What is the cause of increased areola complex asymmetry after my breast revision and what can fix it? (Photos)

I already had nipple/breast asymetry. I had a saline partial under muscle BA in 2008. Developed cc in left breast and left breast mound was higher than right. Got revision in 2014 with silicone under muscle and asked for breast mounds to be symmetrical (to lower left fold) and closer together. Mostly happy with results (I like the right breast), but developing cc in left breast again. I'm going to get it fixed and want to know if left areola can be lowered/centered to match right during surgery?

Doctor Answers 3

Post Op #BreastAugmentation and Revision Results

From your photos, it appears that the left breast has descended as a result of the manipulations relating to the contracture. The support was removed on the inferior aspect of the breast and the left implant bottomed out. Thus the nipple seems relatively higher on that side. This can be corrected with a tightening of the capsule on the left side. You did have a noticeable pre-op asymmetry that likely will persist despite an effective correction.
Be sure to find a board certified expert in revision breast surgery before you proceed.  Best of luck, Vincent Marin, MD San Diego Plastic Surgeon


San Diego Plastic Surgeon
5.0 out of 5 stars 42 reviews

Breast asymmetry

Thank you for your question.  You appear to have two separate but related issues-- capsular contracture and asymmetry of the nipples.  It is very helpful to have your original preoperative photos for comparison, BTW.  In looking at your breasts prior to your first surgery you have a fairly marked asymmetry.  Your right breast is larger and the entire breast is positioned lower on your chest.  Importantly, your nipple-to-fold distances appear to be fairly even.  After your first augmentation your shape and symmetry were quite good, given where you started.  Your left implant was sitting a bit higher (perhaps because of the capsular contracture) but this kept the nipple centered on the implant.  When the capsule was corrected and the left fold was lowered in 2014 it allowed the nipple to rotate superiorly on the breast, giving you a pronounced asymmetry.  To correct this you will need to have the left fold raised to elevate the implant to rotate the nipple down on the breast.  In other words, you can have symmetry of your breast mounds or symmetry of how your nipples sit on the breast, but not both (this due to your natural asymmetry).
Recurrent capsular contracture is another challenge.  It appears that your implant surgeries have used a periareolar approach.  This has been implicated in capsular contracture due to increased bacterial presence in the gland, so you might consider an inframammary approach to reduce future risk.  Textured implants and ADM like Strattice can also help reduce future capsular contracture risk.
Hope this helps, best of luck with your future surgery!

How can I adjust the nipple position of my breasts?

The nipple position of your breasts can be adjusted by doing a periareolar uplift. Normally, when you have asymmetry before surgery, you will continue to have it unless this is addressed and corrected.Also, after implants the asymmetry may even be more noticeable.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.4 out of 5 stars 27 reviews

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