7 years post - What can be done to fix this asymmetry? (Photo)

Question

7 years ago got 625 high profile silicone (most rigid type due thin skin) under the muscle. I had a bit of asymmetry, but to a level I was comfortable forgoing a lift. I mostly wanted to fill out empty skin after pregnancies and breastfeeding. The asymmetry has gotten worse What can be done to fix it? Will I get a good result worth the scars?

Waylon Zeng, MD · Answer

Hi thank you so much for your question and sharing your photo! I can appreciate the asymmetry you are experiencing. I wouldn't recommend treating this degree of asymmetry, as women naturally will have a similar degree of asymmetry. However, if this is something you are really desiring, a Right lollipop lift would be adequate in raising the breast tissue and nipple to match the left side. Hope that helps!

Yily De Los Santos, MD · Answer

What you are experiencing is not uncommon several years after breast augmentation, especially after pregnancies, breastfeeding, and natural tissue changes over time. From your description, the asymmetry may be related to differences in skin stretching, implant position, breast tissue descent, or a combination of all three.

In many patients, revision surgery can significantly improve symmetry and overall shape. Depending on your examination, this could involve:

* A breast lift to reposition the tissue
* Implant exchange or pocket revision
* Internal support techniques
* Fat grafting for additional contour correction

The concern about scars is completely understandable. However, when there is noticeable asymmetry and tissue descent, a lift is often what creates the most balanced and aesthetically pleasing result. Most patients feel the improvement in shape, symmetry, and confidence is worth the tradeoff.

Mehmet Ozdemir, MD · Answer

Based on your photo and history, it appears you are experiencing a combination of **pseudoptosis** (where the breast tissue slides off the implant) and a likely malposition of the implant pockets, which is quite common seven years after a submuscular augmentation, especially following the skin changes of pregnancy and breastfeeding. Because you have high-profile, heavy silicone implants and thinner skin, the "most rigid" type may be providing volume but lacks the internal support to keep your natural tissue aligned with the device. To achieve the symmetry you're looking for, a revisionary mastopexy (breast lift) is likely necessary to reposition the nipple-areolar complex and tighten the skin envelope, possibly combined with capsulorrhaphy to tighten the internal pockets and keep the implants centered. While every surgery involves a trade-off with scarring, most patients find that the improved "perkiness" and balance far outweigh the fine lines of a lift, especially since a surgeon can often use your existing incision sites to minimize new marking.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. Revision surgery is likely to be able to correct asymmetry depending on the source of the asymmetry. Could be related to the implant or the capsule around it or it could be related to the tissue on top of the implants. Only a consultation with a board certified plastic surgeon will be able to tell.

Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Daniel Barrett, MD · Answer

Dear whatsinanamerose,

breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.
While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Frank Agullo, MD · Answer

Seven years out and noticing asymmetry that wasn't there at six is almost never the implant itself. It's the soft tissue around it. Capsule thickening on one side, slow contracture, weight changes, gravity all eat away at symmetry on a thin-skinned chest. With 625s in high profile under thin skin, you have less coverage to hide anything that shifts. The fix depends on what's driving it. A capsulorrhaphy tightens a slid pocket. A capsulectomy plus exchange handles a thickened capsule. Sometimes a small lift on the heavier side, or fat grafting on the lower one, evens it. Photos go a long way but in-person evaluation tells you which it is. With your particulars I'd also have a frank talk about going smaller, or even an explant with auto-augmentation, before another round of 625s.

#StayBeautiful,

@RealDrWorldWide

#StayBeautiful,

@RealDrWorldWide

Harry T. Haramis, MD, FACS · Answer

All breasts are different right to left before and after any surgery. This includes size, shape, chest wall, etc. They also heal differently over time.

Your breasts have fair symmetry, one side appears higher and fuller on top with different shape.

If one side has changed, you should be evaluated for changes in pockets, scar tissue/ capsule contraction, etc.

Options to improve symmetry, they will never be 100% identical, can then be discussed with your/a plastic surgeon along with risks, benefits, complications, limitations, so forth.

John LoMonaco, MD, FACS · Answer

You have more skin on your right, and the only sure way to correct that is removing some of it and raising the nipple in the process. That of course means scars so you'll need to weight the benefit of that.

An internal lift may move the implant higher, but the niple position is unlikely to change enough to match.

An internal lift may move the implant higher, but the niple position is unlikely to change enough to match.

Milan Doshi, MS, MCh · Answer

Hi whatsinanameroseFrom your photo, there appears to be progressive breast asymmetry with implant-related stretching and soft tissue descent. With 625cc implants, especially in thin tissue, gravity and skin relaxation over time can make asymmetry more noticeable.
Improvement is possible, but it will likely require revision surgery, which may include implant exchange or downsizing, pocket adjustment, and a breast lift to reposition the nipple and reshape the breast. If the goal is better symmetry and long-term shape, the lift scars may be a worthwhile trade-off.
This is a great question. I would recommend consulting with a board-certified plastic surgeon to further discuss your goals and evaluate you in person.

7 years post - What can be done to fix this asymmetry? (Photo)

Answers (9)

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