Help! Need a second opinion on BA revision? (photo)

I have discussed my issues with my surgeon, and he has asked me to get a second opinion. The right side is drooping slightly (400cc), and the left sits higher (425) silicone HPs sub muscular. I asked for 375cc MP's I was encouraged to go to bigger. This has resulted in the left sitting higher while the right side droops. (see attached photo) When i lie down, my breast are so far apart and have a huge gap Please tell me what you would do to correct this.

Doctor Answers 10

Breast Implant Symmetry Will Be Hard To Achieve

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Thank you for your question.I do see the asymmetry that you mention and I do see the widened cleavage when you are lying flat.

However your photographs when standing up lookvery good and your asymmetry is most likely due to the fact that your right breast had more ptosis or sag than the left breast preoperatively.

Every woman has some asymmetry in the size and shape of her breasts and yours although present is not great. If your implants are soft and movable and do not have capsules I would think long and hard before considering revision of your breast augmentation.

There are always plastic surgery techniques available to revise your breasts but you need to be concerned about potential scarring and potential complications if you do decide to have revision surgery.

I would be very reluctant to try to lift your right breast because your nipple areolae are symmetrical and I would not want to put a visible scar on your right breast. If the left breast implant is firm and has a capsular contraction then open capsulotomy and a smaller implant on the left might create a small amount of sagging to match the right breast.

The lateral portion of your breast implant pocket can be sutured which will move your implants towards the midline and reduce the widening that you see when you lay down. However doing internal sutures to push the implants towards the midline also carries a significant risk of making the nipples and areolae I point out to the side and I would be very concerned about doing this.

I suggest that you meet with your plastic surgeon again and discuss your options. You look very good and I would urge you to be conservative. If there is evidence of a capsule on the left side then removing the capsule which will enlarge the pocket and placing an implant the same size that you have on the right I think might be the best option. But I have not had the opportunity to examine you in person thus my discussion is about general principles and does not represent a consultation or formal recommendation.

Breast revision

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There are multiple ways to address this depending on your expectations.  The differences between a MP and a HP implant are not as big as you think, often only millimeters is width or height.
A tacking and or adjustment of the pocket may be indicated. A smaller implant will most likely result in an even wider gap and less cleavage.

Smaller implants and simultaneous lift

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Your implants may have been sub-pectoral but the pectoral muscle has extruded them inferiorly and laterally. Your implants are too big for the pectoral cavity. You need smaller implants placed higher and a simultaneous mastopexy. I recommend a circumareola approach so the scar can be hidden at the areola-skin junction. This technique will reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage. Aligning the areola, breast tissue and implant over the bony prominence of the chest wall maximizes anterior projection with a minimal size implant. Small silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision. Best Wishes, Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Capsulorapphy for the breast with your surgeon

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Your surgeon seems to be open-minded and perhaps you can discuss the feasibility and options available for a capsulorraphy with him for the left breast.

Raffy Karamanoukian Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Help! Need a second opinion on BA revision?

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I think your surgeon wanted you to obtain IN PERSON second opinions! But you also did not post a before photo so we could compare the result. I think you were asymmetric in volume and shape, possible pseudo ptosis also. But again no before photo.. There is what appears as a lateral pocket issue of either to much lateral dissection or poor result allowing lateral displacement. Yes you will need a revision but be sure you fully understand what is involved and try to have realistic expectations. Good luck.

Breast asymmetry

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Thanks for your question. I definitely see your concerns and am sympathetic. That being said, it looks like your natural breasts were likely quite different pre-op. I suspect that you will need both an uplift and also a capsulorraphy to improve upon your asymmetry. Best of luck.

Breast Augmentation, Mastopexy, Dr. Adibfar , Plastic Surgeon Toronto

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Unfortunately it would be impossible to make any recommendation without a full history and examination.

It seems that there is a difference in SHAPE and not just SIZE of your breasts.

This difference may not be fixable with different size implants only. Sometimes a Mastopexy may be necessary to adjust the SHAPE of a breast.

Was this assymetry in shape present prior to your first augmentation?

One can try to improve the assymetry however perfection is rarely achieved.

You may find it reassuring that assymetries to a certain extent in the breast are quite common in the population.

Best wishes.

Impalnt issues

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It is always best to be seen in person. If your pocket is too large, the implant can drift to the side. This may require a capsulorrhaphy if it bothers you.

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

Second opinion on breast implant revision

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No one can give you a specific opinion online but there are a few things to consider: First, since you have 2 different sized implants, you must have had asymmetrical breasts before surgery and they will never be a perfect match (natural breasts are never perfectly symmetrical either.) If they look reasonably symmetrical in a bra, a revision may not be worth the extra expense and recovery. When implants move too far to the side in the lying down position, then reinforcing the pocket should be considered or the problem may recur. This could be done with an acellular dermal matrix such as Strattice, or newer products such as SeriScaffold.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Help! Need a second opinion on BA revision?

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The size and position issue is a but hard to determine on the photos. The implant movement to the side when you are lying down may be due to the muscle pushing the implant to the sides over time. This can be corrected by revising the internal capsule, adding a biologic tissue product or making a new implant pocket.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 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.