10 Weeks Post-Op BA, One is Placed Higher than the Other, Nipples Pointing to the Sides, Why Did this Happen? (photo)

I have posted about my problematic BA before. I included the before pictures this time b/c Dr.s say it would be helpful. 450cc Gel above muscle 10 weeks ago. Left is too high, right is too low. I think moderate profile may have been a better implant option for my anatomy. Also, my nipples are pointing to the side and the right one has bottomed out. I want to use my existing implants because of the added cost of purchasing new ones. 1. Why did this happen? 2. What will it take to make them nice?

Doctor Answers 12

10 weeks post op asymmetry

Thank you for the question. You are still in the post operation recovery stage. It is not uncommon to feel pain,swelling, and asymmetries during this period. It usually takes about 8-12 weeks for the wounds to heal and around 4-6 months for the implants to fully settle. It would be best to visit your board-certified plastic surgeon and get a full assessment if you have any concerns. Best of luck. Dr. Michael Omidi.

An in-person exam with a board-certified plastic surgeon is the best way to assess your needs and provide true medical advice.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 91 reviews

Breast asymmetry

From your preop photos it is clear that the left nipple is lower than the right and tthe right fold now has a double bubble. More than likely you will need a revision.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Asymmetry before augmentation and asymmetry after.

Thank you for the before and after photos. From your before photo, it appears as though you had some asymmetry between the breasts to begin with. The left nipple appears lower than the right and the left fold is also a bit lower. After surgery, the left nipple remains lower, but the effort to lower the right fold has resulted in a "double bubble" deformity. This happens when the fold is lowered but not entirely released causing a band to form (in reality, not a band, but the original fold line). Correction requires a fold recreation on the right breast with a minor lift of the left nipple. Your nipple position on the outer aspects of the breasts is within the normal anatomic range that we see. That is simply due to the position of your breasts/nipples on your chest wall (note the separation between your breasts before surgery). As for costs associated with correction, you need to discuss this with your surgeon.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 25 reviews

Surgery will be needed to correct your right breast.

There are two reasons for your problematic result. First there is a double bubble on the Right side as the result of the submuscular pocket having been extended below the fold. The crease in the breast is actually the remnant of the fold. To repair this the fold must be surgically shored up from within. This will cause the implant to be positioned as it is on the left and will unfortunately result in the high look that you dislike. The size of your implant base diameter is causing this high look and is the second reason for your appearance problems. If you are unwilling to change your implants you will have to accept this higher implant position. The right breast surgery can be performed at anytime since the double bubble will not spontaneously improve.

David A. Ross, MD (retired)
Chicago Plastic Surgeon
4.6 out of 5 stars 89 reviews

Breast implant revision

Make sure you stay in close contact with the surgeon who did you surgery.  He/she should be your best resource. 

There are soooo many factors that surgeon's do not control after surgery - the tissue elasticity of the patient and gravity are the two main examples.  Need for revision occurs in the very best of hands. 

As far as your nipple position goes, that is just the way your nipples are positioned.  They were lateral to start with the implants won't change that.  I hope your surgeon discussed this with you before surgery.

IMO, your right impant has good position and your left one would be improved with lowering of the implant.  I sometimes do this under a local anesthetic to keep the cost down. 

Nobody is at fault here execept maybe Mother Nature.  I think a pretty straight forward revision can get you a nice result. 

I am sure your surgeon wants you to have the best result possible. 

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 72 reviews

Breast augmentation and asymmetry

The fundamental problem that you have with this augmentation is that the implants were not placed behind the nipple. You have breast asymmetry with tubular like findings meaning that the inframammary folds are high and the breast tissue is slightly herniated toward the nipple away from the chest wall.

You cannot correct the asymmetry in the breast with the implants. If you try to do that and did not place the implants behind the nipples the problems you are having is what will happen. You're right implant is placed more to the inside then your nipple so it makes the nipple point to the side. If the implant was centered behind the right nipple then the nipple will be pointing straight ahead like it was in your preop photo. Your left breast is lower than your right breast in the preop photo now your nipple on the left side is pointing down because the implant is too high and not centered behind your nipple.

Implants can sometimes partially mask breast asymmetries but can't completely repair breast asymmetries.  Your options are to replace the implants and center them behind the nipple in the correct fashion. I would place them under the muscle and except that there's an asymmetry in the breast, but most people have some asymmetry in the breast. Your other option is to lift the left nipple to match the right nipple and this would leave the scar lift. 

Wendell Perry, MD
Miami Plastic Surgeon
4.8 out of 5 stars 229 reviews

What and why this happened to me after breast augmentation?

Thank you for the photos. You have widely spaced asymmetrical breasts with a slight depression of your lower breast bone and a lower placed nipple on the left side. Your breast tissues are thin, do not have enough breast tissue to cover the large implants placed. I'm not sure what you discussed with your surgeon preop, but these should've been pointed out to you. You most likely would have done better with smaller submuscular implants, accepting a wide cleavage. Your nipples will point laterally because they are placed laterally on your chest wall and breasts. This is Mother Nature! Your surgeon tried to give you more cleavage (possible your request?), hence the large implants. Now you are still swollen, but in 3-4 months you will see thinning of your tissues and rippling in your implants. If you have a good rapport with your surgeon, discuss your concerns, but I would advise you to go to smaller implants before you cause hard to reverse tissue thinning. It will save you money in the long run even though you would need to get new implants and hopefully avoid multiple revisions, in essence, becoming a breast cripple. Good luck.

George Marosan, MD
Bellevue Plastic Surgeon
4.8 out of 5 stars 38 reviews

Your before pictures helps

The before pictures show very asymmetrical breasts. Your right breast is higher,wider base and sagging. Your left breast is lower ,narrower and sags more. The other issue is wide the space between your breast. Your surgeon has tried to correct too many issues with implant and that has not worked. Breast implants can make you breast bigger and higher,but not make them even. The issue is not the implant size or shape,but your breast asymmetry.You will need revision of the pocket and possible nipple lift.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 122 reviews

Unhappy Breast Augmentation

Hello Emily555,

I remember seeing your post with these pictures last week.  I do not recall whether I responded, but if I did, then you must still be shopping for an answer you want to hear.  BTW, I am sorry for what you are going through, and I am trying to get the word out as best I can, so that people like you can make the right choices before surgery.  You are not alone.  300,000 women a year get breast augmentation and 25% will need a reoperation in the first three years due to complications, the majority of which are caused by inappropriate implant size and/or profile.  Those stats are also hard to believe too, but unfortunately they are true.

To answer question number one, everything you are currently experiencing is due to your 450 cc HP implants.  I know you don't want to believe this, but I promise you it's true.  Given your quest for how you'd like to look may mean that there is nothing you can do to 'make them nice,' at least in your opinion.  So, it is difficult to answer question number two.  There is no doubt that you might get lucky by having a reoperation using the same sized implants, and get a more reasonable result. Unfortunately, even an early win might not last long.  Look at the photo of you before, and look at the new you. The sides and bottoms of your implants are essentially covered only by thin chest skin.  You will be at high risk for unpredictable tissue stetch, certain rippling, capsular contracture, and implant malposition.

If money is an issue, than you might want to consider that keeping these implants will be much more expensive in the long run than ditching them for something that fits your anatomy.  Additionally, I want to remind you that reoperation is not a simple task.  Many surgeons that perform breast augmentation are not established or experienced in complex issues like yours.  You might want to consider seeing (a potentially more expensive) surgeon that has a great reputation for reoperation of the breast.  This person will more than likely reiterate everything I've said. This will in the end not only save you money, but save you grief that I know you are having!

Best of luck

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

One implant is higher after breast augmentation

With your subglandular breast augmentation the implant should be centered on the nipple, and though your nipple points out a bit this is how things should be. The implant pockets are mismatched however and the before indicates that things might have gone better. You can 'save' the implants if the revision surgeon agrees, and we feel a moderate profile is better for most patients anatomy.

Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

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.