Asymmetry? Bottoming Out? Need for Concern? (photo)

I'm about 3.5 weeks post op and I'm concerned with how my breasts look. The left breast looks larger than the right and the crease seems to be lower. Is this normal swelling at this point and can I expect the breasts to even out? Alternatively should I be worried about bottoming out? I'm not sure what to look for. Thanks for your help!

Doctor Answers 11

Concerns about bottoming out

Hello. At three and a half weeks you are not looking at the final result by any means, but there are some things you should be conscious of if you are concerned about bottoming out. One thing to consider is that your breasts, like everybody else’s, were asymmetric before the surgery as well. Another consideration is that at three and a half weeks you still have some swelling which may not be equal on both sides. The last thing to look for after swelling has gone down and you are still worried would be the distance between your nipple and your inframammary fold. If the distance is greater than nine centimeters then there is a chance that your implant is lower than it should be.

Jaime Perez, MD
Breast Augmentation Specialist
Plastic Surgery Center of Tampa

Tampa Plastic Surgeon
4.8 out of 5 stars 75 reviews

Bottoming out early after surgery

I respectfully disagree with several of the earlier posts. While it is completely impossible to tell for certain with just photos and without a physical exam, I would be very concerned about "bottoming out" based on your photos. While it does take even 3-6 months for the final results to be seen with a breast augmentation, I have never seen implants magically rise back up over the inframammary fold with just time. If anything, your implants will continue to descend over the next several months. It appears to me that they have already encroached upon the incisions. My guess is that the implants will continue to descend and the incision will appear as if it is on the front of the breast instead of in the inframammary crease. The distance from your nipple to the inframammary fold is already longer than what I would expect and will only get longer. I hate to be the bearer of bad news when everyone else is telling you that things will just be fine, but I would expect you to be wanting a capsulorrhaphy procedure in the near future. I hope that I am wrong, but I think you should be concerned and talk to your plastic surgeon about it. 

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 84 reviews

Bottoming out at 3 weeks

It is difficult to say if you have bottoming out at this poppint, and you should give it a few months to settle before becoming too alarmed.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Asymmetry

Early on after surgery asymmetric swelling can cause what you are concerned about. Give it some time and usually it should be fine. If you are concerned about bottoming out, you should be sure that you are wearing a good supportive bra and stay within your activity restrictions early after surgery. At this point it looks fine by what I see in your photos.

Scott R. Brundage, MD
Grand Rapids Plastic Surgeon
4.8 out of 5 stars 24 reviews

Asymmetry? Bottoming Out? Need for Concern?

The left breast looks a bit larger in the pre-op photo, so I wouldn't be surprised if the symmetry is less than perfect in the afters, though they look pretty even to me. The implants do look rather large, and the nipples look a bit high on the curve of the breast. I can't really see where the incision, (which is presumably on the fold) is in order to comment on whether there may be bottoming out. 

At any rate, all these questions will get a better response from your surgeon in the setting of an actual exam, which is far superior to looking at photos.

Thanks, best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Bottoming out and asymmetry at 3.5 weeks post op

Thank you for the question.  At this point, it is still early to tell if you are bottoming out.  Should give it a few months to settle and heal.  Swelling and asymmetry is not uncommon at this time.  If you're so concerned about it, best to contact your board-certified plastic surgeon. Best of luck. Dr. Michael Omidi.

An in-person exam with a board-certified plastic surgeon is the best way to assess your needs and provide true medical advice.

Michael M. Omidi, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 92 reviews

Asymmetry at 3.5 Weeks Post-Op

Thanks for submitting these photos with your question.  At 3.5 weeks, it really is too soon to start worrying about the difference in size.  You do have to give it some time for the swelling to go down and for your breasts to settle in and drop.  They will most likely change over the next several months and settle in nicely.  Make sure you keep in contact with your surgeon so he/she can follow your recovery closely and keep you informed about what to expect.  Best of luck!

Andrew Smith, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 20 reviews

Bottoming out

I would agree that your implants appear to sit too low within the breasts.  There appears to be more implant below your nipple than above it in your pictures.  Right now, I would suggest wearing a good supportive bra that helps push the implants up and press down on the fold area of the breast.  That may help as the post-operative swelling diminishes.  If it is not where you want them to be after about three to six months following your surgery then you may need a second surgery to re-build the crease where it was originally located.  The downside of this is that your scars might now be below the crease and on your chest wall instead of on the undersurface of your breasts.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 24 reviews

Breast implants

I agree with your concerns. Your implants appear low, and it may get worse with time. I suggest you talk to your surgeon about it.

Gregory Sexton, MD
Columbia Plastic Surgeon
4.9 out of 5 stars 73 reviews

Breast Augmentation

It is definitely to early to state anything about the result.  Asymmetry always exists and it does appear that is true in your preoperative photos.  You should discuss your issues with your doctor.

Gary A. Tuma, MD, FACS
Princeton Plastic Surgeon

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.