7 months post op - what can be done to correct asymmetrical results and what could have caused this? (photo)

Question

33 year old mother of 2 had breast aug 7 months ago. Initially both breasts symmetrical and slowly by month 4 1 breast noticeably lower than the other and getting more pronounced. Do I have any options to fix this and why did this happen? I have also reached out to surgeon.

Guler Gamze Eren, MD · Answer

Thank you for your question.You have only one photo taken by yourself and it is not enough to tell you if it is an animation deformity or capsular contracture. It is better to get checked with a physical examination and/or breast ultrasound to check the capsular contracture.If it is capsular contracture, breast implant should be replaced with a new one.If it is an animation deformity the implants should be placed infront of the muscle.

Ellen Ozolins, MD · Answer

Thank you for your question. From your photo, it sounds like you’re experiencing asymmetry that has developed over the last few months following your breast augmentation. You have one breast higher than the other, and this could be due to capsular contracture, where scar tissue forms around the implant and tightens. Also, one of the most common reasons for a breast to drop lower than the other is implant malposition or migration. This happens when the implant shifts downward due to a too large pocket or the implant stretching the tissue over time. Since you’ve already reached out to your surgeon, having an in-person consultation is a good idea to assess the situation and determine the best approach for correcting the asymmetry. If the implant has migrated, surgical revision may be needed to correct the position. If capsular contracture is present, capsulorrhaphy can be performed to remove or release the tight capsule and reposition the implant.

Simona V. Pautler, MD · Answer

Just looking at your photos makes me think that the higher side may have a capsular contracture, where the normal fibrous envelope that forms after implantation slowly tightens around the prosthesis and starts to ride high. This is not unusual and can definitely be repaired. If this is not the case and both breasts feel soft and normal then what you have is implant malposition and this can happen even if your surgery was done with perfection. One drops and the other doesn’t. The human body can be unpredictable. But this too can be repaired by lowering the higher side with a capsulectomy and if needed raising the other side with a capsule repair.

Connie Hiers, MD, FACS · Answer

You may be having two issues. One implant appears to sit a little high and probably has a capsule. The second appears to be sitting too low and is bottoming out from the weight of this implant. You appear too thin to support the chosen size. Please go back to your surgeon.

Darryl J. Blinski, MD · Answer

Based on your only one posted photo, there is a significant a symmetry of your breast. You must be seen by your original surgeon or seek virtual consult or second opinion, plastic surgery consultation. Appears you might have a severe capsule formation of one breast? Best to get a repeat mammogram and or ultrasound as soon as possible. Possible revision would cost between 5000 and $15,000. Again best of virtual consult with.

Mats Hagstrom, MD (license on probation) · Answer

Breast augmentation outcomes are typically based on three variables.
The first is the patients candidacy for the procedure in the first place. The second variable is the selection of implants in regards to size, shape and type.
The third variable is the surgeons ability to put the implants in the correct anatomic location, or in other words, the technical aspect of doing the procedure.
Anytime excessively large implants are chosen the chance of having undesirable side effects, complication rates, and revision rates will always be increased.
In Your case the size of the implants may have had an impact on why one side is bottom out.
On most people the left breast normally sits higher on the chest wall than the right side. 
To make a quality assessment regarding the outcome of any plastic surgery procedure we usually need to see a complete set of proper before and after pictures.
If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took.
It looks like the diameter of your breast implant is probably wider than the baseline diameter was of your breast before surgery.
On the lower side, your IMF (infra mammary fold) Has been opened to accommodate the implant size.
On the contralateral side, the implant is riding high because the diameter of the implant wider than your breast without opening the implant has to sit high. 
Ideally, the IMF should not be disturbed very much or the patient is an increased risk for implants bottoming Out. 
Likewise when the procedure is done correctly, fibers of the pectoralis muscle should be holding the weight of the implant(in subpectoral augmentations) If the pectoralis muscle is transacted too much or too high than the muscle will not be supporting the implant, and this again increases the chance of the implant bottoming out.
If Smaller plants had been selected the chance of having these complications would’ve gone down.
In regards to the above three variables, I would say the problem is related to implant selection and the surgeons skill. 
Follow up with your plastic surgeon and talk to them about your concerns and the possibility of needing revision surgery.
Your low riding implant is still in a reasonable position with early signs of bottoming out. This will most likely continue to get worse overtime if it’s not corrected with a revision. Because the other side the implant is still sitting well above the IMF, the asymmetry will most likely become worse over time without revision surgery. 
Some plastic surgeons may be tempted to lower the high positioned implant. This may be reasonable if done correctly. If not that side may begin to bottom out as well. 
Correcting bottomed out implants is fairly Complex and is typically done using permanent internal sutures with or without mesh or cadaver dermal products like Alloderm. Talk to your sergeant about correcting this or have a few in person second opinion consultations.
If you opt for correcting the bottom out implant, then ask them to show you lots of before, and after pictures of previous cases of correcting this deformity.
For second opinion consultations come prepared to bring with you a complete set of proper before and after pictures and a copy of your report.
You can obtain these by requesting them from your current provider.
There are a number of variables that need to be confirmed or understood in order to make equality assessment.
Best,
Mats Hagstrom MD

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