350cc & 450cc, pectoralis muscles too tight, could we revise the size of smaller implants? (Photos)

Using different size implants for asymmetry is a very tough game to get right. But I agree the size difference is too great and changing the size of one of the implants does make sense. If you were my patient I would let you make the decision regarding size change.

At 6 months post-op, breast implants—particularly those placed submuscularly—may still be in the process of "dropping and fluffing," especially in patients with tight pectoral muscles. The final positioning can take up to 12 months or longer in some cases. Implant asymmetry at this stage may reflect differences in muscle tightness, implant pocket development, or pre-existing tissue asymmetry. While a 350cc vs. 450cc implant can help balance volume, noticeable size differences may become more apparent as swelling subsides and implants settle. If significant asymmetry persists after full healing, revision surgery to upsize the smaller implant or adjust the pocket may be considered. A follow-up evaluation at the one-year mark is typically recommended before planning any corrective procedures.

if the muscle is too tight for placement of the implants then it might be a good option to place them over the muscle. I prefer subfascial for this. If you had dual plane under muscle, then the muscle should be re-attached where it was cut. Fine-tuning the implant size for better symmetry might be easier with over muscle/subfascial, but there may be other things to consider.

Based on your pictures it does appear you have a size asymmetry. This is something that can easily be resolved. I have been in practice for over25 years and augmented thousands of breasts. I have not encountered a pec muscle to tight. I have seen many pts who have had implants way to large for their dimensions for revisional surgery. I would talk with your PS as after 6 months the pec muscle will have expanded. I hope this helps.

Thanks for your inquiry, I believe your surgeon should be able to revise you to create symmetry. I am unsure how to comment about your tight pectoralis muscle, but usually there is significant stretch and relaxation over the first six months, best of luck.

Dear Glorious119530,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

When I started out as a plastic surgeon and I had a patient with asymmetry I used to always place different sized implants like you had done. What I found over time is exactly what you have experienced. Over time, 6 months to 24 months what happens is the larger implant becomes noticeably larger. I say the implant always wins in the end, meaning that eventually it is the implant that becomes the dominant component of the breast and then implants that were placed to correct asymmetry actually generate MORE asymmetry.

Today I still use different sized implants in patients with notable asymmetry, but I keep the implant sizes much closer together in size, say 25 cc or 50 cc and not go for the 100 cc difference as I know with time we will have reversed the problem in that the originally smaller breast will now look markedly larger if I use markedly different implants. In other words, the patient will now see the asymmetry in the implants which is usually more pronounced than the original asymmetry.

For patients that have a normal amount of asymmetry, not something that really stands out, but a little asymmetry (super common), then I use the same sized implants in each breast and I explain to the patient before surgery that there will be a little asymmetry as she has now but that it is better than if I put different sized implants and she will see the different implant sizes in a year. Most people understand this and are happy to accept a little normal asymmetry rather than be left with one large breast and a smaller one.

I would be recommending changing the size of the implants by a discussion based on what your body can handle and what you prefer to have,

I would suggest going smaller since these look quite large on you. Plus, smaller implants will settle down easier into place and not stretch the muscle quite as much.

You had significant breast asymmetry pre-op some of which is from your rib anatomy. Now you still have a reverse asymmetry, but not unacceptable. If this bothers you, then discuss this with your surgeon. It is pretty simple to replace an implant, it comes with a discounted fee in most instances.
Best wishes,
Dr. Taranow