Unfortunately, at this stage of the game, your capsules have probably matured, and I would not expect your breasts to change much on their own from this point onward. It's hard to tell precisely from the one preop picture you have provided, because your arms are being held upward and outward which changes your nipple position, but it appears as though you may have started with slightly widely spaced nipples to begin with. This is not a problem in and of itself, it just needs to be recognized by your surgeon, and its significance needs to be explained to you.The principle at work here is that the for the most natural and aesthetically appealing breasts, the implants MUST be positioned properly. If the implants are positioned even the slightest bit off center, especially side-to-side, this will show up in the nipple position and direction too. From the side-to-side position, the nipples MUST be the visual center of the breast mound, and from the up-and-down position, we ideally would have about 45% of the breast volume above the nipple and 55% of the breast volume below the nipple; so just a bit more full below the nipple than above. But, just a bit. In your case, either the surgeon didn't appreciate this principle, or the implants migrated over time. In either event, they are now positioned too low and too far medially, or toward the midline, and this is why they are pointing upward and outward. They may be slightly different in their directions too because they either started that way, or the implants are slightly asymmetrical in position as well. Thus, the correction for this problem is to reposition the implants.When we do this, we typically perform a procedure called "capsulorrhaphy," which involves tightening of the capsule in the areas where it is too loose, or full, and this may also require "capsulotomy" on the opposite sides to allow for expansion in the opposite direction. Thus, in your case, you will likely require an inferior, or lower, capsulorrhaphy to tighten and raise the lower capsule to the appropriate position, and this may require a release, or capsulotomy, of the capsule at the top to make room as the implant is repositioned upward. We can't always tell if we need to release the capsule until we get in there and see how much room there really is. Then at the same time, the capsule will have to be tightened on the inner border, or medial aspect by the sternum, too. Depending upon the strength and quality of your capsules this may also require reinforcement with a material called acellular dermal matrix, which is a skin collagen product taken either from human donors or pigs. I don't always feel the need to use that, but it's worth mentioning just for your information. In the end, you will want to be sure to consult with properly trained and experienced board certified plastic surgeons who know how to do this procedure, as it can be technically challenging sometimes. Once you are properly evaluated, your surgeon can explain the details of exactly what will need to be done to improve the appearance of your breasts. Good luck.
