1 Month After BA and my Breast Are Uneven, the Right Breast Looks As if is Sagging, Left Breast Bigger and Round? (photo)

At this point I'm desperate my left breast looks ok while my right breast looks totally different and feels empty at the bottom and on its left side. I have the same size on both breasts 380cc Texturized silicone gel under muscle. My PS is almost nonexistent told me to wear the band at my 2 weeks when I saw this problem, wore the band for 1 month and still no change, I'm not even and they look really different from one another, what would need to be done if i got a revision, what went wrong?

Doctor Answers (7)

It's still early, but you may have a long-term problem and require revision.

+2

It is a bit early after surgery, and things always change (somewhat) as time goes by and tissues soften and scar tissue matures. Your photograph shows implant pockets pretty close in the midline, which is good for narrow cleavage, but can end up causing symmastia (uni-boob) or differences in the muscular attachments near the breastbone. This is one problem that time will not correct; if in fact one pocket was created a bit too close in the mid-line, repeat surgery to suture the capsule from the inside may well be necessary.

There's another problem with this situation--you have textured implants. If the textured surface "works" properly and "adheres" to tissues similar to Velcro, there will be little to no dropping possible, even with additional passage of time, and even if an elastic band is used. How can an adherent (because of the texture) implant "drop" into a new position over time?

There is no reason to utilize textured implants below the muscle, IMHO. Textured implants were designed to reduce capsular contracture in the above-muscle submammary implant position because of texture "adherence" to the breast tissues, and were thought to work by "breaking up" the linear contractile vector forces of capsular myofibroblast/collagen fiber bundles in the capsule, as well as possibly "isolating" ductal bacteria from freely moving around a non-textured smooth implant/capsule interface. Some studies showed reduced capsular contracture for routine above-muscle textured implant placement; others did not.

When the FDA restricted use of silicone gel implants in 1991, saline implants became the norm, and the usual above-muscle placement had the same capsular contracture issues as with silicone implants in this plane, so the choices were smooth or textured saline implants instead of silicone, and initially surgeons continued to use the same above-muscle position.

But (regardless of smooth or textured), with saline implants above the muscle, visible rippling became a greater issue. So we went below the muscle. This reduced the rippling concern, but it also turned out to significantly reduce capsular contracture, likely because of fewer bacteria in the submuscular plane (but NOT if the surgeon used blunt--bloody--dissection to create the submuscular pocket as many did above the muscle). This led to surgeons and patients alike claiming that "Below the muscle is much more painful!" True, but only if the surgeon does not use careful, precise technique with meticulous hemostasis. But I digress.

Unfortunately, when some surgeons went below the muscle for the reasons above, they continued to use the implants they had become "used to," and simply used textured implants below the muscle. Not only is this basically unnecessary (since it turned out to be the less-bacteria submuscular position, NOT the texture, that reduced capsular contracture), textured adherence prevents implant movement, limits dropping into proper position, and (with saline) increases the risk of implant deflation. With silicone gel implants deflation is not an issue, but failure to move and drop remains an issue with textured implants.

So in your case I believe you have a higher likelihood for needing revision surgery to (possibly) correct the pocket near the mid-line, and to open and drop the implant pocket and position to better match the "good" side. I would certainly wait for at least 3 months (6 would be better) before making a decision to ask for re-operation, and I would carefully consider what you and your surgeon discuss as a plan to "correct" the potential issues that persist at that time. Good luck and best wishes! Dr. Tholen


Minneapolis Plastic Surgeon
5.0 out of 5 stars 107 reviews

Asymmetric Breasts at One Month

+1

Your photos seem to show that your right implant is somewhat higher than the left. It is not uncommon for submuscular implants to be high postop for several months. Wearing a superior pole strap is a good idea so long as it does not effect your left implant which looks perfect already. In summary, it is tooearly at one month to declare victory or defeat in breast augmentation.

Paul S. Howard, MD
Birmingham Plastic Surgeon
5.0 out of 5 stars 7 reviews

1 Month After BA and my Breast Are Uneven, the Right Breast Looks As if is Sagging, Left Breast Bigger and Round? (photo)

+1

Based on the poorly posted one photo I really see minor asymmetry. Best to obtain IN PERSON second opinions. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

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Implant issues

+1

Every breast is a bit different and therefore not only do they drop at different rates but the folds are usually not the same.

Steven Wallach, MD
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Uneven

+1

It is too early to evaluate your results. The right side drops later in most patients because they are right-handed. You also had unevenness to the size and diameter of your breasts before surgery. Nipple position was also different. These are not corrected with implants but are very minor issues anyway

Michael Hueneke, MD
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Implants Need Time To SETTLE

+1

The good news for you is that this is most likely normal. You are only 1 month out from your surgery. The implants can take up to 8 weeks to settle. The left implant has settled nicely, and there is no reason to suspect that your right implant won't do the same. Be patient and follow your surgeon's instructions.

Implant massage and wearing the compression band provided can speed up the process.

If the implants continue to look like this after 3 months, you will need to consider the possibility of early capsular contraction.

 

 

 

Joseph Ku, MD
Riverside Plastic Surgeon
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HELLO

+1

 

 

In our practice we also tell our patients to wear a breast band as well. The implants need to settle a little lower. It can take longer than one month for that to happen. Continue to wear your compression breast band.

 

Stuart B. Kincaid, MD, FACS
San Diego Plastic Surgeon
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.