6 months after submuscular breast augmentation, one breast is still more projected. What can be done to fix this? (Photos)

Question

At 6 months after submuscular breast augmentation, the left breast is still more projected than the other and positioned more to the side. Since the very first day after surgery, the left breast (275 cc) looked more tense and projected than the right one (300 cc). The left side also took the longest to drop—my surgeon even asked me to come to his office a month after the operation to help stimulate that breast to drop. I can now say that it is almost in its final position; however, it is still more tense than the right breast, more projected, and even appears slightly lower than the right one. The right breast already feels almost natural, with no discomfort. The left breast also looks rounder, and sometimes I feel a bit of tightness and pressure in the inframammary fold in the mornings. I am attaching a photo of how it looks now, as well as how it looked during the first few months. I would greatly appreciate your opinion.

John LoMonaco, MD, FACS · Answer

I can see the left breast is rounder and has a tighter look to it.  This might represent tight skin that has yet to stretch, or could be early capsule formation with contracture.

The treatment for both conditions is massage, tummy time, and possibly ultrasound therapy in combination with the above.

Your surgeon can tell you is surgery to release or remove the scar tissue is needed.

Suleyman Koken, MD · Answer

Based on your photos, it appears that on the left side (the side holding the phone in your picture), the nipple is positioned more centrally over the implant. On the right side, the implant sits slightly higher, which makes the nipple appear lower and less centered. To improve symmetry, the higher-sitting implant could be lowered slightly, and if needed, the nipple position could be raised by a few centimeters in the same procedure.
Regarding the firmness you mentioned, there is a possibility of early capsular contracture on the left side. If confirmed, the capsule could be released or removed during the same revision surgery.
Best,Dr. Süleyman Köken

Tuan A Truong, MD, FACS · Answer

Certainly from these photos there appears to be continued asymmetry and likely implant malposition. Without preoperative photos, it is difficult to ascertain whether it is displacement of the implant, over-dissection or anatomy that has contributed to the current results. A thorough discussion with your surgeon first may shed light on this situation, and if un-satisfactory, a second opinion is certainly recommended.

Mats Hagstrom, MD (license on probation) · Answer

Breast augmentation outcomes are usually based on three variables.
The first is the patient can see for the procedure.
Each patient will have their own unique candidacy for breast augmentation. variables that can affect this include breast shape, breast position on the chest wall, the angle of breast divergence, etc., etc. 
The left breast sits higher on the chest wall on all people.
It looks like in your case, your surgeon opened the IMF(infra mammary fold) maybe to have the implants lineup horizontally, even if the breasts do not. 
The second variable is implant selection in regards to size shape and type.
Whenever excessively large implants are used the chance of undesirable side effects, complications and need for revision surgery will always go up.
The bigger they implant the more patients are going to have problems and need revision surgery.
 The third variable is the surgeon’s ability to put the implants in the correct anatomic location.
In other words to do the procedure correctly.
In your case, I think all three variables are contributing to your outcome.
Creating the pockets evenly on both breasts, recognizing that the left breast always sat higher on the chest wall would be one variable, and
Your implants are in my opinion substantially larger than your natural breast diameter.
There is some baseline of breast asymmetry on all people, and this should generally be discussed during the consultation process.
Plastic surgeons can’t move the position of the breast on the chest wall.
Sometimes the pockets are opened in an asymmetric manner in order to compensate for asymmetry of breast position. When doing so a second asymmetry is usually created.
In your case, the pocket probably needs to be opened on the right side.
Whenever the pocket is opened beyond the IMF, the chance of having implants that bottom out goes up.
This is why using large implants increases complication rates.
To make a quality assessment, we need quality information guide
It’s usually means, including a correct set of before and after pictures.
If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took.
To get a proper second opinion, I suggest you schedule those as in person consultations with other plastic surgeons in your community.
For second opinion consultations come prepared to bring with you a complete set of proper before and after pictures and a copy of your operative report.
These are all part of your medical records that you can request from your current providers office.
 Best,
Mats Hagstrom MD

6 months after submuscular breast augmentation, one breast is still more projected. What can be done to fix this? (Photos)

Answers (4)