Do I need to have a further corrective operation due to an irregular shape in my breast? (photos)

I am now 10 weeks post op and my breasts are softened to a more more normal feel, however I still have a slightly harder and very flat surface to the underside of my right breast that isn't dropping at all, which my nipple appears to hang over. Is this to be expected?

Doctor Answers 11

At 2 months post-op it is still very early to see final results

Although you haven't shown us preoperative images, I would be willing to bet a lot of money that they would show some degree of true tuberous breast deformity, at least on the right breast which is your biggest concern.  It appears that you have a tight, flat lower pole of the breast with a high natural fold which has been lowered (appropriately, in my opinion) by the placement of the breast implants.  You also appear to have an enlarged and loose, "puffy" areola, and these things make me think of tuberous breasts.  What you are seeing on the bottom of the breast essentially are two effects of putting implants into breasts like these.  First, you see a double contour, or "double bubble," with one contour caused by the implant itself as it has been positioned, again where it needs to be to properly and proportionately increase the size and contour of your breasts, and the second higher contour is from your original natural breast tissue and inframammary fold, which now fall higher on the breast mound and cut across the curvature of the lower pole, or bottom, of your breasts.  This is virtually unavoidable if we are going to enlarge the breast to any degree beyond which the natural un-augmented breast dimensions would allow.  Many surgeons limit the size of implants they use in breasts with a short lower pole for just this reason.  I have never felt the need to do so, because with proper techniques and sufficient time after surgery to allow things to relax, it almost always turns out well.  The good news is that in the VAST majority of cases, given enough time, this relaxes quite a bit and becomes virtually unnoticeable.  The second thing you are seeing is a flattening of the contour of your lower pole, and this is simply because the surgeon (again, unavoidably if he or she was to increase the size of the breast to any significant degree) placed a larger volume, in the form of an implant, into already excessively tight tissues.  Excessive tightness, or constriction of the lower breast tissues and skin, is one of the things that leads to tuberous breast in the first place.  Thus, it follows that if we are to change such a breast we will have to deal with this tightness.  When the tightness is severe enough, some surgeons have actually resorted to tissue expansion as a means to stretch the tissues first prior to placing permanent implants.  In my experience, this has seldom been necessary, and again, given enough time, the tissues eventually stretch and accommodate to the implants.  So, your next questions probably are how long are you talking about, and what happens if it doesn’t work that way?  First, I would expect it to take even longer for tuberous breasts (and I really do think you had that!) to settle and relax with implants.  If normal breasts can take 4 to 6 months to see a final result, it may take 6 to 8 or 9 months for tuberous breasts to fully relax.  Sometimes we massage the breasts, depending upon the type of implants that are used, and sometimes we wear compression straps to promote stretching of the lower pole tissues.  If after a reasonable amount of time has elapsed,and we haven’t seen the improvement we want, then a couple of suggestions I might consider would be first, to do a periareolar lift, or more accurately stated, an areolar reduction procedure, and second, some fat transfer to the lower pole of the breast.  The fat transfer may require some stretching with a device called a BRAVA first.  The areolar reduction will do two things.  It will first simply reduce the size of the overabundant areola that you have.  But, probably more importantly, it will take up the looseness of the areola and the central breast tissues that have herniated, or pushed through, the puffy, loose areola, and that is why it seems as though your central breast mound is sort of “flopping” over the top of your implants now.  If after an appropriate amount of time to allow those tensions to balance themselves out, the central breast remains loose and floppy, I think it’s best to actively tighten it up to improve the breast shape.  This generally requires an incision that goes all the way around the border of the areola, and usually I place a special permanent suture in the areola called a “blocking suture” to maintain the shape and position of the breast tissue long term.  Lastly, fat transfer may help to improve the shape of the lower breast, again if natural rebalancing of tissue forces doesn’t happen with the implant alone.  This would especially be true in those areas where the “double bubble” is primarily caused by a lack of breast tissue and fat thickness overlying the implant.  Simply adding a sufficient layer of tissue thickness to cover the implant evenly across the breast is very helpful in these cases.  The one catch is that if the tissues have remained too tight for the implant, they will still be too tight for fat graft too.  In cases like this I might first have you use a device called a BRAVA which works at stretching the tight tissues over the course of about 10 weeks before surgery.  It is very rare that we have to  go to that extreme, though, so I won’t go into any more detail about it now; just know that there are lots of tricks up our sleeves and lots of options, and your breasts are not the kind of thing that none of us has ever seen before.  At this point, though, I think the best thing to do is simply try to relax and follow your surgeon’s instructions with regard to activity, bra or strap wear, activity, and the like.  Again, this will be a long term process, so don’t be too impatient.  Best of luck.

Concern Corrective Surgery May Be Needed Following Breast Augmentation

It's natural to question the way your breasts are healing, but at only ten weeks post op, it's far too early to determine final outcome. Try to be patient as your body heals. Breasts often "drop" at different times and it's best to give it the time it needs.

Robert N. Young, MD, FACS
San Antonio Plastic Surgeon
4.6 out of 5 stars 65 reviews

Breast Augmentation

Dear chelsie218:     Thank you for your questions and photographs.  My recommendation is to wait a full 6 months until one could possibly evaluate a final result.  Best of luck and I hope this helps!

10 weeks post op

From your photos I would give it morew time.The flatness will for sure fall otu so massage and patience are in order.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.8 out of 5 stars 56 reviews

Further corrective operation needed?

Thank you for your questions and photographs.  My recommendation is to wait a full 4-6 months until one could possibly evaluate a final result.  Best of luck.

Breast surgery

Due to slight constriction of your lower pole, the skin on this part of your breast is not stretching, causing the contour deformity.  One option is to perform a periareolar lift/areolar reduction to improve this contour and reduce your areolar size.  However, you may want to give it more time to see if the contour will improve as the implant slowly stretches the lower pole skin.  Best wishes, Dr. T. 

Irregular breast shape after BA

Thank you for your question and photographs.It is important for you to consult with your surgeon about any questions or concerns you may have seeing as they know your medical history, anatomy and surgery best. Without preoperative photo’s it is hard to tell whether this is due to the implants or your natural anatomy. The implants should continue to drop and fall into their pockets over time, I would perform a breast massage to help this occur. The healing process can last up to a year so I would re-evaluate your results at this time and if you are still unhappy I would schedule a consultation with your plastic surgeon or another board certified plastic surgeon who specializes in breast augmentations, for a revision. I hope this helps.

Best of luck in your recovery!

Sincerely,

James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

James Fernau, MD, FACS
Pittsburgh Plastic Surgeon
4.9 out of 5 stars 68 reviews

Do I need further surgery

Thank you for your question. It will be helpful to see pre op pictures. I recommend to wait few more weeks and follow instructions from your PS. More likely going to fill lower part.

Further Surgery?

You look fine for ten weeks. The bottom of the breast will likely soften/stretch over the upcoming months. Without knowledge of how your breasts looked before surgery further input is impossible. Note your concerns to your surgeon as they know your case best.

Robert H. Hunsaker, MD
Miami Plastic Surgeon
4.4 out of 5 stars 72 reviews

Breast Augmentation Revision

Thank you for your question.  It is difficult to determine from the photos but at this point I would recommend waiting.  You may require a revision down the road but at this point I would wait at least 6-8 more weeks before undergoing any surgical intervention.

Aaron D. Smith, MD
Colorado Springs Plastic Surgeon
5.0 out of 5 stars 23 reviews

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.