10 mo. post op and breasts are uneven - is this a result of my implants / surgical approach that was used or anatomy? (photos)

Question

I had my BA in Jan 2024. 190cc right/220cc left, teardrop over the muscle. I am happy with the size, it’s just the shape of my left that’s bothering me. I don’t know whether this is the best result possible based on my anatomy or whether a better result could have been expected based on either different implants or surgery. My left breast sits much higher, points outwards and is very visible from the inside edge. Can’t get an appt with my surgeon until Dec and I’m getting more worried.

Daniel Barrett, MD · Answer

Dear Peaceful927540,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gary Lawton, MD, FACS · Answer

The reason you do not like the look is because the implants are on top of the muscle.  That approach is from 1962 and the edges of the implant are more visible, the risk of infection and capsular contracture is higher because the implant is in direct contact with he breast tissue which is not sterile, sub glandular implants affect mammograms.  The lower pole needs to be opened to allow the implant to give you "bottom boob".  Can't get an appointment with your surgeon until December is absurd.

Zoran Potparic, MD · Answer

Unfortunately it is not possible to give an opinion based on these photos. While your before photos were taken from above, your after surgery photos are taken from bellow. A set of photos where camera is at the level of your nipples, front, side and 3/4 views are needed to make a good evaluation. Both before and after photos should be taken in the same way.

Connie Hiers, MD, FACS · Answer

You may have developed a capsule on the left side which might still be treatable with oral Accolate and external ultrasound treatments, or surgery.

Selcuk Aytac, MD · Answer

Hello .Your result is actually good but before operation, from photos, I m seeing that your nipple are a little bit lower. The projection of the nipples seems below the inframammarian fold. Your implants are over the muscle so in time may be if they can move downwards your nipple position may change. But ın these kind of cases my surgical plan is, inserting the implants under the muscle or fascia and for the nipples periareolar mastopexy... but the disadvantage of it is, there ll be a scar around you areola... If you accept the scar periareolar mastopexy can be done....

Pawel Szychta, MD, PhD, DSc · Answer

Hi.Given that your surgery was done in January 2024, you’re still within the early healing stages, but some of the issues you’re describing, like the left breast sitting higher and pointing outward, may point to something that could need further evaluation.It’s possible that your left breast may still be settling or that minor anatomical differences could be influencing the appearance. However, the symptoms you’ve described could also suggest implant rotation, capsular contracture, or improper positioning, all of which may require revision surgery. While waiting for your December appointment, monitoring for any significant changes and considering a second opinion from a revision specialist could help you feel more confident about next steps.Ultimately, a consultation with your surgeon will provide the clearest path forward, and revision surgery may be able to correct the issues and give you the balanced, natural results you're looking for.

Camille Cash, MD · Answer

At ten months post op you are seeing your final results.  From the submitted photos this appears to be a result that is influenced by your natural anatomy.  Though differently sized implants were used, your breast pointed somewhat laterally preoperatively.  Unless this is specifically addressed during surgery, this will remain post op but it may be more obvious since the volume of the breasts is now enhanced.

Mats Hagstrom, MD (license on probation) · Answer

Documentation outcomes are generally based on three variables.
Whenever there are issues with the results, the problem can usually be traced back to one or more of these three variables.
The first variable is patient candidacy.
Your post is quite insightful. You’ve already mentioned all three variables so you’re on the right track in your way of thinking.
Issues that can affect patient candidacy include things like breast shape, breast position on The chest wall, breast, divergence, etc., etc. 
Most people have the left breast sitting higher on the chest wall than the right side.
The position of the breast is determined by the position of the IMF (infra mammary fold).
On the most people, men and women the left IMF typically sits almost half an inch higher on the left side.
Breast divergence has to do with how much the nipple points outwards.Breast divergence is potentially amplified or put on display with the projection of implants.
Small breast that have divergence don’t look that different but once the implant pushes the breast forward, the angle becomes more obvious.
If breast sit wide on the chest wall, then this too will become more obvious with Implants.
Ideally, any variable that significantly affects breast augmentation having to do with patient candidacy should be discussed during the consultation.
In a perfect world, the surgeon would show the patient lots of examples of previous patients who had similar characteristics, so the patient has a clear understanding of what the results are going to look like 
The second variable is implant selection in regards to size shape and type.
Each plastic surgeon will have their own way of guiding patients through the implant selection process.
Some plastic surgeons do this better than others.
Some providers will ask the patient to make the final decision regarding implant size other plastic surgeons will make the decision based on input from the patient.
 my personal preference is to work with before and after pictures of previous patients who had similar body characteristics.
Once I have a good understanding of what the patient is hoping to achieve I bring those pictures with me to the operating room to use as reference.
During surgery, I use temporary Breast implants sizers to determine what implants will give the desired outcome.
I typically have a complete selection of implants available to meet during surgery.
I’m not implying this is better It is simply what seems to work best for me.
When the surgeon asks the patient to make the final selection, then the surgeon is a sense of the Hook if the patient is unhappy with the size of their breast.
In my opinion, the surgeon has more experience and a better position to make the final decision regarding implant Selection.It is also true that many women wish they would’ve gotten bigger six months to a year after surgery.
Implant envy is a real thing.
Plastic surgeons are aware of this and it is why many of us encourage patients to go a little bigger than they feel comfortable with during The consultation.
It’s very important that the surgeon listens to the patient and tries to obtain the best understanding of what they’re trying to achieve.
The third variable is the surgeons ability to put the implant in the correct anatomic location.
There is also the variable of putting the implant above or below the pectoralis muscle.
Both procedures have certain advantages and disadvantages.
In your case, your outcome looks ideal from a technical perspective.
Implant selection was conservative to modest.
Your results can be explained purely based on your candidacy for the procedure.
None of these variables can be changed by the surgeon Carrie
The one variable the surgeon can control is breast droopiness by incorporating breast lift when indicated.
Overall, I think your breast augmentation outcome is as good as anyone should expect.
I suppose the one thing that could’ve been done better was to explain to you more clearly what your results were going to look like.
Understanding your own candidacy for the procedure helps patient, accept the outcome and have a better understanding of potential limitations of the procedure. 
Best,
Mats Hagstrom MD

10 mo. post op and breasts are uneven - is this a result of my implants / surgical approach that was used or anatomy? (photos)

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