Who to fix breast implant asymmetry? (photos)

Question

Unilateral mastectomy 2020. TE filled 780, awaiting exchange w overfilled 800cc saline implant & reduction/lift to remaining breast. Sagging significant size 44D. Want to achieve same breast shape. Worried I’ll end up w 1 circular reconstructed breast & 1 sloped breast on reduction side. TE slide to side & now have dip in cleavage. PS didn’t seem like he wanted to fix. I asked about tightening of pocket. PS sts poss Fat Grafts but seemed put out by fixing cleavage dip?

Ryan Rebowe, MD · Answer

Based on your pictures you have a medial contour abnormality caused by lateral displacement of the implant and a lack of tissue in that area. In general this can be corrected with a lateral capsullorhaphy, in which the surgeon secures the capsule of the implant from the inside outer aspect of the breast. Fat grafting can help make the tissue slightly more thick on the medial aspect and can help with the contour abnormality. The use of a moderate plus profile implant, rather than a high profile implant, will help in matching your opposite breast.

David Branch, MD · Answer

Dear Jcolbe
Even though breast reconstruction is done purely with expanders and implants often times have a different shape then that of a reduction there are things that can be done to achieve better symmetry. It is difficult to tell from the photos but I would expect tightening the pocket on the left to bring the implant to more central or medial on the breast with a combination of breast fat grafting or fat shifting would be the most direct way to remedy what I can tell on your photo. I hope this helps.Thanks Dr. B

Gary M. Horndeski, MD · Answer

The technique I recommend is The Bellesoma Method on the non-cancerous breast. This will reshape your breast tissue creating upper pole fullness without implants, elevate it higher on the chest wall and more medial to increase your cleavage. The tissue expander is sliding lateral. You will need plication laterally and the implant placed more medially. You may also need mesh or internal material to hold it more medial, if that is a problem.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

M. Shuja Shafqat, MD · Answer

Good afternoon,
I always counsel patients that when you do a unilateral breast reconstruction with an implant, you have an implant reconstruction on one side and a natural breast on the other. That being said, it is possible to get some symmetry. 
Without an exam in person, it would be hard to give you options. You should be seen by a board certified plastic surgeon to give you the best options.
Best of luck!

Derek Fletcher, MD · Answer

I would like to see a full set of photos to give you accurate recommendations on symmetry surgery. Based on what I can see, it does appear as if the implant has fallen to the side and that pocket tightening would be beneficial with or without fat grafting.

Who to fix breast implant asymmetry? (photos)

Answers (5)

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