Breast Pocket Overdissection?

I had a transaxillary, subfascial, 400cc silicone breast augmentation in April. The left one was lower and larger immediately after surgery. My PS had me return the next day, at which time he instructed me to wear tape underneath it for support. I wore the tape for a month. Regardless, the left breast is still lower and appears larger. My PS never discussed any natural asymmetry or size differences I may have had prior to surgery. Please help. What is the problem and how can it be corrected?

Doctor Answers 9

Breast Pocket Overdissection?

Your title of over dissection is not what your so kindly posted series of photos shows. The issue is one of the preoperative appearance and desires not matching the post operative ones. You were asymmetric and N/A uneven before the operation. Either your chosen surgeon missed this issue or you did not fully understand the operation. In the post op photos your result is acceptable but could be better. So are you willing to have a revision? that is the real question. I would increase the size of the smaller breast by 25 cc's silicone (so a new cost), do a donut mastopexy to even out your N/A complexes. and maybe lower the infra fold on your right. But you need to consider if you are gaining much more than you already have. 

Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Breast augmentation -getting it right the first time

Your before surgery photos show some minor asymmetry but the after surgery photo shows significant asymmetry with left breast fold lower than the right and the left pocket tighter around the left implant making the breast look larger. I assume that the same size implants were used on each side.

If the before surgery asymmetry was greater than it appears the left fold may have been lower to start with and this is the only result you can get through the armpit because you cannot change the level of the fold through an armpit inicision. If the folds were at the same level before surgery it is likely that the dissection to create the implant pocket disrupted the fold. This could happen in some percentage of all breast implants placed through the armpit.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Post-Op asymmetry

No woman's breasts are identical nor will surgery make them so.  In 70% of women the left is slightly larger as yours was.  The shape of your breasts were also different.  Even using the same size implants I would expect your  right breast to be tighter, rounder and higher as you have noted it is.  It is 4-6 months before the swell ling is gone and the breasts have settled.  You have a few months to go and things could improve, but if they don't you should think hard about trying to fix such a small difference.  Your "asymmetry" is within normal limits.  A larger implant on the right will increase the asymmetry (as will a smaller one on the right).  Lowering the right fold will make the nipple higher on the curve of the breast.  Breast pocket revisions are more difficult through a transaxillary approach which is one of the reasons I don't use them.

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.3 out of 5 stars 28 reviews

Breast implant position

I think you are correct.  Your left breast implant does sit a little lower than your right, and the inframammary crease height is visibly lower on the left. 

This is a pocket dissection issue.  It won't change over time.

It must be said that your result is otherwise beautiful, and that the height difference does not negatively impact on your breast aesthetics.  The question is whether you can be happy with your result. If you can, then there is no need for anything to be done and you have beautiful breasts. 

If you feel that you are not prepared to live with the height difference, the only solution is a small revisional procedure.  Either the right breast pocket can be slightly lowered, OR the left breast pocket can be elevated by plicating the capsule on the lower left side.

A small inframammary incision at the bottom of the breast would be required on the side you feel needs to be changed, around 4cm long.

Good luck!


Breast asymmetries following breast augmentation surgery

Breast asymmetry is the rule for most women and you are no exception with your left breast being slightly larger and lower than the right. Though the pre-op photo doesn't delineate it, your right lower breast crease may actually be higher than the left though this is (conjecture). The postoperative photos reflect this pre-operative asymmetry in size and possibly in position in that here the left breast sits lower versus the right.

The size difference is not "abnormal" though it can be addressed by either using a larger implant on the right or going slightly smaller on the left. The former choice would probably be the better one. If a smaller implant was used on the left side, the top part of that breast which would be adversely affected by the smaller size.

With regard to implant height and crease position, this can be adjusted. You may be best served lowering the right breast fold and going with the larger implant here (if size symmetry is also desired).

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 30 reviews

Pocket over dissection

Looking at the pre-op photos show the left breast is a little larger then the left. The nipples are asymmetric , the right nipple is slightly lower and points more to the left as compared to the right breast. The left breast with the implant is slightly larger then the right breast with the implant. The pre-op asymmetries are there from the photos post op. An option to discuss with your surgeon is to place a smaller implant on the left side to adjust for the pre-op volume difference. All in all , it is a nice result with only a small adjustment  needed. Good Luck.

Paul Albear, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 17 reviews

What happens if the breasts appear different after augmentation surgery?

Braest asymmetry is very common before surgery. On close examination of the preop breasts it apppears that the left breast is a bit larger. The postop breasts definitely shows that the left breast is larger and possibly slightly lower. The left breast implant may need to be changed to a smaller one. I don't believe that the pocket dissection is the cause of this difference. If the size continues to be larger, and is therefore not due to swelling, then a replacement may be necessary. You should be folllowed by your PS. Good luck!

George Lefkovits, MD
New York Plastic Surgeon
3.8 out of 5 stars 47 reviews

Breast augmentation asymmetry: Pocket, implant, or other causes


Some degree of preoperative breast aymmetry is normal.  From your photos you appear to be fairly symmetric before surgery.  Although a few different views of your postoperative result would be helpful to assess properly it does appear that your left breast is larger than your right after surgery.  This would not be caused by a pocket overdissection alone since comparable sized breasts before surgery augmented with the same implant would yield comparably sized breasts after surgery.  Pocket overdissection would result in a similarly sized breast in a slightly different position.  In your case you would notice more lower pole breast volume on your left breast but at the same time less upper pole volume on the same left breast since the implant would be located lower on the chest.

I would double check the implants sizes used.  Barring postoperative seroma or hematoma, use of the same size implant on both breasts should yield very comparable sized breasts postoperatively since your preoperative photo shows relatively good symmetry.

I hope this helps.

All the best,

Dr.  Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 166 reviews

Breast asymmetry after surgery

No two breasts are identical.  They differ in size, position, direction, nipple.  Your pre-surgery pictures show a relatively good symmetry between the two sides however without a proper examination or additional pictures it is difficult to tell how symmetrical they are.  Your postop pictures do show that the left appears larger and slightly lower.  The position asymmetry is small and could simply be the way your natural breasts sit.  The volume asymmetry is little more difficult to explain without a proper examination.  It could be due to natural different in breast volumes, slightly different positioning of your implants, or perhaps different implants were used?
You should talk to your plastic surgeon, and if necessary, get a second opinion from another board certified plastic surgeon.
Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 469 reviews

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.