Pocket Disection Wrong? (photo)

I am almost 4mo post op. My breasts/nipples were not noticeably uneven before surgery, but the day I came home from surgery, my breasts were very uneven and my nipples looked lopsided. I wore a strap over my right breast for 3 months to try to push it down to the same level as my left breast, but it did not help. Could my surgeon have possibly disected my pocket unevenly?

Doctor Answers 6

Breast Asymmetry #breastimplants

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It would be nice to see your breasts before surgery to see what kind of symmetry issues you had. Lots of patients think they are symmetric prior to surgery but if your exam is not thorough and asymmetry is not pointed out to you before surgery, then often times you see it more post op and then wonder what happened. It is clear in your post operative picture that you have much tighter lower pole on the right compared to the left. If you were like that pre operatively it just needed to be recognized and attempted to correct. I have been in this situation and it can be very difficult to get the breast with the tighter lower pole to expand the same as the opposite side. I tell patients with lower pole asymmetry that they can expect a potential second surgery if I am unable to get the implant to drop well like the side that is not tight. You may need a revision at some point to try and lower that right implant and get the lower pole to stretch better. Even then it can be tough to get them exactly the same.

Scottsdale Plastic Surgeon
5.0 out of 5 stars 54 reviews

Persistent asymmetry of the breasts four months after breast augmentation will probably require surgical revision.

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If your breasts were truly symmetrical prior to the operation than the asymmetry in the photographs will probably require surgical revision. There seems to be some improvement over time so I would watch this a bit longer to see if further improvement occurs.

Breast differences

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It is very difficult to compare the breasts when the pre-op photos are not posted. Breasts will look differently with implants and differences are often magnified.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast dissection wrong??

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Again, it is hard to tell if anything was done incorrectly from just online photos ( and I agree also not fair).  I did seem to notice that your left nipple seems more prominent and protuberant than your right and that your left breast mound appears slightly larger than the right. It is hard to tell if this is just swelling from these photos. It would be helpful to see your preoperative photos as it appears to me that you have at least an element of "tuberous breast" deformity. If your left breast was slightly larger and you do have tuberous breasts then you would need correction of  the tuberous breast with a periareolar mastopexy (breast lift).  You should discuss this possibility/concern with your surgeon as we can not tell as adequately from online photos as he can in person. Best wishes.

Breast Asymmetry because of Pocket Dissection Incorrectly?

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It is difficult ( and not fair) is for online  consultants to comment  on whether something was done “wrong” or not. Generally speaking,  asymmetric breasts implant pocket dissection can occur;  certainly we can agree that no plastic surgeon is perfect.

 At this point, your concern about the degree of breast asymmetry is understandable.  At some point, revisionary breast surgery may be necessary to improve your outcome. This operation may involve lowering the breast implant pocket on the right side and raising the left side as well ( if necessary to improve breast symmetry overall).

 I hope this (and the attached link) help.

Pocket Disection Wrong

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Thanks for adding the more recent photos. These look a bit less different that they did on day one.

The left implant looks like it crosses the over the midline, and sits lower the breast fold. Although it may be simpler to  lower the right implant, I don't think that will be enough of an improvement. Some sort of lifting will probably be needed to bring the nipples and areolas to even levels. 

Without a preop photo, it is hard to comment on the pocket dissection. If indeed the breasts were even before surgery, and the difference is clear on day one (as it is) then uneven pocket dissection is a likely cause. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.