Breast Implants and Scoliosis? (photo)

Question

I just recently had my breasts done. I was a 32 A, got 350 cc, under the muscle, and the incision was from under the breasts ( don't know what that's called). I have scoliosis, and my nipples along with my breasts ended up being lopsided. They were lopsided before, but its very noticeable now. I am 18 days post op now. Will my breasts go back to normal?

Gerald Minniti, MD, FACS · Answer

Hello,

	Your scoliosis has little to do with your current appearance, and it is your original breast/nipple asymmetry that is causing this problem.  Your surgeon was careful to place the implants at an 'even level', however, your breasts were not at an even level.  So, one breast implant has filled out the lower pole of your breast much more than the other implant did to it's respective breast. This actually makes the lopsided appearance of your nipples worse. 

	You should rest, heal and be content for now.  You will need to have an adjustment of your implant at a later date, when your internal tissue has solidified (the capsule), and your skin has softened and relaxed, at least 6 months.  The outcome of a revision surgery will result in you implants sitting at different levels to accommodate each breast properly.  This will be less obvious than your current situation.

	Best of luck!

Stephen Bresnick, MD · Answer

Patients undergoing breast augmentation who start out with uneven nipple positions often find that the nipple position asymmetry is not corrected with breast augmentation alone.  If one nipple is lower than ideal, it can be raised.  Yet if one nipple is higher than normal, breast implants may further elevate the higher side, magnifying the initial difference.

	There are several ways that this can be revised in the future if desired. An implant can be elevated, bringing the higher nipple down.   The lower nipple can be elevated, bringing the lower nipple in better line with the opposite side.  Other options also exist.

	For now, enjoy the very nice volume enhancement, even fullness achieved, and attractive cleavage.   After a period of healing, chat with your doctor about potential options for revision.   Best wishes,    Dr. Bresnick

Boris M. Ackerman, MD · Answer

It is very important that the plastic surgeon makes a note before the surgery the existing asymmetry of the breasts. This includes the skeletal issues of the rib cage, breast position asymmetry as well as nipple asymmetry. Only then the appropriate corrective steps can be taken. It appears that in your case preoperative asymmetry became more pronounced. After at least a 6 month wait, revisional surgery might be indicated. This could include adjustment of the pocket, selection of different style implant as well as possible nipple repositioning.

Kenneth A. Marshall, MD, FACS · Answer

Speak with your BCPS about doing a nipple revision procedure to make them more even. This should be a minor procedure...

Peter E. Johnson, MD · Answer

Some forms of breast augmentation are not 'routine' and skilled judgement and trade-offs come into play. Scoliosis can produce significant asymmetry in skin envelope and nipple position, and shift in the chest wall shape. If the nipple was lopsided before and correction not taken into account, the asymmetry and be 'augmented' along with the breast volume. Currently the size is equal though the nipple position is not, and is unlikely to become so. If you are troubled after six to twelve months, revision and reduction of the implant size, adjustment of the pockets, and an lift of the lower nipple can help place things into better balance.

Hilton Becker, MD · Answer

Breast asymmetry is very common in patients with scoliosis.The asymmetry of the spine affects the anterior chest wall as well

	The nipple position can be elevated by lowering the inframammary fold.So if the fold is initially higher on the one side ,the nipple will elevate if the fold is lowered

	The nipple can be lowered by placing a tissue expander at the first procedure in the upper pole of the breast and expanding the upper tissues of the breast .When the volume is reduced ,the nipple will be lowered,then the fold can be adjusted

	Unfortunately this is a prolonged procedure and the breasts will be uneven for about three months

	At this stage it may be best to lower the right nipple and elevate the left nipple with a circum-areolar incision

Vincent P. Marin, MD, FACS · Answer

From your photos, it appears that the volume is relatively equal, but the nipple position asymmetry is obvious. It is difficult to give you more information as this is likely related to the pre-op plan. Some asymmetries are a challenge to fully correct, but if you were asymmetric to start and nothing was done to try and improve this, then it will be more noticeable after an augmentation - everything is magnified.

Wait several more months to see how things settle, and a revision procedure may be possible in the future to help even out your appearance.

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

Wait several more months to see how things settle, and a revision procedure may be possible in the future to help even out your appearance.

Best of luck,

Vincent Marin, MD
	San Diego Plastic Surgeon

Remus Repta, MD · Answer

Hello,

	Thank you for the photo and the question.  Although we do not have a side view of your breasts it appears that the implants are positioned symmetrically.  The asymmetry of the position of your areolas will therefore require an "areolaplasty" which will move the higher areola complex lower and the lower one higher.  Its a challenging situation and it may in fact be that the position of your areolas will still not be perfectly symmetric but it will be much better.  At this time I would wait for full healing to occur.  If and when you decide to get the areolaplasty I would encourage you to see a board certified plastic surgeon that has experience in this area.

	All the best,

	Dr Remus Repta

Roger J. Friedman, MD · Answer

Breast augmentation associated with scoliosis can be very challenging due to rib cage asymmetries. Your volume symmetry looks great. The problem is that nipple asymmetries can be accentuated with breast augmentation.  I would suggest patience for four to six weeks but an asymmetry present preop will still exist post op.

Stuart B. Kincaid, MD, FACS (in memoriam) · Answer

It’s hard to say if they will ever be back to normal as you said. Can you post some before pictures, if you said they were uneven before the surgery there just more noticeable now after implants. Sorry to say if they were uneven before they are going to stay uneven now.

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