Capsular contracture on my left, or implant pocket stretching/too big on right. (photos)

There is asymmetry of your breasts as seen in the AP photograph. I would employ breast biometrics to determine whether there is true symmetry and the placement of the breast implants relative to the breast. Our office specializes in breast implant revision and repair. Raffy Karamanoukian MD FACSLos Angeles, CA

One of the most common problems is breast capsular #contracture or the development of thickening, and contracture of the capsule that exists around the breast implants. Severe capsule contracture probably occurs in less than 15% of augmentation patients. Every woman has a breast capsule around their implant and this is a normal phenomenon. The capsule itself could be as thin as Saran Wrap but may also become calcified and thickened. As it thickens and shrinks, the patient may develop a feeling a firmness of the breasts and in its worst situation, the breast may become painful and abnormal in appearance, achieving a very round, hard, and uneven appearance. There may be distortion and possible breakage and leakage of an older implant, but may also include a newer #implant. Nicotine users, such as smokers, have up to a 30x increased risk of #capsular contracture.

Saline implants may deflate spontaneously. When the patient has significant #symptoms, complete or partial leakage of their saline implant, or concerns regarding silicone leakage, it is recommended that the implant is removed and exchanged. Frequently, this is performed on both sides depending upon the age of the implant. Capsulotomy or opening of the capsule may be required or frequently capsulectomy, which is removal of the scarred capsule, is #recommended to ensure adequate pocket dimensions.

New implants may then be placed in the same existing position or may undergo a change of #placement frequently from submammary to subpectoral position and, on occasion, the other way around.

It is very uncommon for a woman to have two breasts that are exactly the same.  Based on the fact that your surgeon chose two different size implants, I assume that you had a notable asymmetry prior to augmentation.  I understand your concerns about your breasts being slightly different from one another and only an in-person examination can accurately assess what may be the cause of your concerns, but I would advise you to proceed with caution before choosing to have a revision for these issues.  Based on the photos you provided, you have beautiful breasts, and a revision has the potential to worsen rather than improve your asymmetry in addition to all of the other risks of surgery (bleeding, infection, etc.).  See your surgeon to discuss your concerns.  Best wishes.

You do have a small degree of asymmetry but it on the range of asymmetries its fairly mild. Over time the two breasts will do different things and so asymmetries may be more apparent. If you are right handed, for example, you exert different forces on that side than on the other. Talk with your surgeon at least so you have an exam and photos to reference down the road. Good luck.

you are correct that an in-person evaluation is the only way to get definitive advice, but here are a few things to consider: Since you have different implants, presumably there was some pre-existing asymmetry so that confounds the analysis a bit. If you have a capsular contracture, then the breast should feel more firm in addition to appearing constricted.  I am not sure what type of implants you have, but if they are shaped such as Allergan 410's then one may have rotated (not an issue with round implants.) If the pocket has stretched on one side (not uncommon) then a range of options applies including capsule repair (capsulorrhaphy) to internal bra with Strattice, SERI scaffold, or Gala Flex mesh.

It looks from these photos like your left implant is riding just a bit high. I can not tell if it's from CC or just healed/placed higher. may not have settled same b/c different sizes. I would think a simple capsulotomy on the left would do it.

Thank you for the question and pictures. You are correct in that nothing will replace in person examination for accurate diagnosis, followed by treatment recommendations.  For example, the presence/absence of encapsulation can only be determined on direct physical examination. However, based on your description,  it is very likely that you are dealing with a breast implant displacement problem on your right side. If this is the case, and you wish to keep the breast implants better situated when you are standing or lying down, internal adjustments of the breast implant capsules (capsulorraphy) may be indicated. You may find the attached link, dedicated to revisionary breast surgery concerns, helpful to you. Best wishes.

From the photos it does not look like you have a contracture and your description describing them moving around in the pocket also suggest that is not the case. Best to be seen in person.

Generally breasts that have a spherical contracture appear rounder and very firm. Your left breast sags a little more than the right and so I doubt if there is a contracture. An examination would be your best option to determine what is going on and how to correct it.