Your result is not "bad," but neither is it "very good." Besides, labeling a result is a relatively unfulfilling activity, when your initial self-consciousness has only been replaced by a different variety. You reasonably want this to be better. And it can be! (Notice that I did not say "perfect.")You have mild bottoming out on your right side, and moderate bottoming out on your left. This can happen despite your surgeon's best efforts and your best compliance. It can be improved. (Notice I did not say "fixed.")Also your left implant pocket is slightly more laterally displaced compared to the right side, so in addition to it being lower, it is more lateral. This is evident when looking at the cleavage area (arms up and down).Your volume asymmetry has only been partially corrected. In other words, your larger (pre-op) left breast had a smaller implant and your smaller (pre-op) right breast had a larger implant, but not small enough on the left, or not large enough on the right (or both). In addition, your surgeon should have pointed out that chest walls are almost always asymmetrical as well, since the heart is in the left chest, making it narrower, rounder, and slightly more projecting than the wider, flatter, less projecting right side, where you already had the smaller breast, compounding the visible asymmetry.For women with your breast asymmetry and (normal) asymmetric chest wall anatomy, I might have considered a larger moderate plus implant (bigger size, but with a slightly less wide base) for your right side to match nicely with a smaller moderate profile implant (smaller, but with a wider base) for your left. This would give you the best volume match, nearly identical implant widths despite different volumes, and better-matched projection.Of course, knowing now that you have dropped a bit too far (and knowing that gravity works on 100% of patients, as well as scars softening in 97%), I would have started with pocket positions a bit higher and hopefully more even. I would also have measured the exact nipple to incision distance rather than using your pre-op crease as a reference point, as appears to have been done. This alone may have been the cause of the lower pocket on your left. But this happens sometimes to the best of surgeons.Revision will be required, as 13 months post-op means that "final" positions have now been reached, and no changes for the better can be expected, only more gravity and scar stretch.It's much harder to raise implant pockets (raise the creases) than it is to lower them a bit more. If a surgeon must err occasionally, it certainly is better to err on the high side, rather than the low side. But you do look good early post-op, which is a seductive siren song to the surgeon who wants his patients to show off his work to their girlfriends. Trouble is, they all end up in the surgeon's office a year later wanting their creases raised. But this too can be done, and you can be made much better. But not without a plan like the one I have outlined. Best wishes! Dr. Tholen
