I had breast augmentation two months ago, 600cc silicone placed under the muscle with incisions through my armpits. My right implant has dropped quite a bit and it very soft and natural feeling. The left one hasn't dropped at all since my surgery and is slightly harder. What could be causing this?
Good Right Implant. Bad Left One? (photo)
Doctor Answers (8)
Implant malposition could be a number of things.
Thanks for including a photo; it clearly shows the asymmetry you describe, and the cause could be a number of things.
This could be related to the surgical pocket being created too small, or with inadequate fiber release (as compared to the opposite side). Since your surgeon used an axillary incision and you have pretty large implants, there was probably a significant amount of armpit tissue manipulation, and there may well have been some sweat gland or skin pore bacteria introduced onto the surface of your implant, causing early capsular contracture (the firmness you describe). This can happen despite antibiotics, antiseptic irrigation, or use of a sleeve for insertion, but I believe armpit incisions have a higher potential for this in any case.
Or, it could be that everything is just fine, and you simply have slightly more swelling that needs to resolve, scar tissue that has to soften, or a stronger muscle that needs to relax. Perhaps your "handed-ness" plays a role in your healing (more use of your right causing better swelling resolution, or more use of your left causing slightly more bleeding and tightness--either is possible).
While wearing an elastic band above the left breast may help this implant to drop into position, you may well require more surgery to better release and open up your pocket, or you may require complete capsulectomy--just not yet. I would wait a full 6 months to reach the point where it is most likely that this will not improve on its own, and then proceed if this appears unchanged. Revisional surgery may also be best-performed via an inframammary incision approach (one reason I prefer this incision in the first place, with the second being the lower potential for CC-inducing bacterial contamination via armpit.) Best wishes! Dr. Tholen
Left breast implant needs to drop, see your surgeon
Thank you for your question and photographs. From your photographs it appears that the left breast implant has not dropped into and beneath the breast as well as has occurred on the other side. I am assuming your plastic surgeon is having you do breast displacement exercises on the left side to push the implant down.
If this result does not improve between 3 and 6 months a revision may be necessary to drop the implant into a lower position.
Breast Implant Asymmetry
Hard to know exactly what is going on. I would love to have seen pre-operative photos to see if you had asymmetry to begin with. Being that said here are several things that could be going on. The first is the most simple and obvious problem. You may have a pocket on the left that does not accommodate the implant like the right one does. It is early and the implant may drop over time but if it does not drop by 6 months or so you may need a pocket revision to lower that implant. The next problem you might have is an early capsular contracture around the implant. We can not predict who it will happen to but we only have theories as to why it occurs. Two theories are that either bacteria live in the pocket and stimulate a contracture, or blood in the pocket irritates the capsule and leads to a contracture. If you have a contracture you will need a capsulectomy at some point and a new implant. There are some medical treatments out there, but none that work all that good. Consult your surgeon to discuss the risks and benefits of trying medical management for contracture because there are some potential harmful side effects from the medication used. Another problem could be that you have a higher breast on chest wall on the left than the right. This I can not tell without examining you.
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Breast Implant Asymmetry
I am sorry you are having this problem with your breast augmentation result. Any potential difficulties with pocket dissection with axillary breast augmentation surgery, or the lack of using a breast band after surgery are not the causes of your problem. If you had this problem with both sides, then you might have a good argument for those culprits. Your problem is called capsular contracture, which commonly occurs on one side. You will need a revision surgery to remove the scar capsule on the left side. This cannot be done via the axilla, and is most commonly done via a periareolar incision.
Best of luck!
Good Right Implant. Bad Left One?
Based upon the posted photo I see a poor left pocket dissection on your left implant causing the lateral high riding effect. This can occur more frequently using the axillary approach to implant placement. Especially that larger size range. Re operation on the left is indicated via infra mammary approach in my opinion.
In our practice we give our patients breast bands to help pressure the implant to drop down into the pocket. You are still early on from surgery, you should get help to correct that issue the sooner the better.
Breast asymmetry after surgery
Thanks for your inquiry, you need to be discussing this regularly with your plastic surgeon. You may have early encapsulation on the left or possibly the left pocket was dissected differently. Only on exam can this difference be ascertained, good luck.
It is still a little early to know if it will soften and drop. Possible explanations are a difference in the way the pockets were made or where the implants were placed, differences on your body before surgery, capsular contracture, or just needs more time.