13 Weeks Breast Augmentation Post Op. Am I Bottoming out on my Left? (photo)

There is an obvious difference in size. My ps didn't think it was significant enough to use different implants, but I disagree. Both are 371cc. Over the last few weeks, my natural breast tissue on the left side has moved up on top and above the implant. Also, the left implant is lower both on the upper pole and at the crease. It also appears to have moved slightly outward toward my armpit. My ps says it's not bottoming out and not double bubble. Subtle, but I feel it is the beggining of both.

Doctor Answers 5

Bottoming out

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Thanks for your inquiry and excellent pictures.  Without a before picture, it is hard for me to tell if your asymmetries existed before surgery.  In terms of bottoming out, I agree you are experiencing some on the left breast with a double bubble.  I think your right breast looks great.

Is this early "Bottoming out?"

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Thanks for the excellent photographs; they certainly validate your accurate assessment. At just over 3 months post-op, most, but not all, swelling has resolved, and your asymmetry is indeed visible. My question at this juncture is always the same: "Were you asymmetrical to this visible degree pre-operatively? You should know the answer to that as you put your breasts into brassieres that (presumably) had the same exact fabric cup size on each side. Did your bras fit the same on each side? Did you have a visible asymmetry in your breasts? Can you see that asymmetry in your pre-operative photographs? How different were your pre-op breast measurements?

If you could not really see a difference, then your asymmetry was minimal, and adding exactly the same implants on each side should have decreased the relative percentage of asymmetry remaining. Example:

  • Let's say you had a 90cc breast on one side, and a 100cc breast on the other. This is a 10% difference.
  • Add 400cc implants to each side--this yields 490cc and 500cc, a 2% difference!

If your breasts matched pretty well pre-op (no one is exactly the same on both sides), then adding same-size implants should make you MORE symmetrical (as the above example shows), not less. This is a sure-fire way to determine what is post-op swelling (that will presumably resolve over time) and what is not. If you had visible asymmetry pre-op, then different size implants were probably a good idea (though too late for that now). If not, then this is swelling, fluid, bleeding, or something else.

If you can see a visible discrepancy between breasts, even the most minimal difference requires at least a 50-60cc volume disparity. SInce implants come in 30-50cc increments, this is below the threshhold for visibility, which is why the implant manufacturers chose these increments in fabricating implants.

So, back to your specifics. I agree that your left implant has dropped more than your right (to be accurate, your natural breast tissue has not "moved;" your implant has dropped). Clearly, your left implant needs to drop "down and out" more, and your right one must be "slowed or stopped" for improved symmetry. That's what I use elastic bandeaus for--I would have you wear it above your right breast and below the left, safety-pinning the band to a T-shirt worn at night to hold it in proper position. During the day I would recommend a supportive but not overly compressive (push-up) bra, and ask you to loosen the strap on the right (higher) side.

Since your left breast looks great, I would agree that this is neither bottoming out nor is there any evidence for double bubble (at least thus far). But scar tissue and capsules take 6-12 months to fully mature and settle, and things can change (and be changed, as with bra and bandeau) over that time. I don't think your left implant is too low; I think the right has to drop down and out a bit more.

Unless, of course, you prefer the appearance of your right breast--then your left has indeed "bottomed out" compared to the side you prefer. Frankly, if your left implant can be prevented from dropping further (and this depends to some degree on the inferomedial muscle fiber release done [or not] by your surgeon), your left is a very aesthetic attractive "natural-appearing" breast.

If swelling does not resolve over time, then this could be either initial (un-noticed) asymmetry, or bleeding, fluid, scar tissue causing the presently-visible asymmetry. Any plastic surgeon would need pre-op photos, your input about bra fit, and pre-op measurements to answer the symmetry question properly.

Talk to your surgeon; this is still a result-in-progress, and you (with your surgeon's input) can participate in modifying your ongoing recovery for improved outcome. Proper position long-term is most critical; size can be changed with a new implant(s). Altering either takes another operation, but the latter is easier and with less chance of poor outcome. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Postoperative breast asymmetry

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Based on your photographs there is definitely an asymmetry of the inframammary folds of your breasts medially. It appears that the left breast is lower with a "double bubble" appearance. I would recommend wearing a support bra as much as possible until you are completely healed, which may take 6 months. In the event that this asymmetry doesn't improve or worsens then a secondary procedure such as a capsulorraphy with plication of the capsule can be performed.    

Slight Bottoming Out of Breast Implant?

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Yes, I agree that your breasts to demonstrate enough asymmetry to cause most patients to be concerned. I think that in the long term, you will likely benefit from capsulorraphy surgery to raise the position of the breast implant that is lower on your chest wall.

 Best wishes.

13 Weeks Breast Augmentation Post Op. Am I Bottoming out on my Left?

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         I would say be careful in letting just anyone go about trying to revise this.  If this has developed slowly there may be a tissue laxity issue here that may not be fixed adequately with capsulorrhaphy alone.  There is not a huge amount of bottoming out, and you will need a very fussy surgeon to tinker with this.  The implant volumes can be adjusted as well.   Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast augmentation revisions each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA 

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.