Implants are not in the same position - Would a revision be worth it? (Photos)

Question

I am almost 7 months post op and not satisfied with my results. I definitely had asymmetry before the augmentation but I feel like the asymmetry is even worse now. I feel like the left implant is not in the same position as the right implant which makes it look even more obvious. I know that they sisters not twins but I’m not sure if they are even cousins at this point. At first I thought the left was bottoming out but the implant had not dropped below the incision at all. In a bra, it’s almost like they are different cup sizes because the left one is lower and bulging more at the bottom. My surgeon feels like I have a great result and does not feel that he can make any improvements. Any suggestions/recommendations/advice would be greatly appreciated. And ultimately would like to know if it’s even worth pursuing a revision when taking my anatomy into consideration.

Alejandro Nogueira, MD · Answer

You're right to say there was a pre-existent asymmetry at the vertical axes of both breast, this means one was rooted higher and the NAC (nipple areola complex) was higher too; this is a non treatable featuer and neither a deformity, it is part of the natural anatomy of every and each woman. I have performed surgery on few thousands of breast cases and no one of them showed symmetry. Can't be said your asymmetry got worse, at all, happens your eye is now more focused on it or more critical. However, there are things to discuss here.

In your preop photo, you show what we call pseudoptosis, false ptosis or false droopiness; the NACs are located at the right position, yes one higher but both can be flagged as normopositioned, however the breast tissue has slided downwards behind the NACs expanding the lower pole of the breast, which became a pouch containing 80%, of not all, the glandular tissue. This si a breast tissue bottoming out condition, do not mistake with the prosthetic bottoming out.

Breast tissue bottoming out may be treated in a simplistic way by means of a horizontal crescent resection spanning from the midline cleavage to the side of the chest, however this leads to paying a high price with the associated scars, I'd recommend this option only in extreme cases of breast tissue bottoming out, hence not on yours.

Best approach is employing low set breast implants with large push out effect at the bottomed out tissue, this means lower pole, that at the same time allow for proper fullness at the central and upper areas of the breast mound. These are the anatomical shaped or aka teardrop implants, fortunately available in the whole world, also in the US.

Your surgeon has used old style round implants, which fail to accomplish the aforementioned task; in order to obtain with round shaped ones the push out expansion of the lower pole he has set them a tad overly low, making the prosthetic maximum projection point (MPP) eccentric from the NAC, this aggravates the saggy look of your breasts and, evidently, creates a very empty upper pole.

Do not accept any revision proposal involving the so called periareolar mastopexy, they are calamitous as technique; however to start with your revision plan I'd suggest a cautious areolar reduction to make them more proportionate.

Then I'd replace your implants with anatomical shaped ones, properly centric with the MPP beneath the NAC.

The discussion here comes with what to do with the surplus of skin at the lower pole once the implants are set higher; my choice would be a multipoint capsulorrhaphy, a more refined solution which saves you from visible scars; other surgeons may suggest a crescent resection of skin under the breast, which very unsightly scars.

If you wish to prevent prosthetic bottoming out then I'd recommend the biovelcro of the polyurethane coated anatomical breast implants.

To summarize, you don't have a really bad result, but has great margin for enhancements and a better looking breast. Seek the advice of a surgeon really experienced in results correction, complications and poor outcomes repair.

Daniel Barrett, MD · Answer

Dear Optimistic123378,

breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.
While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Wayne I. Yamahata, MD · Answer

When breasts are naturally asymmetric, in the absence of ancillary procedures such as lifts, they will generally still be so after augmentation. Sometimes the asymmetry can be improved by adjustment of the implant positioning. To make this determination would require a physical examination. It appears that your surgeon does not feel this would be of value, but you might talk with him/her again. You also have the option of seeking an in person second opinion.

Darryl J. Blinski, MD · Answer

Based on your series of nicely, post of photos with preoperative asymmetry, unless you make adjustments, i.e. a breast lift mastery on the lower side, then the cemetery will be magnified. Therefore you need a revision surgery, which is a full breast lift on the lower side to gain cemetery with possible fat graph With liposuction or the use of ALOOCLAE in injections. Fees range from $8000-$15,000. Best of virtual consult with for better understanding regards.

Mats Hagstrom, MD (license on probation) · Answer

It would be helpful to know if you’re implants are above or below the muscle.
I’m almost all people the left breast sits higher on the chest wall than the right side appear.
If you look at your before picture, you’ll see that the left breast does sit higher on your chest.It does look like your left implant has bottomed out somewhat.
I suggest having an in person, a second opinion consultation with another plastic surgeon.
For second opinion consultations come prepared to bringing with you a complete set of before and after pictures and a copy of your operative report.
These are all part of your medical records that you can request from your current provider.
Best,
Mats Hagstrom MD

Implants are not in the same position - Would a revision be worth it? (Photos)

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