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

Question

I am 45 and weigh 119. I had 300cc saline for 25yrs then had a valve leak which caused deflating on left side and had to have replacements. I have 415 srf full profile under the muscle allergen now. My surgeon says looks fine and is out of state so wanted other opinions. My issues are the left is higher, rounder, and looks wider and bigger. The right looks lower and has a slant to it (not round) and looks a lot smaller to me and also ripples on the side when I lean over. I also have lateral displacement? on only the right side while the left stays in place and the right feels like it moves around a lot more. So again I feel they are uneven and two different shapes/sizes. Can this be fixed with galafex or internal bra ( I don't want the super fake pushed up look) for the right side, or can a capsulorrhaphy be done for the right side to make it match the left side, or can the left side be lowered to match the right side (whatever is easier) . Also how do I keep the one side from rippling. I was a 32a and totally flat chested before all this if that helps. lol. Would a different profile implant be better for less rippling like moderate plus or moderate or do I need smaller implants/? Thank you. Sorry for all the questions.

Gerald Minniti, MD, FACS · Answer

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.

Ellen Ozolins, MD · Answer

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.

Gianfranco Frojo, MD · Answer

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.

Camille Cash, MD · Answer

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.

Daniel Barrett, MD · Answer

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

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

Answers (8)

Answer: Revision

Answer: Revision

Answer: Uneven breasts

Answer: Uneven breasts

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Everything you need to know about Breast Implant Revision

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

Answers (8)

Answer: Revision

Answer: Revision

Answer: Uneven breasts

Answer: Uneven breasts

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Recommended reading

Everything you need to know about Breast Implant Revision

Our mission is to create a world where every investment in modern beauty is Worth It.