Lopsided Nipples 3 Months After Augmentation

I had a breast augmentation on July 19th 2010. My right implant is sitting higher , which is causing my nipple to point downward. My PS told me 2 weeks post op that i needed to push down agressively on it to help the implant drop. So I continued to do so for the next 6 weeks. When I went for my 2 month followup, my PS told me that my breasts were uneven before, and that they are going to stay this way. I am nt ok with that answer. Can anyone please give me advise. Do I need a revision?

Doctor Answers 13

Breast asymmetry

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If you are unhappy with the final result of your breast augmentation, then you should probably get a second opinion.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

You need a second opinion to determine if a surgical revision is needed to correct your asymmetry.

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As many of  the physicians have stated before pre-op photos would be helpful to determine if your present asymmetry is a product of your anatomy or a complication from your surgery.  Certain congenital breast asymmetries may be responsible for your problem and these cannot  be overcome by simply repositioning your implants. However, if your problem is a result of a poorly positioned implant then a  second surgery to lower the implant will correct it. If this is the case, then a believe the a 3 month interval from surgery is an adequate amount of time to have waited for the implant to have dropped into the appropriate position. Since it has not  I would recommend a surgical revision at  this time. I think you would be best to obtain a second opinion to determine if more surgery is warranted.

David A. Ross, MD (retired)
Chicago Plastic Surgeon

Breast Revision and Breast Augmentation

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Sorry to hear about your situation.  You are more than 3 months out from surgery and results are more likely permanent at this point.  A picture would be extremely helpful to determine the possible solutions for your issue.

Dr. ES

Re: Lopsided nipples after breast augmentation

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Unfortunately I could give you a better answer if I had pre and post op photos, but several factors could have attributed to the higher riding prosthesis on the right side. It is not unusual to see women with their inframammary crease at different heights. This can cause variation in the nipple to inframammary fold distance. If that is the case, at the time of the surgery it is important to lower the higher fold so that the distances will be equal and hence the position of the prosthesis. Sometimes in the early post operative period there can be variable swelling which will make one side appear fuller but this would have subsided completely by now. When the prosthesis sits in a higher position it forces the nipple areola to project downward. In the later post operative period this can be the result of capsular contracture. At this point in time your plastic surgeon should go over your pre and post operative photos with you and if necessary be willing to undertake a revision to lower the right side with a capsulotomy.

You may need revision

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If after 3 months there is a significant difference between the 2 breasts I doubt that pushing or a strap will help at this point.  I would wait a couple of months more to see if there are any changes.  If your nipples were even before surgery they should be even after, but check your pre-op photos.  It sounds like you will need a lower pole capsulotomy to lower the high breast.  This will cause the nipple to point more like the other.  Check what your surgeon's policy is on revisions in terms of costs as each of us have their own policies.  Fortunately, this type of revision has a high success rate with little down time.  Good luck.

Breast asymmetry

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You may benefit from a revision but in any case it is probably best to wait 6-9 months, in my opinion.  Pre-existing asymmetry is probably the single most common cause of post-operative assymentry,

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Revision breast augmentation will correct problem.

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It sounds like the right implant pocket was not made low enough. The goal is for the folds under your breasts to be at the same level right after surgery.

This happens. You should wait a full six months, and then this can probably be corrected with a revision.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Please send pictures

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I would recommend that you send us pictures. The breast asymmetry is very common and breast augmentation can not correct that. You need picture will help us to see if your problem is due to preop asymmetry or due to implant malposition.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Nipple level differences after Augmentation

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It is important to look at the pre-surgery pictures, as well as the afters. Usually, if you are not just looking at a pre-existing difference, it is because the implant has descended below what's called Scarpa's fascia. Usually when this happens, the nipple seems higher than the other one. This is sometimes referred to as "drop-out". This can happen as a result of the initial surgery, or from subsequent pressure from the implant. If this is the case, then another surgery would be indicated to repair the inframammary fold, which would then hold the implant back up where it needs to be.

The best recommendation, though, is to have a real heart-to-heart with your surgeon.

Verne Weisberg, MD
Portland Plastic Surgeon
4.6 out of 5 stars 18 reviews

Asymmetric breasts after breast augmentation

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Your question cannot be answered fully without viewing before and after photos and knowing the details of your surgery. Having an implant lie higher on one said may or may not be due to capsular contracture. In most cases especially in the first few weeks after surgery it is not due to contracture. It is true that when implants are placed under the muscle the muscle can pull the implant out of position. Sometimes this is due to muscle spasm as the muscle is stretched to a longer fiber length & resolves as the muscle accommodates to its new environment. In some cases there was preoperative assymetry unrecognized by the surgeon or patient. This is even easier to do with smaller breasts when there is too little breast tissue to identify the fold under the breast or a tubular breast deformity. That's why I measure all patients before surgery. I frequently pick up assymetries with tape measure that I missed by eye & that the patient was unaware of.

This is a common problem. I have seen patients with this problem in the past. Some of them even had attempts to correct the problem by other surgeons. One of the patients told me the implant was above not under the muscle-go figure. The implant may settle down with time, gravity etc. If it does not do so within 8 to 12
weeks it is unlikely that it will do so on its own. If it then bothers you sufficiently you would require surgery at some future date (minimum 3 to 6 months after the initial surgery) to correct the problem. Without knowing the details of surgery or seeing before and after photos one cannot say what surgical manipulations would be required at this revision surgery.

In the first few weeks after breast augmentation the implants are malleable so that applied dressings or wraps can change the implant position and have lasting effects. The caveat is you have to do it before the capsule around the implants has matured. Your about 3 months out so this most likely would not work for you.

Aaron Stone, MD
Los Angeles Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.