Uneven Breast After Lift and Augmentation Causing Difficulties Wearing Bra, What Should I Do? (photo)

I had a breast lift with augmentation 8 months ago but my breast looks more uneven. The left side has a 200cc saline implant and on the right a 180 cc saline implant. I can feel the implant on my right breast on the bottom right corner and my areola is closer to my sternum causing me problems when I wear any bra. The left side sits higher and harder then the left. I think it's has capsular contracture. Saw my PS today and thinks i need another surgery but i would be responsible for entire cost

Doctor Answers (12)

Uneven after augmastopexy with saline implants

+2

volume of the two implants is impercepatable. firmnes and contracture can require revision which is neither your fault nor the surgeons.  

most doctors will ask for you to pay facility fees.  see what you can work out for the  surgeons costs.

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Orange County Plastic Surgeon
5.0 out of 5 stars 20 reviews

Concern about breast lift and enlargement results and revision costs

+2

Your breasts were asymmetric before surgery and are still so to some extent afterward. However, the results are relatively good. Whether or not you have capsular contracture can't be discerned by your otherwise helpful photos.

Some of your concerns are related to thinner tissue and the usage of saline implants as opposed to silicone implants, the latter of which should provide you with a better result on several issues.

With regard to charges, that is an issue that should have been discussed prior to surgery. Therefore, I have no clue as to what was agreed upon and signed. For my patients, I will not charge a surgical fee for revisions up to a year but this is explicitly spelled out.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 20 reviews

Uneven Breast After Lift and Augmentation Causing Difficulties Wearing Bra, What Should I Do? (photo)

+2

Thank you for the pictures.  it does appear that the right breast implant has bottomed out compared to the left and some kind of revision is required.  A capsular contracture cannot be diagnoses on pictures, you would need a physical examination for that.  As far as the cost go, my policy is that if revision is needed in the first year, I only charge anesthesia and operating room costs.

Rigo Mendoza, MD
Tampa Plastic Surgeon
4.5 out of 5 stars 26 reviews

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Uneven Breast After Lift and Augmentation Causing Difficulties Wearing Bra, What Should I Do? (photo)

+2

I agree with a secondary operation. I do not charge a personal fee but only the costs of operating room and anesthesias. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 64 reviews

Problems after Breast Augmentation and Lift

+2

A couple of observations:

The post op picture:  If you did not tell me that the implants placed were 200 and 180 cc I would assume that the volumes are much larger than stated.  I believe that they are. 

Preoperatively you had uneven nipple heights and it seems even after a mastopexy (lift) the heights are still uneven.

If you have a capsular contracture this is best determined by a good clinical exam.  Revisit with your PS.  

The cost of revision surgery just needs to be worked out so that all parties are happy.

Dr. ES

Earl Stephenson, Jr., MD, DDS
Atlanta Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast asymmetry

+2

No two breasts are exactly the same.  Your breasts look reasonable close on the photos considering where you started. Certainly some "tweaking" may get it a bit better but that requires another operation.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Breast Augmentation and Lift - Uneven afterwards

+2

The combination of a breast augmentation with a lift (also called an augmentation mastopexy or an "aug-pexy") is, i my opinion, one of the trickiest procedures to do.  It involves combining the insertion of an implant - which can shift or settle - with tightening inherently loose skin (which is why you need the procedure in the first place).  Some surgeons have resorted to staging the procedure; ie, doing the lift first and then, six months or so later, inserting the implants.  I prefer to do both together but with the understanding that there is a higher than average risk of needing a secondary or revisional procedure.  When necessary, I try to do it at minimal cost; I typically charge only for new implants (if any), and I try to minimize anesthesia and facility fee costs.  But each surgeon has his or her own policy and it's hard to dictate that to anyone else.  It's possible that simply revising your left implant will be adequate (ie, addressing the capsule and lowering it).  Again, it's a complicated procedure and the expectation for revisions should probably be higher for this than for most - but I realize that doesn't necessarily simplify your situation.  Perhaps you can have a calm, reasoned discussion with your PS and work something out that is more accessible for you.

 

I hope that this helps, and good luck,

 

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 155 reviews

Breast lifting with implants reulted in uneven breasts

+2

Beast lifting with simultaneous augmentation is not an easy procedure and  possible complications can be compounded. Nevertheless most plastic surgeons do perform them simultaneously after informing the patient of the pros and cons and possibe complications. It appears that you have developed a capsule on the left breast for which you will need to have surgery to correct it. Since it is only 8 months since your initial surgery if I were the surgeon I would only charge for the use of the operating room and anesthesia. You should return to your PS and discuss this issue. Good luck!

George Lefkovits, MD
New York Plastic Surgeon
4.0 out of 5 stars 20 reviews

Uneven breasts after augmentation-lift

+2

Your breasts look nice, certainly an improvement from before your augmentation lift.  Reviewing your concerns, very well articulated, you will feel the implant at its edges, especially lower outer edges, because the implant is not covered by muscle in this area.  This is OK, and normal.  While one areola may be closer to your midline than the other, the areolae both appear to me along the breast meridian.  Some bra styles will completely cover the areolae, others perhaps not.  If this is really problematic, perhaps your surgeon will consider office revision by eccentric purse string periareolar repositioning.  Also, by removing more lower pole skin with a superior capsulotomy to revise the lift, your right bra cup will sit higher and coverage of the areola should be improved.  Capsular contracture, if not responsive to montelukast or zafirlukast, is another potential indication for revision.  None of this is an emergency, and your result is good.  Perfection is never achieved.  While every surgery costs, if and when you decide to have the revision, negotiate with your surgeon.  It appears he/she did a pretty decent job.  Not all variables in surgery can be controlled.  It is not unusual to require a revision for the type of issues you are having.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 38 reviews

Uneven lift and augmentation

+2

Unfortunately problems after surgery can be painful and disappointing.  Combined implants and breasts lifts can lead to unpredictable results and up to 1/3rd of patients will need a revision to correct these problems.  Furthermore, any asymmetries that you had before the surgery can often be more exaggerated after surgery.  It is good that your surgeon is offering to revise your surgery, but I am sure that you are disappointed for any costs associated with this surgery.  I expect that your surgeon's policies regarding revision have been discussed or available for your review.  I would continue to maintain dialogue with your surgeon and may consider a second opinion if necessary.  

Tito Vasquez, MD, FACS
Southport Plastic Surgeon
5.0 out of 5 stars 4 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.