Pranay Parikh, MD

based upon your picture  it looks like you may be developing a "double bubble" phenomenon.   this occurs when the implant is stting lower than the breast tissue on the chest wall creating two separate folds under the breast.   i would definitely being by talking to your surgeon first, to hear his/her thoughts and opinion, and then potentially meet with another surgeon experienced in secondary breast augmentation, or augmentation revision to discuss options for potential improvement.  hope that is helpful! 

Thank you for your question

there are many factors to consider in choosing the best size implant for any given patient. 

These include the width of each breast, the amount of skin and natural breast tissue that is already present,  and the elasticity of the skin and tissue. 

One hopeful thought might be to be review your measurements with your surgeon and understand how here she arrives at the volume that was suggested.  

You might also want to search for the term dimensional planning or the high five system for breast augmentation which try to help eliminate guesswork from implant sizing and determine the volume more objectively. 

Thanks for your question. 

I agree with other responders that capsular contracture should be high on the list of possible causes for a firm implant.  

In addition to the examination and ultrasound that you had your doctor may also consider getting an MRI to look for possible rupture of the implant. 

When contracture is significant for worsening or if there are concerns for implant rupture removal of the implant and the capsule is occasionally necessary.   Replacing the implant with a textured implants may help to reduce the risk of future contracture. 

All of these are topics to bring up with your surgeon.   If you still feel like you need more information getting second or third opinions from other qualified board-certified plastic surgeons is also very reasonable. 

Thanks for your question. 

Although it's impossible to say from an online history and photo I would be most concerned about hematoma or bleeding within the pocket of the implant that is occurred. 

If this is the case you might need additional treatment or possibly even surgery to remove blood clot stop any bleeding and help minimize information that could put you at high-risk of capsular contracture later on.  

Is totally appropriate to call for urgent visit with your surgeon today or as soon as possible

Thanks for your question. 

Based upon your photos it's difficult to assess the symmetry and firmness issues you mention.  

Although I usually advise my patients to wait six months before considering revision surgery, It is certainly reasonable to expect that your results will be starting to settle at three months postoperative.   

The most appropriate thing to do is to visit your surgeon and allow him or her to examine the result, and address your concerns face-to-face.   Causes of asymmetry and firmness such as capsular contracture are issues that a qualified surgeon should be able to explain thoroughly and clearly.