5 Weeks Post-op Breast Augmentation - Breasts Look Different (Bottomed Out, Asymmetrical)

hi all, i had my ba surgery 5weeks ago ( 325 silicone under muscle), and not happy with results. i had a nipple assymetry before the surgery,so would not expect them to be perfect, but now they look COMPLETELY different, the left one seems to be botommed out, and is deformed every time i use the muscle, right one is ok, just different. also, they still hurt when touching, especially nipples (nipple incisicion). isthat all normal and i should just wait, or i need to consider revision?

Doctor Answers 11

Bottoming out can be corrected with subfascial placement

The problem is indeed that your left implant has dropped to low.  This is a progressive deformity resulting from the combination of two factors :  submuscular(or dual plane) placement and violation of the tight attachments at your native inframammary fold.  Placing breast implants under the muscle creates a few aesthetic problems. If you look at your picture, your breasts are too far apart at midline to have a natural appearance.  any time your arm moves this appearance will widen and worsen.  This is the reult of releasing the inferior portion of the pectoralis major muscle.  The more superior origins will not allow the implant to sit in a natural place and the continual forces of the muscle constantly push the implant down and out.  When this is combined with excessive undermining of the inframammary fold, the deformity that you are seeing results and continues to progress.  This is a very common finding with submuscular placement.  To understand these forces better, stand in front of a mirror topless, put your hands on your hips and push down onto your hip bones firmly.  You will see both breasts move down and out.  these forces over time always cause lowering, lateral displacement, thinning of the breast tissue and stretching of the skin.  This is the reason that I use a unique technique in my practice called 'cold-subfascial augmentation.' This technique leaves the muscle alone and out of the equation but should not be confused with 'above the muscle' which I would also not recommend.  The cold-subfascial augmentation harnesses the strong structural power of the pectoral fascia to create a truly natural breast shape and act as a living structurally sound brassiere inside the breast protecting the breast from the pressure of the implant and forces of gravity.

I have seen many patients with identical problems to the one you present and in my opinion there is only one good solution- changing placement to a new cold-subfascial plane.  All of the native inferior support of your breast is now violated and conventional techniques like capsulorrhaphy and neosubpectoral placement rely on structurally unsound scar that will surely stretch and recur.  There are several mesh and biological products people use to restore support but these in my opinion do not offer lasting support or add new risks or unnatural feeling/appearance.  In my experience, revising breasts such as yours with a subfascial plane can create a more beautiful and lasting augmentation then your original before the problems started.  I hope this helps! 

All the best,

Rian Maercks M.D.

Miami Plastic Surgeon
5.0 out of 5 stars 46 reviews

4500 Biscayne Boulevard
Miami , FL 33137

Breast asymmetry can be magnified with breast augmentation

Hi victoria,

From your photo (which is taken from an angle looking up, so not the best view), it appears as though the left implant sits lower than the right. I will assume that pre-operatively, the left nipple was higher than the right. The combination of those two factors makes the overall asymmetry more noticeable.

You are still early from your surgery, so things may con tine to settle (ie the right implant drops to the same level), and your symmetry would improve. The discomfort at the nipple sound like hypersensitivity, which usually subsides with time.

Bottom line: it is too early to talk about revision. Wait 6 months. if your implants have not settled to your liking, discuss the issue with your surgeon; if a revision is appropriate, that would likely be the right time to make the judgment. The type of revision cannot be predicted at this time (if needed at all), but lowering a higher implant is always easier than raising a lower implant.  Good luck.

Best regards,

Lawrence Tong MD FACS FRCSC

Lawrence Tong, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 23 reviews

199 Avenue Road
Toronto, ONT M5R 2J3

Apparent Asymmetry, corrective surgery in 3-6 mos.

It appears that you have significant post-operative asymmetry following your breast augmentation. This asymmetry is hard to evaluate without pre-operative pictures and a physical examination, but was probably present prior to your surgical procedure. Your post-operative pictures suggest significant asymmetry of your nipple areola complexes and infra-mammary folds which was probably present prior to surgery.
Breast asymmetry represents one of the more challenging situations encountered by plastic surgeons. This is especially true when asymmetry involves the nipple areola complexes. Under these circumstances, it’s virtually impossible to have symmetry without re-positioning one of the nipple areola complexes. Unfortunately, this requires a breast lift procedure with its associated scarring.
In this situation, breast augmentation performed without correction of nipple areola malposition has inevitable consequences. When the implants are centered beneath the nipple areolas, the infra-mammary folds are asymmetric. When the infra-mammary folds are symmetric, one of the nipple areolas will be off center.
In your case, it appears that your left infra-mammary fold was lowered to create symmetry between the two folds. Unfortunately, your left nipple areola now sits high relative to the breast mound.
Although some adjustments can be made to improve symmetry, these should not be undertaken for at least 3 to 6 months. It’s important to thoroughly discuss your surgical options with your surgeon. It’s also important to be realistic and realize that some compromises may be necessary. In some situations, perfect symmetry isn’t always possible.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 142 reviews

8900 West Dodge Road
Omaha, NE 68114

Pre Operative Measurements Needed

You certainly are asymmetric, but without seeing your pre operative photo or your measurements it is hard to tell exactly what is going on.  It does appear that you have quite a bit of asymmetry before the surgery, this should have been pointed out to you before the procedure, because that asymmetry is going to still exist post imperatively and may even be magnified by the implants.

You need to be patient and wait at least 3-6 months for the final results.  The incisional pain around nipples is common and should subside.  Try using a Lidocaine (numbing) cream on the incisions for temporary relief. 

You mentioned that the left implant is deformed on movement and sits too low on your chest wall.  I suspect the surgeon placed the implant lower to match the crease on the right side and probably placed the implant partially under the pectoralis muscle and partially on top of the muscle.  So, now when you flex the muscle the implant is half "squeezed" and half not "squeezed" which makes it look funny.  That should also improve with time, if it doesn't you may need to have the implant repositioned.

Good Luck,

David R Finkle, MD

David Finkle, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 62 reviews

4911 South 118 Street
Omaha, NE 68137

Unequal breast after an augmentation

It appears that was done was to place the implants evenly so the fullness in a bra would be even as you will be seen in a bra more often than without. In so doing, as you started out with asymmetry of the nipples and the left nipple was higher, that necessitated there to be more implant below the left nipple than the right, giving the optical illusion of a bottoming out, but it has not bottomed out. If a smaller implant had been used in order to achieve a symmetrical amount of breast tissue above and below the left nipple, then the right breast might have needed a lift along with a smaller implant to achieve symmetry. When one starts uneven, the limitations of the end result are greater than when they start more even. .

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.5 out of 5 stars 11 reviews

6020 South Rainbow Blvd.
Las Vegas, NV 89118

Breast Assymetry Postop

It seems that you still have quite amount of assymetry.   It is difficult to predict how much has changed without preoperative photos.    I would recommend that you let everything settle for 6 months and then consider a 2nd revision procedure to further improve the symmetry.

Paul S. Gill, MD
Houston Plastic Surgeon
5.0 out of 5 stars 62 reviews

9200 Pinecroft
The Woodlands, TX 77380

Assymtric results after breast augmentation


This is actually a rather challenging case.  Given the fact that you had asymmetry before your surgery, chances were high that you would have asymmetry after your surgery if adjunctive procedures were not performed. These include a possible mini-lift (on one or both sides) to adjust nipple position, use of differently size implants ( to address a difference in size, and adjustment of fold position. 

My recommendation is that you speak with the Plastic Surgeon who actually performed your surgery.  A good surgeon will most likely want to make sure that you have great results since a majority of our referrals come from happy patients! 

Gregory A. Buford, MD, FACS
Denver Plastic Surgeon
5.0 out of 5 stars 19 reviews

125 Inverness Drive East
Englewood, CO 80112

Post-op breast augmentation

You pointed it out in your query that you had asymmetry.  Asymmetry is normal and the folds I am sure where different to begin with, and the may be different post-op as well.  As for the discomfort, it probably is normal but if you have concerns contact your surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.5 out of 5 stars 20 reviews

1049 Fifth Ave
New York, NY 10028

Revisionary breast surgery.

I can understand your disappointment but you may have had a very difficult asymmetry to commence with. In this situation I typically would advise pateints to wait at least 6-9 months prior to performing a revision to minimize the possiblity of operating prematurely. YOur surgeon will surely want to work with you to get an optimal result for your condition.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 58 reviews

880 W Central Rd
Arlington Heights, IL 60005

Give it more time then re-evaluate

Given the short time since your procedure, I would counsel some patience before doing another procedure. That said, since you did have asymmetry before the procedure, your result after surgery would be asymmetrical in all likelihood. I would wait at least a few months and then go back and have your surgeon address the concerns you have. A nipple incision makes it more difficult to define the fold.

Victor Au, MD
Chapel Hill Plastic Surgeon
4.5 out of 5 stars 7 reviews

4301 Lake Boone Trail
Raleigh, NC 27607

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.