Fixing Uneven Breasts After Breast Augmentation?

3 wks po...335 cc shaped cohesive gel under the muscle. My left breast is much smaller and not as full as the right, plus they are not as big as what i thought they would be even after trying on sizers.

I am very upset with my results. i would like to know if i had gone with a round implant as well as larger if it would have made any difference? i am having huge regrets :( and am seriously considering an implant exchange asap. Any advice on possible fix ups would be truly appreciated.

Doctor Answers 25

All patients have some degree of asymmetry

I agree with the other physician, I would not panic at 3 weeks and start thinking about revisions.

ALL PATIENTS have pre-existing asymmetries of their breasts and it is important to point them out in detail because many of the asymmetries CANNOT be fixed by breast augmentation alone. For example, the nipple position is slightly different (as it is in most patients) and that was undoubtedly there prior to breast augmentation.

I do not put that much stock in breast sizers...They always slightly "overestimate" the size that a patient can expect. I see this more of a problem with silicone gel than saline implants and typically have to go "plus 1" size from the sizers for patients to be happy. I also believe in using a sterile breast sizer at the time of surgery because there really is not better and more accurate place to determine the best implant size for that patient's tissues than at surgery.

I personally do not favor shaped, "teardrop", or anatomic implants but that does not mean that some surgeons get excellent results with them.

It doesn't appear that the left breast is much smaller and it takes a complete 3 months for implants to settle downward even with doing implant displacement exercises...the only thing in your case is that the textured anatomic implants won't settle as much as a smooth round implant because it "locks into" the capsule, but at 3 weeks the capsule is still not completely formed so it is still worth being aggressive with implant displacement exercises.

Even if you needed an "exchange of implants" which I would consider at 3 months if you were still unhappy with either size or position of the implants, the exchange is even a faster recovery for the patients as your tissues are already "stretched" and switching out implants even if you decided on a slightly bigger smooth round silicone gel implant wound not be difficult and you would do fine with that.

Realize that no women's breasts are perfect mirror images of each other and no breast augmentation can give you that. Wait and see where you are at 3 months and then talk with your surgeon about your options.

I hope this helps!

Houston Plastic Surgeon
4.8 out of 5 stars 41 reviews

Fixing Uneven Breasts After Breast Augmentation?

Thank you for the question. The breast asymmetry that you are referring is commonly experienced, early in the postoperative period, after breast augmentation surgery. Often, breast implants “settle” at different rates. Of course, online consultants will not be able to  reassure you adequately;  your plastic surgeon, after in person examination will be your best resource for advice and/or reassurance.   Ultimately, I think that only time will tell whether the breast symmetry will improve over the course of the first several months after the procedure was performed.

 Of course, generally speaking, patient should be aware that absolute symmetry of the breasts is rarely present before or after surgery;  hopefully, the degree of breast asymmetry that you experience in the long-term will  not be bothersome.  My patients have to tolerate me saying:  “sisters, not twins” or "breasts are like snowflakes, each one pretty, but different” during each visit.

For precise answers to questions regarding returning to exercise, you may wish to request an earlier than  already scheduled follow-up with your plastic surgeon.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,465 reviews

Breast asymmetry

I can notice that you have inherent breast asymmetry as well as breast sagging. it also seems that your left breast implant might be a bit higher than the right one. changing to a round breast implant will give you a better cleavage. bigger impalnts will also make them look better. You need discuss things in detail with your surgeon and have patience.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 49 reviews

Few things

First of all, if they are shaped cohesive gel implants, then they will not drop any further. Shaped implants are textured and stay where they are placed. You seem to potentially have had asymmetric breasts to start with and I wonder if your doctor had pointed that out to you beforehand? Either way, I do not think that more time will lead to significant enough changes that will make you more pleased with your results, and I do agree that you will need a revision at some point. I recommend waiting at least 3 months prior to reoperating to give the tissues a chance to fully heal before you re-traumatize them with more surgery. I do think that you will have a better, more natural results utilizing smooth, round implants, but you will most likely also require a breast lift to provide you with that result as well. This means more scars on the breast. You have a to think about and to discuss with whichever plastic surgeon you wind up seeing. Good luck!

Brian S. Glatt, MD, FACS
Morristown Plastic Surgeon
5.0 out of 5 stars 47 reviews

You will need a revision, but wait several months.

Hi. There are several problems:

1) Your two breasts are different with more sagging and less volume in the left breast. You may need a breast lift on the left.

2) The implant pockets are too high. Unfortunately, they are not going to "drop".

3) The implant pockets are too far apart.

4) I would not get bigger implants, at least not on the right.

You can definitely be made a lot better with a sophisticated revision. You need a detailed plan. In Manhattan, we would wait several months, because your breasts will change.

I recommend placing the patient in the sitting position (of course, you are still asleep) before the end of surgery, because then the surgeon can actually see if you have great shape and symmetry. If not, we keep working. This step takes all the guess work out.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

You needed a lift

Unless your plastic surgeon discussed your needing a lift to get the best result, they have not served you well. Clearly, you are asymmetric and your left breast is droopier than the right. That is why you think the left is smaller, because the breast is falling off the bottom end of the implant, not because the implants are different sizes.

Many plastic surgeons are afraid to tell their patients that they need a lift because of the scars and that telling you something you don't want to hear will lose you to another doctor. I would rather be sure you know what your starting point will give you and won't give you without a lift. Your areolas are large and your skin is loose. You were destined to have the result you have without a lift.

I am also not a fan of the look of the implants you have because they are too buldgy and high on your chest. These were chosen to fill up your loose skin envelope but didn't do the trick so well. I would rather you have a more natural looking implant and the lift you needed all along. So don't try to correct what you have with an implant exchange - it won't work!

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Many different options for breast implant revision

Clearly there are many issues here which need to be addressed:

1) Volume discrepancy: Right larger

2) Nipple dystopia: Left lower

3) Ptotic glandular tissue: Pseudoptosis with involutional atrophy

4) Enlarged Areolae: Probably larger than average 4.2cm

5) Mild constriction: Left sided narrow base diameter

Each of these issues needs to be addressed. To some degree in quick summary, you may benefit from biplanar approach radial relaxing incisions, mastopexy. All of these interventions may not be required but would likely result in significantly more scarring associated with more risks and costs; these procedures may need to be staged (more than one operation to avoid possible compromise of the blood supply to the nipple). However, plastic surgery is an art and open to interpretation. It is no doubt that you will get differing opinions from different surgeons and that is to be expected.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 79 reviews

Too early to say

Thank you for your question.  Temporary asymmetry is quite common after breast augmentation.  For one thing, most patients have asymmetry before surgery but just never notice it, and maybe their plastic surgeon never noticed it.  If you look back at your before pictures you may notice it now.  So with a breast augmentation, your breasts will be fuller and larger but they are still going to have some of that inherent breast asymmetry.  A breast augmentation can not change the nipple position, the width of the breast, the level of the crease etc.  This requires more advanced techniques like a mastopexy or revision which often requires more scars on the breast.  So your breasts will be sisters, not twins afterwards.  That being said, sometimes we will place two different size implants if the discrepancy is substantial enough to at least try to correct some of the difference between the two breasts...but again this is not going to make them twins.  In addition, implants tend to settle and sit in the pocket differently.  So one breast might seem lower and smaller, or lower and larger depending on the rate of settling.  I typically recommend patients wait a full 3 months before we critically assess the results and begin having any discussions about a revision surgery.  

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"The above answer has been given without seeing this patient and cannot be substituted for actual in-person examination and medical advice; it is only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Brian Arslanian, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 25 reviews

Fixing Uneven Breasts After Breast Augmentation

It is still quite early into your healing and it's not uncommon for #asymmetry as each breast heal quite differently. One breast may swell more, feel more uncomfortable, or have a different initial shape. After complete #healing, they will be more similar and natural. 

#Healing will continue for 2-3 months following your #Augmentation #Mastopexy procedure. There may be some swelling, bruising, malposition, color differences. Sensation will be abnormal. Scars will also be changing.
But, it can be up to one year see your final result. Your doctor may require you to move or massage the implants within the breast pockets during the #postoperative period. #Textured implants do not require breast massage. You will be informed about this at your post-operative visit. 
You must have patience, but if there are any causes of concern, ask questions of the doctor or the nursing staff.  

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 106 reviews

Uneven Breast Size

It is quite common for the two breasts to heal differently. One may swell more, one may feel more uncomfortable, or the shapes may differ initially. After complete healing, they should look more similar and natural. Patience is required, but if you are concerned, ask questions to your doctor or the nursing staff.

#breastrevision #breastimplants

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 150 reviews

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