Capsular Contracture Requires Capsule Removal And New Implant Plus Strattice Or Alloderm
Thank you for your question. I am sorry to hear that you have a capsule.
Modern treatment of capsular contraction usually involves removal of the capsule and placement a new implant. In addition wrapping the new implant with a dermal substitute like Strattice or Alloderm may reduce the chance of repeat capsular contracture.
Asymmetry and breast augmentation.
As you have mentioned, you had asymmetry prior to augmentation. Augmentation alone of asymmetric breasts usually leads to a more pronounced asymmetry. From the photos (2 and 3), it appears as though your right breast implant and fold is sitting higher than the left. Although the preoperative photo does not appear to show a large discrepancy in fold height, the photo is self-shot and a poor substitute for an exam. Lowering of the fold/implant on the right will rotate the right nipple into a more superior position and may provide improved nipple symmetry.
Options for improvement of implant results
Especially in patients like yourself, who have already had an aesthetic procedure and are not happy, it is critical that any subsequent procedure to improve the outcome be reviewed extensively, planned in extreme detail, and executed as carefully as possible.
Because this is what I believe, I would not feel comfortable making recommendations to you without the benefit of examining you... I think anything I say would be unfair to your surgeon if what they tell you is different- and the fact is that as the only one who has examined you and will be responsible for your happiness, they don't deserve that.
What I can tell you is that you do have very good options, and I do think that a more lovely shape and better symmetry are possible for you.
Breast Augmentation - Uneven Breasts Post-Op
It's very difficult (impossible, actually) to make legitimate suggestions without being able to examine you in person - but here are a few thoughts. You had some asymmetry before, so it's not surprising that you have some after wards. Asymmetry is normal on virtually every body. So the question is, how do you feel about your result? To me, and based on the second photo (which seems to be the most straight on shot), it looks like the left is pretty good, but the right implant is high. If you have a capsule, and you generally agree with that assessment, it may be appropriate to remove the right implant, do a capsulectomy (total or partial) and reinsert the implant, perhaps in a lowered pocket (if appropriate to match the left). I would typically use a drain in a case like this. You should, of course, discuss all of this with your own PS.
I hope that this helps, and good luck,
Asymmetry after breast augmentation
In the third picture things look pretty good. The left nipple is a little higher, as it was pre-operatively. I would recommend a small peri-areolar adjustment to lower the nipple on the left.
If there is a persistent size mismatch then you may need to have a smaller implant replaced on the right side.
Remember: the breast has only two components, skin and volume. You can fix volume asymmetry by changing implant size and skin envelope issues by tailoring the skin.
Another trip to the OR offers a great opportunity to switch to gel implants: they are softer, more natural, and are warranteed for life. the softness will translate to better symmetry when you lie down.
Can my right and left breasts match better ?
The left breast looks better than the right. My choice, judging from your photos, would likely be a carefully planned and meticulously executed periareolar purse string elevation of your right nipple-areola complex, designed to preserve the current areolar shape and diameter, which now match the left side. The areolae themselves are symmetric, only their position is asymmetric. This does not adjust the breast mound asymmetry or the firm texture you undoubtedly have from over-inflated prostheses, but improving those problems cannot be performed in the office under local anesthesia, but areola repositioning can, and may sufficiently improve symmetry that you will be satisfied.
You had very uneven breasts before surgery and would not recommend revision
The role of the breast implants are to give volume and help with the asymmetry, but not to make the breast 100% even. You have very uneven nipple position,breast width and chest wall before surgery and same issues after surgery. Capsule revision,implant exchange or repositioning of the implants will not work.
Breast asymmetry after augmentation
The asymmetric nipple heights were present before your augment and the effect was exacerbated by the new, larger size of the breasts. A capsuloraphy could open the pocket more and result in settling of the left breast such that the nipple-areolar complex would be at a more acceptable height.
Uneven breasts after augmentation.
Thanks for posting photos; they are important and helpful since they show the degree of asymmetry you noted yourself prior to surgery. You stated that your left breast was larger pre-operatively, and it appears as if your nipple areola complex was higher on the left as well. The second photograph was labeled "capsular contracture" but this simply appears to be an early post-op appearance ("high and tight" is normal at first). The right implant was indeed higher than the left in this early post-op view. The third photograph (6 months post-op) shows the breast mounds to be pretty close in size (volume) and reasonably symmetrical on the chest wall. However, the higher nipple on the left is still higher, and after the right implant dropped, the overall position symmetry on your chest wall is better, but the left is still a bit lower than the right..
If your breast volume (size) had been "perfect" prior to your surgery, you would have not required implants, and the only asymmetry would have been the (minimal) discrepancy between the two breasts in size, and the rather noticeably higher left nipple. If you had asked only for the nipple position to be corrected, your surgeon would have had to tell you that repositioning the nipple areola complex requires an incision around the areola (and of course, a permanent scar) on one and perhaps both sides.
Simply raising the left implant position will make that nipple look a bit lower and more symmetrical, but the breast mounds will be off (imagine the look in a tight sweater that does not show your nipples--the breast position needs to match, and that would take raising the left implant position only a tiny bit). Raising it too much to try to correct the nipple position entirely by suturing the bottom of the pocket internally will leave the left breast too high. And the left nipple will still be too high!
So, the best solution, based on your photographs (and a direct examination is better), would be a combination of tightening the lower pocket of the left breast (perhaps a tiny bit higher than the right since it will drop as it heals, and a bit of intentional over-correction will help to compensate for the naturally higher left nipple), plus consideration of a crescentic excision on the lower part of the areola to drop the nipple-areola position a bit on the left.
I have stated elsewhere on this site that I feel crescentic "lifts" hardly lift at all, and I still believe that after two decades of breast surgery and lots of "hardly-worth-it" crescent excisions in an effort to get a lift with a little scar. It just doesn't work very well.
However, a "little bit higher" on the left implant position, plus a "tiny bit lower" on the nipple position will help overall breast symmetry the most--though you will have a visible scar on your left nipple. Your augmentation must have been via axillary incisions (no periareolar or inframammary scars visible), so having to add one now on the left is a bummer, but would still have been needed if all you requested in the first place had been to lower the left (or raise the right) so they matched better compared to each other.
Your augmentation did not cause this; you had it in the beginning, and simply placing implants did nothing to correct the asymmetry. That, dear lady, will take a little more surgery! Talk with your surgeon; it is likely that he or she already sees this as well, and will be able to discuss the pros and cons of the approach I just outlined for you. Revision surgery costs should have been discussed prior to your first surgery; if not, discuss it now, so you know what to expect. Good luck and best wishes!
Thank you for the question and pictures.
Yes, your symmetry can be improved. This will involve adjustment of the breast implant pockets. On the left side, it appears that the implant has settled more than the right. This makes the nipple/areola look "higher". The implant can be raised by using an internal suture technique (inferior capsulorrhaphy). This will improve the symmetry of the lower poles of the breasts by decreasing the distance from the areola to the inframammary fold on the left side. The nipple/ areola will be better centered on the left breast mound.
The right breast implant may need to be adjusted also, if it adjusts to the side - using lateral capsulorrhaphy technique.
Make sure you are working with a board certified plastic surgeon well versed in revisionary breast surgery.