9 months post op and left breast still sits higher than the right. Should I consider a revision? (photos)

Thank you for the question. If you're 9 months Postop and concerned about the result, I would recommend you first return to see your surgeon again, and if unsatisfied after that visit seek a second opinion. There are multiple reasons why your implant could be sitting higher on your left. This could be due to your anatomy, implant pocket, or you could have an early capsular contracture, or a combination of these possibilities. It's hard to say definitively from the photo but it appears your left inframammary fold, and therefore breast, sits a bit higher on the chest wall. If that is the case, so will the implant if the inframammary fold is not slightly lowered.

You have formed a capsule that is not letting it drop. Large implants do have a harder time in dropping. You could try oral Accolate and external ultrasound treatments to soften the pocket and see if your implant will drop. Otherwise, you will need surgery.

Your implants are on the large side, and the diameter of the implant is larger than the natural diameter of your breast. In order for the implant to sit centered under your nipple, areola complex, the pocket needs to be opened further. Having a high riding implant happens and can easily be corrected with revision surgery. In my opinion, it’s far better to end up with a high riding in plant and implants the bottom out(the opposite problem). Correcting high riding implants is simple and straightforward. Correcting a bottom down implant is complex and difficult. When implants that are substantially larger than the natural breast diameter are used, there is an increase the likelihood of postoperative issues.
To make a good assessment, we need to see proper before, and after pictures understand how the implant was placed(subglandular, or subpectoral) as well as the size and shape of the implant.
On your first picture, your left breast looks like it has a high riding implant, but the second picture shows more issues with baseline asymmetry.
Breast asymmetry can be accentuated with augmentation, and when that’s the case, more aggressive augmentation can over emphasize the asymmetry. Most people have a left breast that sits higher than the right breast. This is the case with you as well.
Seeing preoperative pictures would be helpful in making accurate assessment.
If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took.
I’m not sure revision surgery is indicated in your case. Having a complete set of information is needed to make him more accurate assessment. Consider having a few in person second opinion consultations if you’re not happy with the assessment of your current provider.
Best,
Mats Hagstrom, MD