0.028; satisfaction with implants <i>p</i> = 0.014). The VAS scores were higher in groups 2 (<i>p</i> = 0.013), which was also the one undergoing fewer secondary procedures (lipofilling) compared to group 1 (<i>p</i> = 0.030).</p> Conclusions <p>This study is one of the few in the literature that highlights the importance of achieving good symmetry in tuberous breasts with different degrees of severity and different asymmetry, with greater predictability and without secondary procedures, and according to the data of this study, the use of prosthesis with different projection has better results.</p> Level of Evidence II <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to&#xa0;Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.&#xa0;</p>