One month post op - I think I have a Muscle Flex Deformity/Protruding Ripple/Asymmetry? (photos)
Doctor Answers 4
Flexion deformity after breast augmentation
Thank you for your photos and questions. Your assessment seems to be very accurate - your right certainly appears to be noticeably larger than the left in photos and there is also noticeable distortion with flexion.
Trusting the Vectra to be the absolute answer when determining what volume of implants to use can be a bit misleading at times. Simulations are a wonderful tool, but may not always be absolutely accurate when real implants are inserted. I also use a 3D simulator in my practice, but always tell my patients that I will have a variety of implants/sizers both smaller and larger available just in case what we see on the computer screen isn't quite matched by what happens when the implant is placed in the OR. Out of curiosity, was a Vectra scan done after your surgery to determine how much larger the right is than the left?
Without being able to see you in person and do a physical exam, it is impossible to be absolutely certain what the best approach to solve your issues would be. If you are happy with the size of the left breast, then down-sizing the right implant may solve many of the issues you are having with distortion/palpability of the right implant with flexion. You may require additional pocket support so that the implant does not protrude during flexion, however simply downsizing the right implant to match the left might solve the majority of your problems without further intervention.
I would recommend that you have a candid discussion with your surgeon about your options, perhaps get another Vectra scan to determine how much (at least theoretically) larger the right is than the left, and potentially seek consultation with other board certified plastic surgeons in your area who have breast augmentation experience for a second opinion.
Vectra is a fancy device but it cannot accurately determine volume or predict real outcomes. The difference in volume was closer to 30 cc, something that your surgeon really should have been able to see. Your periareolar scar on the right is wide and hypopigmented, and is a shining example of why these scars are not aesthetically superior to an inframammary scar. Additionally, they put you at risk for capsular contracture and other scar related problems. In your case, it may have contributed to your animation deformity as well. Regardless, you will need a revision surgery to better match implant sizes, as well as release the muscle from the capsule on the right. This should be done through an inframammary incision, as your risk for capsular contracture is even greater in revision surgery. If your surgeon is not ABPS certified and a ASAPS member who specializes in revision breast surgery, you should visit a few who are. Best of luck!
Breast Augmentation Postop
Thank you for the detailed photos. What you are noticing when the muscle is activated of flexed is animation deformity which to certain extent is normal after breast augmentation behind the muscle. There are many reasons why most surgeons do choose to place the implant in a subpectoral (behind the muscle) position. The one drawback is what you are experiencing.
As far as the symmetry of the breasts, you look very good for being 1 month out. The left breast does appear to be a little bit smaller than the right, yes I can see that. At this point, you should give it another 3-4 months before considering revision surgery. Revision surgery would be simple, place a slightly larger implant on the left side. I would discuss this with your plastic surgeon in about 3-4 months, if it is still apparent.
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Good day. Of course an examination is the best way to ascertain your concerns. That said, some dermal separation sometimes allows for palpation of the implant at the incision site. The change in shape with flexing is to some degree normal an inevitable. The pectoralis muscle becomes continuous with the capsule around the implant and moves with it when flexed. Yes the left breast does appear to be smaller. You should be examined by your plastic surgeon to get definitive answers. Best wishes.