5 Weeks Post-op Breast Augmentation - Breasts Look Different (Bottomed Out, Asymmetrical)

hi all, i had my ba surgery 5weeks ago ( 325 silicone under muscle), and not happy with results. i had a nipple assymetry before the surgery,so would not expect them to be perfect, but now they look COMPLETELY different, the left one seems to be botommed out, and is deformed every time i use the muscle, right one is ok, just different. also, they still hurt when touching, especially nipples (nipple incisicion). isthat all normal and i should just wait, or i need to consider revision?

Doctor Answers 12

Bottoming out can be corrected with subfascial placement

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The problem is indeed that your left implant has dropped to low.  This is a progressive deformity resulting from the combination of two factors :  submuscular(or dual plane) placement and violation of the tight attachments at your native inframammary fold.  Placing breast implants under the muscle creates a few aesthetic problems. If you look at your picture, your breasts are too far apart at midline to have a natural appearance.  any time your arm moves this appearance will widen and worsen.  This is the reult of releasing the inferior portion of the pectoralis major muscle.  The more superior origins will not allow the implant to sit in a natural place and the continual forces of the muscle constantly push the implant down and out.  When this is combined with excessive undermining of the inframammary fold, the deformity that you are seeing results and continues to progress.  This is a very common finding with submuscular placement.  To understand these forces better, stand in front of a mirror topless, put your hands on your hips and push down onto your hip bones firmly.  You will see both breasts move down and out.  these forces over time always cause lowering, lateral displacement, thinning of the breast tissue and stretching of the skin.  This is the reason that I use a unique technique in my practice called 'cold-subfascial augmentation.' This technique leaves the muscle alone and out of the equation but should not be confused with 'above the muscle' which I would also not recommend.  The cold-subfascial augmentation harnesses the strong structural power of the pectoral fascia to create a truly natural breast shape and act as a living structurally sound brassiere inside the breast protecting the breast from the pressure of the implant and forces of gravity.

I have seen many patients with identical problems to the one you present and in my opinion there is only one good solution- changing placement to a new cold-subfascial plane.  All of the native inferior support of your breast is now violated and conventional techniques like capsulorrhaphy and neosubpectoral placement rely on structurally unsound scar that will surely stretch and recur.  There are several mesh and biological products people use to restore support but these in my opinion do not offer lasting support or add new risks or unnatural feeling/appearance.  In my experience, revising breasts such as yours with a subfascial plane can create a more beautiful and lasting augmentation then your original before the problems started.  I hope this helps! 

All the best,

Rian Maercks M.D.

Post-op breast augmentation

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You pointed it out in your query that you had asymmetry.  Asymmetry is normal and the folds I am sure where different to begin with, and the may be different post-op as well.  As for the discomfort, it probably is normal but if you have concerns contact your surgeon.

5 weeks post op

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Thank you for the question. You are still in the post operation recovery stage. From your photo, you do have asymmetry in your nipple position and the left breast is slightly lower than the right.   It usually takes about 8-12 weeks for the wounds to heal and around 4-6 months for the implants to fully settle. It would be best to visit your board-certified plastic surgeon and get a full assessment. 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.

Apparent Asymmetry, corrective surgery in 3-6 mos.

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It appears that you have significant post-operative asymmetry following your breast augmentation. This asymmetry is hard to evaluate without pre-operative pictures and a physical examination, but was probably present prior to your surgical procedure. Your post-operative pictures suggest significant asymmetry of your nipple areola complexes and infra-mammary folds which was probably present prior to surgery.
Breast asymmetry represents one of the more challenging situations encountered by plastic surgeons. This is especially true when asymmetry involves the nipple areola complexes. Under these circumstances, it’s virtually impossible to have symmetry without re-positioning one of the nipple areola complexes. Unfortunately, this requires a breast lift procedure with its associated scarring.
In this situation, breast augmentation performed without correction of nipple areola malposition has inevitable consequences. When the implants are centered beneath the nipple areolas, the infra-mammary folds are asymmetric. When the infra-mammary folds are symmetric, one of the nipple areolas will be off center.
In your case, it appears that your left infra-mammary fold was lowered to create symmetry between the two folds. Unfortunately, your left nipple areola now sits high relative to the breast mound.
Although some adjustments can be made to improve symmetry, these should not be undertaken for at least 3 to 6 months. It’s important to thoroughly discuss your surgical options with your surgeon. It’s also important to be realistic and realize that some compromises may be necessary. In some situations, perfect symmetry isn’t always possible.

Pre Operative Measurements Needed

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You certainly are asymmetric, but without seeing your pre operative photo or your measurements it is hard to tell exactly what is going on.  It does appear that you have quite a bit of asymmetry before the surgery, this should have been pointed out to you before the procedure, because that asymmetry is going to still exist post imperatively and may even be magnified by the implants.

You need to be patient and wait at least 3-6 months for the final results.  The incisional pain around nipples is common and should subside.  Try using a Lidocaine (numbing) cream on the incisions for temporary relief. 

You mentioned that the left implant is deformed on movement and sits too low on your chest wall.  I suspect the surgeon placed the implant lower to match the crease on the right side and probably placed the implant partially under the pectoralis muscle and partially on top of the muscle.  So, now when you flex the muscle the implant is half "squeezed" and half not "squeezed" which makes it look funny.  That should also improve with time, if it doesn't you may need to have the implant repositioned.

Good Luck,

David R Finkle, MD

Unequal breast after an augmentation

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It appears that was done was to place the implants evenly so the fullness in a bra would be even as you will be seen in a bra more often than without. In so doing, as you started out with asymmetry of the nipples and the left nipple was higher, that necessitated there to be more implant below the left nipple than the right, giving the optical illusion of a bottoming out, but it has not bottomed out. If a smaller implant had been used in order to achieve a symmetrical amount of breast tissue above and below the left nipple, then the right breast might have needed a lift along with a smaller implant to achieve symmetry. When one starts uneven, the limitations of the end result are greater than when they start more even. .

Breast Assymetry Postop

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It seems that you still have quite amount of assymetry.   It is difficult to predict how much has changed without preoperative photos.    I would recommend that you let everything settle for 6 months and then consider a 2nd revision procedure to further improve the symmetry.

Paul S. Gill, MD
Houston Plastic Surgeon

Give it more time then re-evaluate

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Given the short time since your procedure, I would counsel some patience before doing another procedure. That said, since you did have asymmetry before the procedure, your result after surgery would be asymmetrical in all likelihood. I would wait at least a few months and then go back and have your surgeon address the concerns you have. A nipple incision makes it more difficult to define the fold.

Victor Au, MD (retired)
Chapel Hill Plastic Surgeon

Assymtric results after breast augmentation

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This is actually a rather challenging case.  Given the fact that you had asymmetry before your surgery, chances were high that you would have asymmetry after your surgery if adjunctive procedures were not performed. These include a possible mini-lift (on one or both sides) to adjust nipple position, use of differently size implants ( to address a difference in size, and adjustment of fold position. 

My recommendation is that you speak with the Plastic Surgeon who actually performed your surgery.  A good surgeon will most likely want to make sure that you have great results since a majority of our referrals come from happy patients! 

Breast asymmetry can be magnified with breast augmentation

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Hi victoria,

From your photo (which is taken from an angle looking up, so not the best view), it appears as though the left implant sits lower than the right. I will assume that pre-operatively, the left nipple was higher than the right. The combination of those two factors makes the overall asymmetry more noticeable.

You are still early from your surgery, so things may con tine to settle (ie the right implant drops to the same level), and your symmetry would improve. The discomfort at the nipple sound like hypersensitivity, which usually subsides with time.

Bottom line: it is too early to talk about revision. Wait 6 months. if your implants have not settled to your liking, discuss the issue with your surgeon; if a revision is appropriate, that would likely be the right time to make the judgment. The type of revision cannot be predicted at this time (if needed at all), but lowering a higher implant is always easier than raising a lower implant.  Good luck.

Best regards,

Lawrence Tong MD FACS FRCSC

Lawrence Tong, MD
Toronto 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.