Only 1cm difference in symmetry pre-op - now not proportionate, different sizes. Can it be fixed in revision? (Photos)

Many of these questions can be difficult to answer without seeing someone in person. Only an in-person examination, with feeling the implant's location, seeing how the implant moves when people are lying on their back, and feeling their underlying chest wall give the best sense.

When assessing a breast that contains an implant, it's important to take into account the factors of:
1. The chest wall (projection, and slope)
2. The implant pocket'a location and security (where is the pocket in vertical space? Do the implants fall laterally when supine? )
3. The IMF position (is one fold higher than the other? , This is very common, I find that typically the right breast is higher than the left.)
4. The laxity of the skin/breast/tissue
5. The nipple position.

It appears that your left chest wall is sunken more than your right (left ribs appear indented whereas right is more convex). This significant difference in the platform for your implant will make your implants appear different between the two sides.

As you know, overall perfect symmetry in breast augmentation is very uncommon. And I would say that overall, I'm not sure I would recommend a revision to attempt to improve these relatively small differences.

Hi there,Thank you for sharing such a detailed and thoughtful explanation .
Based on what you've described, there are several important factors at play:1. Over-Dissection and Pocket Instability
Over-dissection can sometimes lead to a weak or unstable implant pocket, even if the “shelf” appears to hold. When tissue above or around that pocket is loose or unsupported, it can fold, flatten, or shift, causing the implant to settle unpredictably.
2. Shifting Appearance Throughout the Day
The fact that your breast changes position or shape depending on arm movement or time of day suggests a potential pocket malposition, possibly with capsular looseness or tightness in certain areas. This may explain why your nipple shifts and why bottom pole fullness disappears at times — especially if the implant is riding high or pushing forward.
3. Implant Flip or Rotation?
A true implant flip is rare with round, smooth implants — but rotation or shifting within an unstable pocket can absolutely mimic that sensation. It can also lead to asymmetry in shape, volume, or projection even with the same implant size used on both sides.
4. Symmetry Expectations with Reconstruction
Even small pre-op differences (like your 1 cm asymmetry) can become amplified post-op, especially when one side required structural reconstruction. Soft tissue, healing patterns, and scar formation can all lead to uneven tension and positioning — even with matching implants.
So, can lowering the pocket help?Yes, lowering the pocket — particularly to restore lower pole volume and shape — can absolutely be a valid approach. However, this needs to be done cautiously, ideally with internal support techniques to avoid bottoming out.
A revision surgery that involves:
Pocket adjustment or repairPossibly removing residual scar/filler if presentRe-centering the implantRe-establishing symmetry…can restore a more balanced, natural shape — especially since your goal is restoring what you naturally had before surgery.

It’s hard for me to really see the issue.
Breast asymmetry is normal.
The left breast almost always sits higher on the chest wall than the right side.
Your left breast has a greater degree of divergence.
Make sure you know exactly what you’re hoping to achieve.
Maybe having a in person second opinion, consultation would be helpful.
For second opinion consultations come prepared to bring with you a complete set of proper before and after pictures and a copy of your previous operative report.
These are part of your medical record that you can request from your current provider.
I don’t see an obvious need for revision surgery.
Best,
Mats Hagstrom MD