3 Weeks Post Op Breast Augmentation - Asymmetrical Shape and Healing

3 weeks post op. I had saline, sub muscular, 375 right, 400 left to correct asymmetry in size. Right side healing and dropping well. Left is not. It is firmer, looks smaller and has upper pole fullness and seems to be taking on a strange shape. The left did have significant bruising that I think may have been a hematoma. Is it normal for breasts to heal so differently? I am extremely concerned. PS just keeps saying wait and see. In your opinion, what is going on and what do I need to do?

Doctor Answers (9)

Assymetry post-surgery

+1

At this point in time of the healing process, it is normal for you to have some asymmetry. Each breast will have some bruising and swelling. Swelling will subside and the implant will settle over time. I instruct my patients to massage the breasts as much as possible to prevent capsular contracture (scar tissue) and to expediate descent of the implants. A surgical bra is provided and patients are required to wear the garment for 4 weeks to aid in the healing process and help the implants settle. Be patient and continue to follow up with your doctor.


San Diego Plastic Surgeon
5.0 out of 5 stars 726 reviews

Breast Implant Asymmetry

+1

Dear Rebecca,

If you hadn't provided photographs but only described your situation, then I believe my colleagues' advise would be agreeable. However, your photographs depict a situation that is not going to improve with time, and corresponds well with what you described during your post operative course of events.  You may have in fact had a soft hematoma, something that does occur after breast augmentation and causes the implant to almost immediately sit higher in the pocket than when it did at the time of surgery. The problem you are experiencing is early capsular contracture and will unlikely soften on its own nor drop into proper position with time.  Bandos and message will not improve this problem either, but only give you false hope.

Sometimes it is difficult for the surgeon to be this blunt about the prognosis, and perhaps is hopeful in his own mind that 'things' will improve.  However, a watch and wait position is appropriate at this time, none the less. You are very early in the post operative period and should not have an immediate revision.  I recommend to everyone a three month minimum.  At that time, if the right side is without issue, and very soft, then the left side can be definitively addressed with a removal and discard of implant, a total capsulectomy, and a replacement with an appropriate sized new implant.

Revisions surgery is very different than primary surgery, and should be performed by surgeons who do many.  If your surgeon doesn't have a reputation for revision surgery, you should see someone that does.  This person would be certified by the American Board of Plastic Surgery and also be a member of the American Society for Aesthetic Plastic Surgery.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 29 reviews

Asymmetric breasts after breast augmentation

+1

From this end of the computer the only thing that can be said for sure is you hand significant asymmetry before surgery with a smaller flatter breast on the left, left nipple lower on the body vs. the right and likely uneven skin fold level under the breast. I think the original size difference was more than 25cc or gm. The after photo shows a left fold higher then the right and a left implant sitting higher than the right. The right has a rounder shape than the left. It is impossible to know from where I sit whether there is a hematoma on the left responsible for the shape after surgery or if the muscle is just holding it that way. Time will tell and the left implant may or may not drop into better position. I suspect you will need a revision on the left but you will need to wait a few months to know for sure.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

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Your right implant sits higher but you need to wait

+1

You had very uneven breasts before surgery and your left breast is lower and narrower. Your post op pictures show that your left breast implant is higher and does not expand your nipple/aerola complex(that why you have fold in the aerola). You have also have extra brusing over left implant incision which can be due to small hematoma. I would recommend that you follow your surgeon recommendation and give at leasst 2 months to heal.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.5 out of 5 stars 56 reviews

No hematoma, allow time for breasts to settle

+1

You did not have a hematoma, just more bruising on the left side.  One side always seems to bruise more than the other.  Three weeks is early.  There is a lot of settling that is going to take place in the next few months.  Don't look too critically at your breasts until at least three months after surgery.  Then if you have significant asymmetry, you and your surgeon will discuss whether any surgical treatment will be necessary.  If the asymmetry is slight, it's usually better to do nothing.  Almost all women have at least a slight amount of asymmetry.  Sometimes a mild capsular contracture will cause more upper pole fullness on one side than the other (it's too early to tell at this point, until settling has occurred), and sometimes a capsular release is needed to treat this problem.  I discuss this in the complications section of my website.  Also, you can look at examples of settling after surgery.  If this is necessary, it's not a big problem.  The expense should be nominal, and the recovery is typically easy.

Eric Swanson, MD
Kansas City Plastic Surgeon
4.5 out of 5 stars 34 reviews

Post-Op Breast Asymetry

+1

Dear RebbecaW,

I agree with my colleagues. It is very common for one breast to settle before the other. This can take up to several months to even out. Massaging of the breasts and wearing a Bando are two ways we use to speed up the settling process. A bando is an elastic strap with velcro that can be used to push the higher implant to a lower position. Patience and time are needed however. If your asymmetry persists after 2-3 months, then discuss options with your surgeon. Good luck.

Douglas L. Gervais, MD
Minneapolis Plastic Surgeon
5.0 out of 5 stars 82 reviews

Breast asymmetry

+1

It is too early to tell . You have to give it 4-6 monthst to see how the breasts fill out the pocket.  Keep close tabs on it and follow closely with your doctor.

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

Too Early To Tell

+1

I would agree with your plastic surgeon that it is too early to be concerned about asymmetry. 

Just because you had bruising, I doubt you had a true hematoma.  Hematomas are typically due to an artery that starts bleeding after surgery.  If an artery starts bleeding, it usually doesn't stop until the pressure in the pocket equals the pressure in the artery.  Therefore your left breast would have gotten huge, tight,  and very painful.  The bruising may have been an indication of some blood left in the pocket or minor bleeding from a vein (which have low pressure) after surgery.  Unfortunately, this blood may put you at increased risk for a capsular contracture in the long run, but again it is too early to tell. 

If your surgeon has recommended massages, be sure to follow the instructions.  Massaging can help the implants drop faster if done properly.  The massages should be somewhat uncomfortable, but if they're painful, you are either pushing yourself too hard or just not doing them right.

Another factor may be that your folds at the bottom of the breast ("inframammary folds") were not even before surgery.  In the photo with your purple markings, it appears that the left inframammary fold was higher than the right.  If that's the case, then your surgeon should have lowered it as long as it did not cause an undesireable nipple tilt (i.e. the nipple tilts up towards your chin).  If the folds were uneven and not corrected, then the left implant may end up higher than the right. 

Regardless of the cause of the asymmetry, most surgeons wait at least 3 months before even considering a revision.  If things are progressing (even slowly), it would be wise to consider waiting even longer.

Hope this helps!

Victor Ferrari, MD, FACS
Charlotte Plastic Surgeon
5.0 out of 5 stars 19 reviews

Your breast assymetry may still improve

+1

I is not unusual for one breast to soften and the implant to settle faster than the opposite breast.  Based on the info you provide, the left breast was the smaller breast and required an implant with a larger filling volume.  In essence the left, smaller breast was stretched more and was tighter than the right side. The breast with the tighter skin often will take more time to settle. I have seen this numerous times in my practice and in most cases the two breast do even out.  It is not unusual for an implant to take 1 or 2 months to settle. I instruct my patients to massage smooth saline implants which helps the implant pocket remain open and facilitates the implant to settle.

Your mentioned a hematoma.  Is this documented and if so what was done to correct this?  A hematoma can delay the recovery. This must be discussed with your plastic surgeon.  Did you indeed have a hematoma? Did it require drainage? Are you developing a firm breast consistent with a capsule contracture?

You are still early in your recovery period and you may do just fine as the healing process progresses.  However, you should relay your concerns to you plastic surgeon.  Ask him/her if things are progressing normally. Ask hem/her if you did have a hematoma or other problem that may be affecting you recovery and final result. You should get honest answers.  If you feel this is not the case, then consider a second opinion.  Always seek out a board certified plastic surgeon who is experienced in these procedures.

 

 

 

 

James H. Schmidt, MD
Sarasota Plastic Surgeon
5.0 out of 5 stars 5 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.