Hi again :) I read all of the advice given with my previous question regarding my asymmetric breasts (TY!). I have provided pics of my pre op breasts, per request, to show what they looked like. I do see the asymmetry before as well. I am wondering if there are other ways to correct this or, help it without a lift? If I were to get a lift would a donut lift be useful/helpful/? I am planning a revision and wondering if I switch to saline and have different sizes in each if that would help?
Asymmetric Nipples. Revision Without A Lift? Am I Bottoming Out? Is Their Hope? (photo)
Doctor Answers (12)
Size Well Matched and Need Donut Lift
Your photos indicate that you have well matched sizes for your breasts and the donut lift would be advisable. Kenneth Hughes, MD Los Angeles, CA
Improving Breast Symmetry after Breast Augmentation?
Thank you for the question and pictures.
Yes, there is hope to improve your breast symmetry significantly. Doing so may necessitate adjustment of the breast implant pockets. For example, if one breast implant is “riding higher” than the other, the nipple/areola complex on that side may seem to be pointing downwards.
This adjustment of the breast implant pocket along with a limited breast lift on the side with the lower nipple/areola complex should help improved breast symmetry significantly.
Uneven nipple position before and after implants
Overall the result is fairly good considering the asymmetry you had originally. If you want better symmetry, I would slightly lower your left breast fold (although the difference is minor) and do a periareolar lift on the left side. Best of luck.
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Revising asymmetric results
I agree with Dr. Squires' assessment. In your case, the augmentation with oversized implants tended to accentuate the difference in the nipple-areola position. Raising the right inframammary crease and lowering the left would help as would lowering the forward profile volume of the implant along with a slight reduction of the width of the implant.
Implants do not lift the breast (or nipple-areola) position and removing or lowering the forward volume doesn't correct nipple-areola position either. Aside from the crease adjustment and downsizing the implant so it fits better, I would not recommend a lift procedure as you don't really need a lift. If you want to raise the left nipple-areola position, I would consider it instead of the revision or after the crease adjustment and implant change had settled but not both done together. This would be a type of peri-areolar or "donut" mastopexy on one side (not a so-called crescent lift).
You had some asymmetry after your first surgery and it clearly became exaggerated after your revision. We don't have pictures of your breasts prior to your first surgery. Nonetheless, it appears that your left breast had a slightly lower nipple position and a slightly higher inframammary fold. You mentioned you had mild capsular contracture after your first surgery. I am assuming that was in your left breast.
At this point your asymmetry is quite apparent and you appear to have capsular contracture on your left breast. Prior to considering any kind of lift, I think it is crucial to treat your capsular contracture and optimize the positions of your implants. It may be that your asymmetry will be adequately addressed with these above maneuvers. There are also certain maneuvers that can be done internally to change the orientation of your breast and either raise or lower your nipple position. Dual plane dissection, raising or lowering the inframammary fold, and suturing the breast onto a higher position on the muscle are some possible maneuvers . It is only after the above maneuvers are attempted should a lift be considered if the asymmetry persists to any significant extent.
Ary Krau MD FACS
A Solution to your Problem
Your pre operative photos show asymmetry of both the nipples and the inframammary crease positions. Your left nipple was lower than the right before surgery and this has been accentuated by the breast augmentation. The right crease was lower than the left and this allowed the right implant to sit lower, thereby making the right nipple look even higher than it was before surgery. I would elevate the right crease slightly and lower the left slightly to correct the implant position. You may still need a periareolar left on the left to achieve the best symmetry possible.
Asymmetric Nipples. Revision Without A Lift? Am I Bottoming Out? Is Their Hope?
A review of your photographs reveals the asymmetric nipple areolar position in the original photo. After going larger, the implant size and shape looks good but I think a small upper periareolar mastopexy would be helpful on the left side.
Asymmetric Nipples. Revision Without A Lift? Am I Bottoming Out?
The breasts look pretty even in size and shape at least in the photo on the right. I would suggest only peri-areolar lifting to correct the nipple position. I can't tell if these are above or below the muscle. If above, I think that moving them to the submuscular plane would make these look a bit more natural.
Thanks for your question, and for the posted photos. All the best.
Breast implant and nipple asymmetry
Thank you for submitting your photos. Patients with post operative breast and nipple asymmetry always need to review their pre operative photos. Your post operative photos show that your left nipple is about an inch lower than your right. That in fact is present in your pre op photos as well. Your implants appear to be near the same height. So, I think that your nipple asymmetry is due to ptosis on the left which is easily treated by a crescent or donut mastopexy on the left side.
As for changing implants, i would recommend you speak with your surgeon before jumping to a conclusion as there are many factors which go into that decision, which your doctor can help elucidate.