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

Dear lottir,

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

It is very common to see differences between the two breasts even months after surgery. Each side heals at its own pace, and sometimes one breast stays tighter or sits differently because of natural tissue differences, implant pocket healing, or how the muscle and capsule adapt to the implant.
In your case, the left breast feeling more tense, more projected, and rounder can be explained by slower soft tissue relaxation or by differences in how the pocket healed. The mild tightness you feel in the fold in the morning is also consistent with residual healing and tissue adjustment.
At six months most of the settling has occurred, but some changes can still happen up to a year. If the asymmetry remains after that, options like pocket adjustment, capsular release, or small fat grafting can help improve balance.
For now, close follow up with your surgeon is the best step, as time may still soften the left side further. If the difference does not improve, revision procedures exist to bring the two sides into better harmony
— Güray Yesiladali, MD

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.

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

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.

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