4 weeks post op, my left breast is noticeably smaller, harder, and 'stiff'. Do I Need Revision Surgery? (photo)
Doctor Answers 10
Do I Need Revision Surgery
Yes, if you want a better and more symmetric outcome. The left breast looks smaller before surgery, and still looks smaller despite the 25 cc differential. There seems to be an incomplete dissection on the lower middle part of the left breast. This is clear on the four day photo, so that aspect cannot be from capsular contracture.
At revision surgery the pocket dissection should be made more even, and a larger implant on the left should be considered. Usually we advise holding off for 3 to six months, but I doubt this will resolve. However, it may be more reliable in terms of choosing the correct implant size to wait until all swelling has resolved and the implants have settled.
Thank you for your question, and for the photos, which were well chosen and helpful. All the best.
Revisional surgery probably indicated in this one
Although I can't comment about any volume disparity right side versus left will it appears as though the pocket on the left side has thumb printing on the infero medial portion due to inadequate release of the tissue. A revision will be necessary.
4 Weeks After Breast Augmentation
At 4 weeks, the left breast can be massaged and can help stretch the medial breast. The left breast had more constriction and less medial fullness before surgery, so this should be expected to some extent after surgery. Continue massage and give at least 6 months. Remember that you and your surgeon both are asking for more fullness of the left breast medially where it did not exist before.
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It is too early to tell for sure. It will take 3-6 months before you know the final result. You had two fundamentally different breasts before surgery, and it takes a while for the tissue to stretch and settle. Follow your surgeons post-operative instructions.
Revision of breast surgery
It appears that you will require a capsulotomy to revise the fold under the right breast and a larger implant to create more symmetry.
Talmage Raine MD FACS
It does appear that you may need further surgery, although it may be a litttle early at this point. Also your surgeon may have underestimated your size difference and you may need a larger size on the left.
Left Breast Implant Revision Needed
Clearly the pocket on the left implant is underdissected and developed. That is not an issue that more time is going to change or potentially expand out on its own. Thus I can understand your surgeon's desire for earlier revision rather than waiting. What is not clear is whether opening up the left pocket to match that of the right may reveal that the left breast implant is too small. Your revisional surgery should be approached with the possibility that a new larger implant is needed, regardless of the timing of the revision.
Do I Need Revision Surgery?
I agree with your assesment that the surgery was not completed with full understanding of the breast issues. Your before photo demonstrates an asymmetry of volume, shape, and N/A complex position. Each of which needed to be determined before the operation. On your left the dissection was limited medial-inferiorly, the size was to small that was used. You have options. Leave alone for total of 6 months to see the final result. Re operation by more medial dissection and using larger implant. Or use of fat grafts to try to even out volume and shape on the left. Or a combination. Best to you.
I think it is too soon to do a revision. I try to wait a minimum of 4 months before any revision surgery, because things change with stretching and relaxation.
At four weeks it is too soon to tell. It looks like you are still smaller onthe left side, and your implant needs more time to settle.