Will the asymmetry in my breasts resolve with time and will the implants appear larger as they settle? 1.5 weeks p.o. (photos)

Question

I had 295 Natrelle Soft Touch round implants placed over the muscle 1.5 weeks ago. I was concerned about the asymmetry of my breasts prior to surgery and now post op feel the difference is more noticeable. Is this because one side has not dropped as much as the other side or will this asymmetry remain? Also, given that they are overs will the size remain about the same? I'm feeling that they are too small but am wondering if they will appear larger as they settle in.

Karl William Schwarz, MD · Answer

The short answer is it is too early to tell. 
We certainly know that preoperative asymmetry in nipple position, breast position on the chest, and chest shape will not be changed by the addition of an implant. Implants are however good at improving discrepancies in breast volume with use of different volumes of the implants during the operation. Giving you a concrete answer in terms of symmetry is not possible at this stage of your recovery and won't be probably for another 6 months or potentially even longer. I will say however that implants placed above the muscle tend to achieve a final result more rapidly then the traditional location below the muscle that most of us use. It also looks as if your right breast implant is just lagging behind your left implant in its descent and this is something we can see and it usually eventually catches up to the other side restoring symmetry.
Will your breasts get larger? The implants of course will not change in size, but what you will find is that as the implants settle you will lose some of your unnatural upper pole fullness, and the breast will take on a more natural shape, and that lose of fullness in the upper part of your breast will be gained in the lower part of your breast giving you the impression that your breasts have become larger.

Richard H. Tholen, MD, FACS · Answer

Asymmetry present before surgery will remain if you add identical implants to each side. Volume asymmetry, that is. If you have positional or anatomic asymmetry, this too should not be changed by adding identical implants to each side, assuming they scar, heal, drop, soften, and settle the same on each side. But let's do a little mathematical exercise regarding size discrepancies, the most common concern when someone asks about asymmetry.BTW, thank you for spelling asymmetry correctly--you would be surprised to see how many physicians even spell it "assymetry!"For example, let's say you have breasts whose natural volumes are 90g on one side, and 100g on the other. This is a 10% volume discrepancy, right?! Now, add identical 400cc implants to each side, for a total of 490g (1cc = 1g) on one side and 500g on the other. This is now a 2% difference! However, there is still an absolute difference of 10g, the same as you started with.Still, with breast augmentation, natural differences often seem magnified--especially since healing differences are usually much more noticeable. Also, remember that your chest and ribcage exhibit differences between sides--your left chest has a heart that causes more rib protrusion on that side, and this usually means a slightly narrower ribcage and breast base with slightly more (apparent) breast projection. The right chest does not contain a heart, so the ribs are flatter, breast base is slightly wider, and breast projection is less, meaning that absolutely identical breasts (and who has that?) already LOOK different because of natural chest wall anatomy asymmetry! Plus you might have more muscle bulk on the dominant hand side, etc.Positional asymmetry (one dropping faster than the other) can be improved by use of an elastic bandeau positioned above the higher implant and below the lower implant ("Mexican gun belt style") at night. You will need to wear a T-shirt over the elastic bandeau and safety pin the elastic band to the T-shirt to keep it in place as you sleep. Ask your surgeon about this option.I'm not sure why you or your surgeon went above your muscles. You do not have much ptosis at all, and the slight submuscular compression on implants can easily be accommodated-for by adding 10-15% volume to the chosen implant size. Implants don't shrink OR swell as time goes by, either above OR below the muscles. Below-muscle placement minimizes risk of bacterial biofilm on the implant surface, and thereby reduces the risk of capsular contracture. Above-muscle placement exposes the implants to the intraductal bacteria from the base of your breasts. But I wasn't there for this discussion you had with your surgeon, and I don't know his/her thinking on this. I do know the vast majority of experienced breast surgeons go below the muscles for the very important reason noted above. Regardless, as healing progresses, tissues stretch, and scar capsules soften, so your breasts will develop a more teardrop shape with slightly more projection. If you had lots of post-op swelling, this goes away over time, and the end result is the perception of "smaller." If your surgeon uses careful tissue handling and precise technique that results in less swelling post-op, as tissues stretch and scars soften, implant projection increases can be perceived as slightly "larger." Either way, implants don't swell or shrink, so there's that!The important take-away here is that at 1.5 weeks post-op you are far from your final result. Complete healing can be determined by looking at your external scars. Once they have completely faded, softened, and flattened to (hopefully) a thin white line, you know your internal scar capsules have similarly completely matured. This take all patients 6-12 months, during which changes can occur by activity, bra pressure, gravity, and ongoing scar stretch or contracture. This is also why SOME women who look fantastic at 3 months post-op end up looking pretty funky (now there's a medical term we all recognize!) at one year post-op. And then they march right into the office wanting to know what the darn surgeon did wrong!If you are "too small" at 6-12 months post-op, you can always go back for larger implants. Any residual asymmetry can also be addressed at that time. Breasts are NOT twins, they are sisters. Perfect symmetry is virtually never seen (go back to basic anatomy lesson above!). You may be interested in more information which you can access by clicking on the web reference link below for my Comprehensive Guide to Breast Augmentation. Best wishes! Dr. Tholen

Emily B. McLaughlin, MD, FACS · Answer

Thank you for your question. Keep in mind it is not uncommon to have swelling and you are still early in your recovery process. Breasts may not heal at the same rate, causing one breast to appear different than the other. It can take up to 12 weeks for the implants to settle and you to see the final result. If you had any asymmetry prior to surgery, identical sized implants will not correct this. Adding implants can exaggerate the asymmetry but wait at least 3 - 6 months before deciding if you are satisfied with your final result. Follow up with your board certified surgeon to address your concern. Good luck!

Will the asymmetry in my breasts resolve with time and will the implants appear larger as they settle? 1.5 weeks p.o. (photos)

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Will the asymmetry in my breasts resolve with time and will the implants appear larger as they settle? 1.5 weeks p.o. (photos)

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Everything you need to know about Natrelle Breast Implants

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