How to get better breast symmetry following nipple sparing mastectomy 5/17 and implant exchange with fat grafting? (Photos)

Question

I understand there will always be asymmetry, but I heal very well & believe this can be improved upon. Since so much tissue was taken with the NSM (L>R), the L breast began to drift laterally, was smaller, and nipple pointing down and out. Bigger implants exaggerated this, making the nipples appear much more uneven, L implant drifting down and out still (despite the PS repair to the lateral breast pocket.) I like the size, and when I lift the implant and push it medially, looks great.

Stephen U. Harris, MD · Answer

It appears that you had a preexisting breast asymmetry which has remained after breast reconstruction.  The left breast implant is displaced and there is less fullness in the upper pole of the breast, which can also exaggerate the nipple level asymmetry.  Depending on your goals, a unilateral revision of the left breast, with implant repositioning,  support for the lateral implant pocket with acellular dermal matrix, fat grafting, and possible nipple areolar repositioning with a breast lift approach (resulting in some additional scars around the areola) would improve symmetry.  There is also the possibility that some additional surgery on the right breast would be indicated add that operation to add to the final balance achieved by the left breast revision.
A detailed physical examination would be helpful in creating a customized treatment plan for revision reconstruction that would help meet your goals to improve symmetry.

Libby Copeland-Halperin, MD · Answer

Thank you for your question and for sharing your photos. It is difficult to give you an exact answer without examining you and understanding your reconstructive goals. As you said, there will always be some asymmetry and this is normal, however, it should be possible to improve your asymmetry with fat grafting/transfer, adjusting the position of the left nipple (which would require scars on your breast around your nipple areola area), and possibly revising the implant/implant pocket. Breast reconstruction and revision surgery requires an individualized approach and I recommend you speak with a fully-trained plastic surgeon to discuss your goals and treatment options.

Maria M. LoTempio, MD, FACS · Answer

Thank you for your question. To have the nipples at the same height, incisions will need to be made on the breast. A small incision can be made on the nipple areolar-skin junction and a wedge of skin can be removed. This can bring up the nipple 2-3 cm without adding a vertical incision to the breast. Ask your surgeon for an opinion on this technique. Best of luck!

Peter R. Neumann, MD (retired) · Answer

The right implant has a capsule and the implant is now pushed up with the nipple pointing down. The caspsule must be opened and the implant lowered with either Alldoerm or some biologice material to prevent future capsule formation. The left pocket needs to be closed again with biologic material sewn in to prevent drift with is a natural recurrance without something blocking it. Unfortunately, both breasts need to be modified to achieve a desirable result.

How to get better breast symmetry following nipple sparing mastectomy 5/17 and implant exchange with fat grafting? (Photos)

Answers (4)

Answer: Breast Symmetry

Answer: Breast Symmetry

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Everything you need to know about Breast Reconstruction Revision

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How to get better breast symmetry following nipple sparing mastectomy 5/17 and implant exchange with fat grafting? (Photos)

Answers (4)

Answer: Breast Symmetry

Answer: Breast Symmetry

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Recommended reading

Everything you need to know about Breast Reconstruction Revision

Our mission is to create a world where every investment in modern beauty is Worth It.