Uneven breasts - lateral displacement on one side. Do I need a revision or a possible capsulorrhaphy? (Photos)

Your right implant pocket is larger laterally and inferiorly, allowing the implant to migrate there, and making that breast's upper pole appear less than the other's. This can be corrected with a classic capsulorrhaphy, which is the placement of sutures with or without cautery. The addition of mesh may also entertained to make the repair more predictable and durable. The latter is known as an 'internal bra', but the goal is to achieve symmetry with the left breast and nothing more. As for rippling, your current implant is NOT highly cohesive, AKA gummy bears. The 'R' in your implants code SRF 415 stands for responsive, referring to the gel type. Responsive gel is the least cohesive gel, which was found in Natrelle's implants prior to the advent of the Inspira implants in 2013. Minimizing rippling for you should include an implant with highly cohesive gel, and preferably the highest cohesive gel possible. In the Inspira line that would be a SCF 415. In addition to gel cohesivity, shell fill is also important to minimizing rippling. Although Inspira implants are considered 100% filled, the new Motiva implants actually have a greater fill, and their gel and shell physical properties are matched for one another, creating much less rippling.

Thank you for your question. Capsulorrhaphy with or without Galaflex on the right side could be your best first step. It can tighten the stretched capsule on the right, reduce lateral movement, and provide a more lifted, centered position. Adjusting the left side is not advisable because it may become more challenging and increase the risk of bottoming out. Most surgeons prefer to match the tighter/higher side by tightening the looser side (as in your case, fix the right).The rippling is due to the thin breast tissue and implant behavior. You can consider switching to a different profile (Moderate Plus can sometimes help if the tissue is thin) or fat grafting.

There are many things happening in the photos including:
1) Inframammary fold malposition/instability
2) Visible implant rippling (related to the saline implant structure/thin tissues)
3) Long nipple to fold distance (due to stretching of the lower pole by the saline implant overtime)
I would recommend tightening the internal pocket/capsule (capsulorrhaphies), placing Galaflex for support, placing cohesive silicone gel implants. This is all just based on the photos. The plan may change after a history and physical exam with ultrasound in office.

Dear kerriann88,

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

Since you started with a 32 A, you have very little breast tissue. The breast tissue helps conceal imperfections and hides the rippling. In your case, you have very little tissue to do that. I recommend smaller implants on both sides. Galaflex is not permanent and the effect is temporary.

Best Wishes,

Gary Horndeski, M.D.

Thank you for posting your question here!My answer will be based on the limited information and pictures provided , for a more detailed and personalized plan please consult with your plastic surgeon in person.
Even though every plastic surgeon aspires to achieve symmetry it's not always attainable , From the pictures I do see what you are pointing out and you do have some asymmetry , it is not super obvious but if it's bothering you then something can definitely be done about it. Lowering the IMF is always easier but if overdone it can result in bottoming out and potentially a double bubble , while raising the IMF on the other side and/or using galaflex or a similar mesh might have less risks but might be a technically harder surgery to do , the laterization can also be fixed with capsulorrhaphy and potentially even using mesh in that area. As for the rippling , it can be improved by changing the implant you have , going for a more cohesive implant and potentially a different profile. The other way to mask it is to thicken the soft tissue on top of it with fat grafting , but that being said , your rippling is more laterally and adding fat in that area if overdone can give you a more pronounced lateral fullness which might not be appealing. Even with all that there is always a chance that you might still have some asymmetry.Again those are all just suggestions based on the limited data available , I would always recommend consulting with your plastic surgeon in person for a more personalized and detailed plan.I hope this helps, best of luck !

From the photos it appears you will need a revision to correct your concerns. I encourage you to meet with a board certified plastic surgeon for an evaluation to discuss your options. Mesh is an option to help give more support to the tissues to help minimize the risk of the rippling. You can certainly switch to smaller implants during the procedure.

The lower implant can have the lateral and inferior pockets tightened. I would suggest changing to gel implants and using mesh to help hide the ripples. You are thin and going larger thins your own tissue even more.