Capsular contracture on my left, or implant pocket stretching/too big on right. (photos)

There is asymmetry of your breasts as seen in the AP photograph. I would employ breast biometrics to determine whether there is true symmetry and the placement of the breast implants relative to the breast. Our office specializes in breast implant revision and repair. Raffy Karamanoukian MD FACSLos Angeles, CA

One of the most common problems is breast capsular #contracture or the development of thickening, and contracture of the capsule that exists around the breast implants. Severe capsule contracture probably occurs in less than 15% of augmentation patients. Every woman has a breast capsule around their implant and this is a normal phenomenon. The capsule itself could be as thin as Saran Wrap but may also become calcified and thickened. As it thickens and shrinks, the patient may develop a feeling a firmness of the breasts and in its worst situation, the breast may become painful and abnormal in appearance, achieving a very round, hard, and uneven appearance. There may be distortion and possible breakage and leakage of an older implant, but may also include a newer #implant. Nicotine users, such as smokers, have up to a 30x increased risk of #capsular contracture.

Saline implants may deflate spontaneously. When the patient has significant #symptoms, complete or partial leakage of their saline implant, or concerns regarding silicone leakage, it is recommended that the implant is removed and exchanged. Frequently, this is performed on both sides depending upon the age of the implant. Capsulotomy or opening of the capsule may be required or frequently capsulectomy, which is removal of the scarred capsule, is #recommended to ensure adequate pocket dimensions.

New implants may then be placed in the same existing position or may undergo a change of #placement frequently from submammary to subpectoral position and, on occasion, the other way around.

Thank you for the question and pictures. You are correct in that nothing will replace in person examination for accurate diagnosis, followed by treatment recommendations.  For example, the presence/absence of encapsulation can only be determined on direct physical examination. However, based on your description,  it is very likely that you are dealing with a breast implant displacement problem on your right side. If this is the case, and you wish to keep the breast implants better situated when you are standing or lying down, internal adjustments of the breast implant capsules (capsulorraphy) may be indicated. You may find the attached link, dedicated to revisionary breast surgery concerns, helpful to you. Best wishes.