My Surgeon Says No Need to Do Another Surgery. Have You Ever Heard of Symmetry with One Implant Under and One Over? (photo)

3weeks since my surgery,I have been on two rounds of 600 mg antibiotics, 2 rounds of 500MG CEPHALEXIN 4x per day.To reiterate, I had severe capsular contracture that was extremely painful.led to inversion of my nipple.Before I had surgery, an MRI that stated nothing else was wrong.the healthy breast implant was inserted over the muscle. when the other was opened, a major infection was discovered.My doctor a new pocket under the muscle. My doctor lifted the healthy breast and says they will be even.

Doctor Answers 9

My Surgeon Says No Need to Do Another Surgery. Have You Ever Heard of Symmetry with One Implant Under and One Over? (photo)

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I would suggest a revision. You have severe asymmetry and it appears that you have a capsular contracture on the right side. I would suggest going with a slightly larger implant, silicone in nature, and have it placed underneath the muscle.

Los Angeles Plastic Surgeon
5.0 out of 5 stars 254 reviews

Breast Revision surgery

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In my practice, if an infected breast and implant occur, which is rare, the implant is removed and left out for approximately 6 months, and then depending on many factors a new implant is inserted, and I generally go beneath the muscle. 

Jonathan Ross Berman, M.D. , F.A.C.S.

Jonathan Berman, MD
Boca Raton Plastic Surgeon
4.7 out of 5 stars 19 reviews

Breast revision

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It may be too early to see the final result. The implant may be high due to the placement under the muscle.  As things relax it should get better.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Infection after implant

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Something doesn't sound right here. First of all, it seems very unusual to find a major infection that was not suspected. Secondly, if an infection was encountered, it would be most unusual to replace the implant, let alone to increase the field of dissection by going under the muscle. The usual course would be to remove the implant, and then replace it only after a delay of at least three months after complete wound healing has been documented. 

My real concern is not just the asymmetry, but the chances of having to remove this implant i the near future once the antibiotics have stopped.

Forgetting for the moment the issue of infection and just looking at the current photos, I do think that you can expect a lot of improvement in the symmetry over 4 to 6 months. Implants under the muscle commonly are high riding earlier in the post op course, and settle as the muscle accommodates to the presence of the implants.Whether the symmetry will be adequate, only passage of time will tell. Continue to follow closely with your surgeon. 

Any changes in your condition--fever, drainage, redness, etc.--may be urgent issues, so if they occur, call your surgeon promptly.

Thanks for sharing your difficult course and for the photos posted. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

1 Implant under muscle, and 1 implant above muscle?

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It is very unlikely that your breasts will look symmetric after they heal. I am not sure the exact specifics of your situation, as it all sounds a bit odd. Regardless, I agree with my colleagues that an implant above the muscle and an implant below the muscle will heal differently and look different over time. I suspect a revision may be in your future. Sorry.


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Even in a  healthy breast it is not a good idea to put one implant on top of the muscle and the other underneath the muscle.  While it might look good initially, the implants would be subject to different forces and it will result in asymmetry over time.  Although I am not sure about the details of your situation, it sounds like you had an infection in one breast.  Although different doctors have differing opinions about how this might best be handled, I might have tried to get the infection under control before re-inserting the breast implant.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 26 reviews

Implant problems

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If an infection was present at the time of surgery, an implant should not have been placed.  However, at this point, if an infection recurs when you stop your antibiotics, you will likely need to have the implant(s) removed for at least 3 months before considering placing them again.  If you had capsular contracture of implants placed in front of the muscle it is come to reposition the new implant under the muscle to try to prevent recurrent capsular contracture.  Being only three weeks out from surgery, you will need to wait 3-6 months to see how things heal and settle before making any decisions about revision surgery.  You should discuss your concerns with your surgeon and if you are not comfortable with the information provided, you may wish to seek a second opinion for reassurance.

Todd C. Case, MD
Tucson Plastic Surgeon

Infection and Insertion of Implant

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   I am not sure why an implant would be inserted into an infected pocket, and I think you should determine exactly what was done.  If you are not having any issues with infection, wait for healing to occur over 3 to 6 months before assessing what should be done for symmetry.

Concerns after Breast Augmentation/Lifting Surgery?

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Although I can understand your concerns based on your description ( and previous posting),  I would suggest that you allow yourself several months to heal and then evaluate the end results of the procedure performed. At this point, there is not much that could or should be done surgically. Continue to follow-up with your plastic surgeon who knows your situation best.  Try to occupy your mind with other activities to avoid excessive anxiety/worry.

 Best wishes.

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.