Revision needed? Pocket? Bottom out? (Photos)
Doctor Answers 4
Revisions only needed if you want to change things
and it appears your implants do fall to the side a lot. Your texturing isn't really helping here. An exam would be needed to evaluate the dimple you mention and to determine what the cause is but without thinning of your skin, its likely just the implant edge that you feel. If you want your implants more medial when on your back, you will need a revision that is challenging to predict outcome, can hurt a lot, and requires 24/7 use of a cut out bra for 6-8 weeks. So its a long road if you want to correct that. Some surgeons use artificial materials to help shore up the lateral pocket and their recovery may be different from what I've described. Otherwise, if you can live with it and the overall appearances, do nothing until a real problem develops.
Lateral breast implant displacement...Revision needed?
I am sorry to hear about the problem you are experiencing. You demonstrate your concerns nicely. Although some “falling to these sides” of breast implants is quite normal when you lie down, if this occurs “excessively”, it may be a concern to patients. This phenomenon is called lateral displacement of the breast implant; it may be of concern from the visual and the discomfort standpoints. Surgical correction is an option.
Generally, the lateral breast implant displacement can be corrected using an internal suture technique, decreasing the size of the pockets and moving the implants toward the midline. In my practice, I use a 2 layered suture technique (capsulorraphy) to close off the space laterally (towards the axilla). The use of acellular dermal matrix is an option ( although not usually necessary) especially if significant implant rippling/palpability is present.
I hope this (and the attached link) helps.
Healing after a breast augmentation
Altogether, it looks like you have an extra nice result. There will always be differences from one side to another. This is a time when you should sit down with your plastic surgeon so they may give you a good idea of what you can expect over time. Even revisions for small asymmetries carry significant risks and can leave you with other problems.
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Lateral implant displacement
Your implants are relatively large and larger implants tend to have more issues than smaller ones--particularly gravity related issues as well as others (bottoming out, lateral displacement, skin thinning, rippling etc.)
Your implants look good when up front. This lateral displacement you are seeing is simply stretching of the implant pocket from the weight of the breast implant when you are lying on your back.
Wearing a supportive bra after a breast augmentation is important to maintaining a long lasting result. If you wear a bra at night that keeps your implants up front this will not happen to the same degree.
Having said all of the above, I believe your results are quite good and that you should be as excited now as you were originally. It is really helpful if you take a look at your original pictures!