BA Post Op Asymmetry? (photo)

BA on 9/7/12 to correct asymmetry. AA on small side, B on big side. Silicone Mod. Plus Profiles with 425 cc on small side, 375 on big side. Husband noticed asymmetry immediately post-op, it remains now 4 days post op. PS says it’s just swelling, I’m not convinced. Is 425 enough to get me from AA to full C on small size as I requested? Will reduction in swelling be enough to correct this dramatic asymmetry post op? Was wrong size implant used on small side?

Doctor Answers (7)

Breast issues

+1

You had asymmetry to start with the left one hanging lower than the right. Give it time to heal and settle, but you may need a lift on the left.


Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Breast Augmentation Asymmetry

+1

Hello Sea,

I am sorry that you are having this problem.  This is not swelling. There are a few issues here that are causing this problem.  Two issues were in the preoperative planning, the other two issues were in the execution of your surgery.

Regarding the preoperative planning, your photo shows your native breasts with one more sagging than the other, and this is with your hands on your hips, causing a subtle lift of the breasts.  This degree of breast sag is best treated with a lift, both to improve shape, and get better symmetry.  The other issue is that the size of your implants are too big for your anatomy.  All the points that I bring up are arguable between plastic surgeons, and this one is perhaps the most contentious. The fact remains is that so many complications that lead to an unplanned revision surgery, when carefully analyzed, could be avoided if dimensional planning was used to determine the implant size, shape and profile, not the patient's desire for a given cup size.

Regarding execution, both implants are sitting too high for their size, and the left implant is higher than the right, accentuating the the left breasts already greater sag.  Kudos should be given to the surgeon for NOT overdissecting the implant pockets: had he done so the implants would have definitely been lower, but the inframammary folds might have lifted, causing another complication called a 'double bubble'.  As you can see, you are an example of someone who would have done much better with smaller implants.

It is very early in your recovery, and you will need to wait, perhaps 3 to 4 months, until you show little change in your appearance. At that point, you should plan for a revision surgery.  I would seek consultations with a few breast specialists. A minimum but necessary requirement is certification by the ABPS, and membership with the ASAPS.

Best of luck.

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 28 reviews

Post Op Asymmetry After Breast Augmentation

+1

Thank you for your pictures. At 4 days post-op you are extremely early in the healing phase of your recovery. Your implants are sitting up rather high on your chest wall, which is not unusual. Right now there is a significant amount of inflammation and the scarring process is very active. Over the next 3 to 6 months the swelling and the scarring process will begin to subside and the soft tissues will relax and accommodate, allowing the implants to drop into their desired location. As this happens you will notice that your breasts will change as they fill out.

Having said that, there is a preexisting asymmetry not just in breast size, but in the position of your folds and the amount of sagging. At this point I would caution you to wait till the implants settle (at least 3 months) before trying to decide if you need a revision. Continue to follow up with your surgeon closely and make sure you discuss your concerns with them. I hope this helps.

Good luck.

Pedro M. Soler, Jr., MD
Tampa Plastic Surgeon
5.0 out of 5 stars 7 reviews

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Asymmetry

+1

It is too early to evaluate this fully. You had a significant difference in breast position preop. Without a lift this will be true postop. The size difference will be less than before surgery. The implants will need to settle and then you can decide if the size match is satisfactory. 

Michael Hueneke, MD
Nashville Plastic Surgeon
5.0 out of 5 stars 24 reviews

BA Post Op Asymmetry?

+1

Though only a week post op YES I see the issue. 1. the size of the asymmetry was determined incorrectly. 2. You need a left lifting to complete the symmetry. Wait 3 to 6 months for revision. Sorry. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Breast Augmentation Asymmetry

+1

Thanks for posting pre and post op pictures.  It is very helpful in answering your question.  The asymmetry is in your breast tissue, not the implants.  You can see the same asymmetry in both your pre-op and your post op pictures.  You have issues with your implants riding high and hopefully this will settle.  However, this is not contributing your asymmetry.  The asymmetry is due to your anatomy and requires a lift (mastopexy) component to your surgery to make any improvements.  Most surgeons do both the implant surgery and the lift at the same time.  However, some surgeons prefer to separate it into two surgeries.  Perhaps this is what you discussed with your surgeon?  I would not suggest going with larger implants than you already have or you are going to look very unnatural.  At this point, I would suggest letting the implants settle for 3 months or so and then discuss with your surgeon if you need mastopexy to achieve better symmetry.

 

Good Luck

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 56 reviews

BA Post Op Asymmetry

+1

As I look at the photos, I see that

  • both implants are high riding (typical this early)
  • volumes look pretty similar, though hard to assess with only one view
  • left breast and nipple/areolar complex is lower

The asymmetry that I see is the lower breast and nipple and areola. This was present on the pre-op photos.The nipple and areola are lower on the left, the breast fold appears to be lower, there is more breast skin and tissue.  Implants alone cannot correct this-they can only correct the volume.  Only with a mastopexy, or breast lift, can correct this by moving the nipple and areola, and removing excess skin. 

At any rate, it is way to early to evaluate volume symmetry as a number of factors will affect the appearance of the implanted breast, and it takes about 3 months for these all to settle. You will need some patience, and continued follow up with your surgeon. 

Thank you for your question, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 31 reviews

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.