Am I Bottoming out and in Need of Revision Surgery? (photo)

I am 4 months post BA -dual plane silicone 371cc-left /397cc-right. I had a hematoma in the right breast that was corrected a day after surgery. I think the pocket might've been over dissected and it appears that I'm bottoming out. The right breast (shown on left) is much lower than the left and looks distorted. Finding bras and swimsuits that fit is very difficult. My PS tells me they look great and not to worry, but I feel self so conscious and dissappointed. Any advice would be appreceiated!

Doctor Answers 10

Wait it out.

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I agree with the other plastic surgeons and that you should wait for several months before planning a revision surgery.  You do have a "double bubble" and that the right breast implant has dropped below the inframammary fold.  Although sometimes this can be fixed by recreating the pocket superiorly, sometime alloplastic material is necessary in order to strengthen the inframammary fold to minimize chances of recurrence.

Double Bubble After Breast Augmentation

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Thank you for sharing your photos and I am sorry that you are disappointed with your results.

As your photos indicate, you do have drooping at your left breast and an implant displacement (Double-Bubble) at your right breast; the hematoma correction may have played a role creating the double-bubble issue.


For now, you will need to be patient. I believe that you could benefit from revision surgery but not until you reach a full recovery; the corrective procedure is of a delicate nature so you have to choose your surgeon carefully.


Thank you for your inquiry and the best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Breast Revision Surgery

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Hello and thanks for the question.


In review of your photos, it appears that you may be developing a double-bubble deformity on the right.  The right infra-mammary fold appears lower than the left as well. On the contra-lateral side, the left breast is demonstrating elements of ptosis.  In any event, you are early in the healing process and the breasts will continue to change in shape considerably over time. Hence, I would give your breasts ample time to heal - at least 6 to 8 months - prior to considering any surgical intervention, if necessary.  In the interim, continue following up with your plastic surgeon so that he may follow the progression of your healing.  


Kindest Regards,


Glenn Vallecillos, M.D., F.A.C.S. 

Glenn Vallecillos, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 30 reviews

Breast asymmetry

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It looks like you have a double bubble on one and ptosis of the other, but better photos and an in person evaluation would be most helpful.  Good luck!

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

Breast augmentation question

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Lots of good advice so far so I will keep it short and say that you will probably have revision surgery. Waiting a few more months is a good idea. We do not have pictures of you before surgery which are always a help in these situations. If you have faith in your doctor listen and if not please see a board certified plastic surgeon for a second opinion.

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 62 reviews

Need revision breast surgery (photo)?

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Your imperfect results are due to the configuration and asymmetries of your native breasts, the limited implant choices available (your surgeon had to fit your breasts to available implants, rather than select implants that would have been perfect for you), and perhaps your surgeon avoided mastopexy scars in exchange for residual asymmetry.  

Your inframammary creases and nipple areola complexes are asymmetric, and one breast has a visible implant-tissue interface.  Your breast augmentation was a challenging case to begin with, and secondary procedures are often necessary to achieve satisfactory results. 

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

?Bottoming out and revision surgery

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The photos you have taken do show a double bubble appearance on the right and ptosis on the left. A before pics would have been helpful. Either way, you will need to wait for several more months for the implants to settle and the final shape is determined. Then one can decide on the next step. I think you will need a revisionary surgery.

Moneer Jaibaji, MD
San Diego Plastic Surgeon

Bottoming out (fold displacement) correction

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You are correct that your right fold is lower than the left and due to either over dissection , weak tissues or the hematoma that you had. This will not get better on its own and you will need correction with capsule repair or new pocket creation. Depending upon the tissue quality I might use strattice for support. I would not wait too much longer to do this repair.

Jason Pozner, MD
Boca Raton Plastic Surgeon
4.7 out of 5 stars 46 reviews

Breast Asymmetry after Breast Augmentation?

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Thank you for the question and pictures.

The breast asymmetry and the difference in breast implant pockets that you describe are visible in the pictures. It is very possible that revisionary surgery princes (capsulorrhaphy) may be beneficial in the future. Given that you are only 4 months out of your surgery, I would suggest waiting closer to one year postoperatively to evaluate the situation. I think that when internal sutures are used to “repair” a breast implant pocket it is best to have strong/mature breast implant capsule to work with.

In the meantime, continue to follow-up with your plastic surgeon.

Best wishes.

??Bottoming out, asymmetry after breast enlargement

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I see four things contributing to the asymmetry of your breasts. 

1) right nipple and areola are higher.

2) right inframammary fold is lower (the fold under the breast)

3) indentation on the central lower portion of the right breast which is presumably the lower edge of the pectoralis muscle.(double bubble)

4) scar indentation on the right areolar incision.


Without seeing before photos, I wouldn't be able to know if the areolar position and the folds were different before. Apparently there was asymmetry, enough to require use of different sized implants. 

It seems hard to imagine that items 3 and 4 were present before surgery. 

I would suggest you ask your surgeon to review the pre- and post-op photos with you, and explain your issues. Getting another opinion would be appropriate if you don't agree with your surgeon's opinion or advice. 

Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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