Do I need capsulorrhaphy? (photos)

Hello, I had a BA done about 5 months ago I was very small 32 A before my BA with very dense breast tissue. I choose to go with high profile saline implants 275 cc in left 250 in right . I am very unhappy with my results both when laying and standing, I have no cleavage ,my left breast is sitting lower and when I lay down it move almost towards my armpit. Could my surgeon have created to large of a pocket ? Or could I have stretched to the pocket out so early into my surgery ? Do I need a capsulorrhaphy??

Doctor Answers 6

Breast implants - very unhappy with result

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Thank you for asking about your breast implants.

  • I am very sorry you are so disappointed with your surgery.
  • The cleavage depends on the placement of your breasts -
  • So that lack of cleavage is not something your surgeon can create.
  • However I am concerned that your left, larger implant shifts upward into your arm pit.
  • You may need a capsulorrhapy.
  • I suggest you return to your surgeon, review your before/after photos with your surgeon, explain what you want and ask what is possible to do - and above all, be examined to see if the implant pocket needs revision.

Always consult a Board Certified Plastic Surgeon.  Best wishes. Elizabeth Morgan MD PHD FACS

Cleavage depends on your anatomy

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If you look at your pre-op photos, your breasts are NOT close together, if it impossible to safely put implants closer together than your breast "footplate" determines. It appears your implants are in a pocket appropriate based upon your pre-op photos. sounds like something you should have discussed a little more with your surgeon prior to augmentation. Implants will always slide some towards your armpit when lying flat due to gravity, thats also very normal. The patients anatomy dictates where we can put implants, not the other way around. I am sorry this was not made more clear to you prior to your surgery. 

Breast asymmetry and lack of cleavage

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Sorry you are not happy with your recent augmentation.  It appears that you had some asymmetries pre op with the left nipple areola pointing more downward.  It is difficult to assess what is occuring without a physical exam.  It appears that the central lateral portion of the the left breast is lower than the right.  Some lateralization of implants do occur even without over dissection of the pockets by the surgeon.  The use of a small implant (250 and 275cc) as well as the high profile shape (which are much more narrow that moderate + impalnts) limits how much cleavage you can get.

Speak with your Plastic Surgeon.  He wiill examine you and be able to give you options.

Best of luck.

Dr. T

Douglas Taranow, DO, FACOS
New York Plastic Surgeon
4.8 out of 5 stars 65 reviews

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Breast issue

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Your cleavage is dictated  by your anatomy and it looks like the implants are in the pocket and not too lateralized.  Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Do I need capsulorrhaphy?

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 I am sorry to hear about your concerns after breast augmentation surgery.  It is very difficult to give you good advice based on the posted photographs; your plastic surgeon will be in a much better position to do so.

 Generally speaking, although some “falling to these sides” of breast implants is quite normal when patients lie down, if this occurs “excessively”, it may be a concern to patients.  This phenomenon is called lateral displacement of the breast implant;  it may be of concern from the visual and the discomfort standpoints. Surgical correction is an option.

Generally, the lateral breast implant displacement can be corrected using an internal suture technique, decreasing the size of the pockets and moving the implants toward the midline.    In my practice, I use a 2  layered suture technique to close off the space laterally (towards the axilla). The use of acellular dermal matrix is an option ( although not usually necessary)  especially if significant implant rippling/palpability is present.  Also, the use of a larger/wider breast implant may help improve/decrease the space between the breast implants.   

I hope this, and the attached link (dedicated to revisionary breast surgery concerns), helps.  Best wishes.  


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I am sorry to hear of your dissatisfaction with your breast augmentation. From what I can see in the photographs it does appear that the left breast implant has migrated slightly downward and outward compared to the right. While this could be repaired with some cinching up of the lateral capsule, I don't think it's gonna make the cleavage area as prominent as you might like. You might want to discuss with your plastic surgeon going to a slightly larger, more projecting implant at the same time. Best of luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 58 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.