What is going on with my breast implant?

Question

I had my breast augmentation with gel silicone under the muscle in April 2018. I noticed not too long after that my cleavage & nipples were not even. My right breast sits lower & more towards my sternum than my left. I have slight tenting as well. Is this the doctors error? How should I have it repaired?

Christopher V. Pelletiere, MD · Answer

Based on your pictures, you have symmastia.  This is where the implants cross the midline, lifting up the sternal skin and muscle at times.  This can occur for a number of reasons, the most common being too wide of an implant for your frame or overdissection of the pocket.  It also appears that one implant is sitting lower than the other on your frame.  You would probably benefit from a narrower implant, fold support, and internal symmastia repair. The best thing to do is to have a few consultations with board certified plastic surgeons who have experience with symmastia repair (see examples in link below).  I hope this helps.

Vincent N. Zubowicz, MD · Answer

The asymmetries in the photograph should be discussed with your surgeon. If you have true synmastia the repair can be difficult. It might be easiest to place a new set of implants in a sub glandular position and reattach the pectoralis to the chest wall.

Scott W. Harris, MD, FACS · Answer

The implants have for some reason come to rest too close to one another. This is not always the surgeon's error. Regardless, the implants needs to be moved further apart and doing so will also make your nipples point more straight. As to your question about the nipple height, this is frequently related to your preoperative appearance and cannot be changed. You will require more surgery to improve this... sorry to say. Best of luck!

Deborah Sillins, MD · Answer

From you photos you appear to have symmastia. To correct this you will need a revision. Most likely smaller implants and repair of the symmastia.

Peter D. Geldner, MD · Answer

Thank your for your question and photos. You have several observable asymmetries. The right breast implant seems to sit at both a higher and lower level on the right side. It also show lateral displacement of the nipple. In effect, the right breast just looks bigger. Without an in-person examination and knowing what you looked like before, and exactly what was done during surgery, any answer is pure speculation. It looks as though the implant pocket was different on the two sides with greater release of the muscle on the right side. It also looks as though the footprint of the implants are different. Careful review of the medical records could provide an answer of why this occurred. You might also benefit from an ultrasound to rule out a seroma. What can be done is complicated. you will likely need to correct the symmastia of the right breast and possibly change the implant to more closely match the left side. A logical question is what does your doctor say. If they say this is normal or desirable, it's not. Persist in your desire to correct this problem. If you seek a second opinion, make sure that you have copies of your pre-operative photos and medical record that reflect the operative details. Best of luck!

Michael Constantin Gartner, DO · Answer

it would be interesting to see your before pictures because if one nipple was higher and the other was lower that's a difference that's not going to change much. I find most patients do not notice this and I have to point it out to them in the preoperative consultation. But it does look like your implants have shifted too close to the middle. This would require a surgical repair to improve. I recommend you follow up with your surgeon.Best Regards,Dr. Michael Gartner

Daniel Barrett, MD · Answer

Dear Kailynbffieh,Women’s breasts have some degree of asymmetry. Some may be more noticeable than others. If you have breast asymmetry before breast augmentation surgery, there is a great chance that this will exhibit right after the surgery.If the asymmetry becomes more noticeable after breast augmentation surgery, a revision may be needed to correct the asymmetry. In most cases, the revision involves correction in both breasts. For example, large breasts can be reduced to a more manageable size, but the amount of reduction might differ between each breast if one happens to be naturally larger than the other. The same can be said if a person wants to augment their small breasts to a larger size: one might be augmented more than the other.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

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast augmentation surgery. Based on your description and photographs, you are experiencing a medial breast implant opposition problem 
 In my practice, having used a variety of “techniques” for correction of medial breast implant malposition and symmastia, I find that the most reliable technique involves capsulorrhaphy ( internal suture repair of the breast implant pockets along the cleavage area).   Often, the use of acellular dermal matrix is helpful also.  I have also been pleased with the direction of skin tenting that can be achieved with the use of the acellular dermal matrix. These maneuvers also serve to better position the nipple/areola complexes, centered on the breast mounds.   
Often, it is necessary to “open” the breast implant pocket laterally (outer breast fold AKA lateral capsulotomy) to allow for positioning of the implant centrally behind the breast mound. This maneuver may also decrease the amount of implant pressure against the medial suture line.  These maneuvers also serve to better position the nipple/areola complexes, centered on the breast mounds.  My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully. Working together you will come up with a good plan to achieve your goals.I also find that careful attention to postoperative activity restrictions is key to success with this type of surgery and other types of implant malposition revisionary breast surgery.  Activity restrictions are individualized patient by patient, depending on exactly what was found and done during the procedure.  For example, for most patients with medial implant malposition or symmastia repair, I ask that they avoid pec major related exercises ( especially exercises that involve abduction of their arms) for at least three months after the procedure is performed.
 
Best wishes.

What is going on with my breast implant?

Answers (8)

More Breast Implants Questions

5 months post op. 34D to 34E. 375 high profile round overs. Have my breasts dropped too much? (photo)

Do I have snoopy/waterfall deformity? (Photos)

How many cc's to go from 38B/C to 38 D/DD?

Should I go for moderate plus or high profile? (Photo)

Can tearing chest muscle cause implant/capsule rupture?

Can you overcome a large chest gap with a wider implant?

WE SEND PRETTY
EMAILS