I'm 13months post-op and wondering if I need a revision. What is wrong and how can it be fixed? (Photo)

Hello there, I was initially asymmetric pre-op by about a cup size and it was my goal to correct my asymmetry. Within the first 2 weeks of recovery, I noticed that my left breast had lowered below the crease and that it projected much further from my body than my right breast. I have been to see my ps several times and he has assured me that I have a very good result. Im extremely self conscious as I feel like it is becoming more and more noticeable. Any feedback would be amazing. Thank you

Doctor Answers (9)

I'm 13months post-op and wondering if I need a revision. What is wrong and how can it be fixed?

+1
It is very obvious that your left is "bottoming" out! Only revision surgery will correct this. Best to seek other in person opinions... 


Miami Plastic Surgeon
4.5 out of 5 stars 64 reviews

Asymmetric results

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suggest you have bottoming out as mentioned by others.  You can let your surgeon know you got comments from this website and that revisions can certainly be pursued, depending on your expectations and goals and what you are willing to accept.  At minimum, elevating the lower breast would be my focus, but suture reinforcement could be done on the 'okay' side at the same time introducing the risks for contractures again.  In my experience, I have my patients wear a cut out underwire bra for up to 8 weeks 24/7 (yes, even when taking a bath/shower).  Are you willing to do this to improve you symmetry (notice - did not say perfect)?

Curtis Wong, MD
Redding Plastic Surgeon
4.5 out of 5 stars 17 reviews

Revision would help

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Thank you for your pictures.  Your result is ok.  I would recommend downsizing your implants and a lift.  This should give you a more appropriate size and equalize your shape.

Dr. ES

Earl Stephenson, Jr., MD, DDS
Atlanta Plastic Surgeon
5.0 out of 5 stars 9 reviews

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Breast implants bottoming out

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hello
 Your breast shape indicates a bottoming out phenomenon on both sides, more prominent on the left. This is not a rare post operative finding and can occur after a well performed breast augmentation. This can be corrected with a revision surgery to reposition the folds. It's best to review your concerns with your plastic surgeon.

David A. Bottger, MD
Philadelphia Plastic Surgeon
5.0 out of 5 stars 29 reviews

Residual asymmetry and bottoming out following breast augmentation.

+1
Your result is not "bad," but neither is it "very good." Besides, labeling a result is a relatively unfulfilling activity, when your initial self-consciousness has only been replaced by a different variety. You reasonably want this to be better. And it can be! (Notice that I did not say "perfect.")

You have mild bottoming out on your right side, and moderate bottoming out on your left. This can happen despite your surgeon's best efforts and your best compliance. It can be improved. (Notice I did not say "fixed.")

Also your left implant pocket is slightly more laterally displaced compared to the right side, so in addition to it being lower, it is more lateral. This is evident when looking at the cleavage area (arms up and down).

Your volume asymmetry has only been partially corrected. In other words, your larger (pre-op) left breast had a smaller implant and your smaller (pre-op) right breast had a larger implant, but not small enough on the left, or not large enough on the right (or both). In addition, your surgeon should have pointed out that chest walls are almost always asymmetrical as well, since the heart is in the left chest, making it narrower, rounder, and slightly more projecting than the wider, flatter, less projecting right side, where you already had the smaller breast, compounding the visible asymmetry.

For women with your breast asymmetry and (normal) asymmetric chest wall anatomy, I might have considered a larger moderate plus implant (bigger size, but with a slightly less wide base) for your right side to match nicely with a smaller moderate profile implant (smaller, but with a wider base) for your left. This would give you the best volume match, nearly identical implant widths despite different volumes, and better-matched projection.

Of course, knowing now that you have dropped a bit too far (and knowing that gravity works on 100% of patients, as well as scars softening in 97%), I would have started with pocket positions a bit higher and hopefully more even. I would also have measured the exact nipple to incision distance rather than using your pre-op crease as a reference point, as appears to have been done. This alone may have been the cause of the lower pocket on your left. But this happens sometimes to the best of surgeons.

Revision will be required, as 13 months post-op means that "final" positions have now been reached, and no changes for the better can be expected, only more gravity and scar stretch.

It's much harder to raise implant pockets (raise the creases) than it is to lower them a bit more. If a surgeon must err occasionally, it certainly is better to err on the high side, rather than the low side. But you do look good early post-op, which is a seductive siren song to the surgeon who wants his patients to show off his work to their girlfriends. Trouble is, they all end up in the surgeon's office a year later wanting their creases raised. But this too can be done, and you can be made much better. But not without a plan like the one I have outlined. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 138 reviews

You can certainly get another opinion!

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Please find an experienced Board Certified Plastic Surgeon and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all aspects of facial surgery, breast augmentation and body procedures including tummy tucks or mommy makeovers!

In breast augmentation I have chosen to spend time reviewing photographs with patients to fully understand their expectation of size and shape. Many times this simply raises more questions. I will make measurements and use the implant guides to allow the patient to understand exactly the sizes that are reasonable for their body type and measurements.

Robert Whitfield, MD, FACS
Austin Plastic Surgeon
5.0 out of 5 stars 14 reviews

Asymmetry

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You may improve the asymmetry by wearing an underwire bra in which you have cut out the bra cup.  Wear it 24/7 for 3 weeks.  Hopefully this will adjust the pockets. If not, you may need a revision to match the folds.

Malcolm D. Paul, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 6 reviews

Lower pole stretching

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At this time it does looks like your lower pole has stretched out a bit more than the right side. I don't see any evidence of double bubble.  There are procedures which can help totighten  up the area but with your smaller degree of assymetry at this time you really have to give it some thought as to whether it is worth more surgery.  You were assymetric to start and very close at this time.  At 13 months things are very unlikely to change.  

Terrence Murphy, MD
Englewood Plastic Surgeon
4.5 out of 5 stars 10 reviews

Advice re your breast asymmetry surgery result

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hi and thank you for your question and photographs. Firstly, perfect symmetry is rather unrealistic as no-one is perfectly symmetrical! Analysing your photos pre and post op alone means advice must be tempered with caution as nothing is better than  face to face consultation. There was significant asymmetry preop and there remains some asymmetry clearly postop. It is not just about volume asymmetry as often folds are different, nipple positions vary as well as your underlying chest wall. I always start by setting out the initial goal of achieving what I call 'balance and symmetry in clothing, naked symmetry follows on!' Its best to seek an opinion from an accredited PS as to what further surgery could achieve, as its always down to balancing potential risks against benefits! good luck. 

Sultan Hassan, MD, FRCS(Plast)
London Plastic Surgeon
5.0 out of 5 stars 16 reviews

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