Breast Very Uneven After Augmentation

Question

I have had Mentor silicone gels placed, submuscularly exactly 4 weeks ago. I am 4'11" and 97 lbs.,very petite frame. My PS recommended a small silicone implant, so I had 250cc implant placed on both sides. I am right-handed, and my right breast was always a little smaller than left breast. At 4 weeks post-op, I am very worried because my left breast is fuller, slightly more swelling; my right breast is a little higher and firmer, but smaller. Will my breasts even out in time?

James F. Boynton, MD, FACS · Answer

It is important to recognize that there are slight size and shape asymmetries between each women's breast before having breast augmentation, and there will always be slight differences afterwards as well.  With that being said, at 4 weeks after breast augmentation what you describe is a very normal scenario.  One muscle may be thicker and more developed (usually the right side if you are right-handed) and usually one implant "falls" into place sooner than the other side.  I recommend to my patients to increase the frequency and duration of the implant massages on the tight side and to be patient. Sometimes it can takes 6 to 8 weeks for the implants to completely settle into place.  I don't make any decisions until 3 months.  If at three months there is a malposition of the implant or capsular contraction, then I consider revision; however, this is rarely necessary so in all likelihood it wont be in your case either. Be patient and do your massages! 
	
	Sincerely,

	James F. Boynton, M.D., F.A.C.S.

Stephen T. Greenberg, MD, FACS · Answer

I always discuss in great detail, a patients pre op asymmetry prior to preforming a breast augmentation. If a patient is not symmetric before implants, chances are they will not be symmetric after implants. There are options to use two different implants to accommodate for asymmetry depending on the patient. That being said, what you are experiencing sounds typical. It does take up to 6 months for the implants to fully settle, change shape and for swelling to go away. You are right handed, this makes that right pectoral muscle stronger and make take that right side a little longer to settle into the pocket. I have my patients massage their implants daily to help soften them and help them fall into place. Certain types of implants do not require massaging, so make sure to check with you Physician first. Good luck !

Larry S. Nichter, MD, MS, FACS · Answer

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

Otto Joseph Placik, MD · Answer

It takes a few months in some cases for the swelling to go down all of the way. If you started with uneven breasts and the same size implants were placed without reducing the size of the bigger breast, you can expect the breasts to be asymmetrical after the swelling is gone. Asymmetrical breasts are very common as 2 sides of the body are not identical.

Scott Tucker, MD · Answer

After a submuscular breast augmentation it usually takes about 3 months for the muscle to accomodate having the implant in place. As hard as it is try and be patient before making any decisions about further surgery. Things usually will equalize with time.

Good Luck,

Dr T

Good Luck,

Dr T

Amy T. Bandy, DO, FACS · Answer

If you had volume asymmetry before surgery, and the same size implants were used, you will still have volume asymmetry- this will not change over time. The issues about firmness difference and upper pole fullness difference may resolve over time, but there may be things that you can do to assist in this, such as a breast strap but without pictures, it it difficult to say. You really should discuss this with your operating surgeon and get his/her advise. Good luck!

Tom J. Pousti, MD · Answer

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.

Babak Dadvand, MD · Answer

You are still in the early phase of healing. You stated that your breasts were asymmetric preoperatively. If the same size implants were placed then expect to be asymmetric after surgery. In someways the asymmetry is more evident because 1) the breasts are larger and 2) women look at their breasts more after augmentation and notice differences they may not have before surgery.

	hat being said, two things you mentioned I feel need to be looked at more carefully. 1) Your right breast is firmer and 2) Your right breast is higher. Now this could still be a part of normal healing, but could also be the early signs of capsular contracture. I recommend you see your plastic surgeon so you can be examined.

	Hope that helps and good luck!

	Dr. Babak Dadvand

Aaron Stone, MD · Answer

It is way to soon to assess the results of your surgery. If there was right left asymmetry before surgery and the exact same surgery was performed on the 2 sides there is no way the result could be symmetric. These issues should be discussed with your surgeon before surgery not after surgery with surgeons who have never seen you or a photo of you and have never examined you. This is not a logical approach.

	Furthermore if you are petite the main issue is breast implant base diameter rather than actual implant volume. You can have the same volume with different base diameters and front to back projections. You need to first pick an implant whose base diameter will fit and then decide on the available implant volumes with those specifications. Again this should be done before surgery not afterward. If you place too large a breast implant base diameter for the patient's rib cage frame the breast contour can be squared off instead of a smooth curve, the risk of inframammary crease disruption increases, the risk of symmastia (unibreast) increases etc.

Peter A. Aldea, MD · Answer

Regarding: "Breast Very Uneven After Augmentation
	I have had Mentor silicone gels placed, submuscularly exactly 4 weeks ago. I am 4'11" and 97 lbs.,very petite frame. My PS recommended a small silicone implant, so I had 250cc implant placed on both sides. I am right-handed, and my right breast was always a little smaller than left breast. At 4 weeks post-op, I am very worried because my left breast is fuller, slightly more swelling; my right breast is a little higher and firmer, but smaller. Will my breasts even out in time?"

	Breast and facial asymmetry is the rule NOT the exception. It is a true exception for a woman to have exactly the same sized breasts on the mirror image location on her chest. More often than not the breasts are different and the degree of asymmetry varies from subtle to extreme. As Plastic surgeons we may be able to decrease the asymmetry but not always completely correct it.

	In your case, silicone gel implants were probably used because they are more natural feeling, lighter and ripple less than saline implants. Since all breast implants ripple and therefore require adequate cover by your soft tissue coverage using saline breast implants in flat women who do not have enough breast tissue coverages results in artificial looking breasts with ripples. Hence the use of silicone gel implants. BUT - silicone implants come prefilled and as a result when the SAME volume implants are placed into different sized breasts the asymmetry is NOT corrected, if anything, it becomes more obvious as the breasts move farther from the chest. It would be illogical of you to expect breast symmetry if you started with breast asymmetry and had the same volume implants placed.

	But - at barely a month after surgery it is not a time to start worrying about the size of your breasts. I think massaging is in order and you should follow with your surgeon as to what he would recommend. In a few months the result will be significantly better but unlikely to be perfectly symmetrical.

	Dr. Perter Aldea

Breast Very Uneven After Augmentation

Answers (18)

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