400 CC implants asymmetry - would exercise help? (Photo)

Question

Hi, I am posting again as I didnt include a before picture in previous post. I had implants 5 months ago. During the procedure a vein was cut in my left breast which caused alot of bleeding and recovery took 3 week bed rest. Now I feel like the the left breast is lower, muscle in the upper part is softer than the right one and it also feels bigger than the right one. I would like to avoid revision surgery at all costs but I am affraid that it will descend lower and lower. Would excercise help?

Daniel Barrett, MD · Answer

Dear adinaoana,
I understand your concern. It is unlikely that exercises will improve asymmetry. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Eric Swanson, MD · Answer

It sounds like you had a hematoma of your left breast. Three weeks of bedrest is highly unusual even in patients who have this complication. Your left breast and nipple do seem to be a little lower than on the right side. However, the degree of asymmetry is quite minor. One perfectly good option is to do nothing and accept a small degree of asymmetry. The other option would be replacing your left breast implant with one that is slightly smaller, but your nipple would still be a little lower on the left side. The asymmetry is not enough to justify doing a breast lift in my opinion.

Leopoldo Baccaro, MD · Answer

Slight breast asymmetry is common after breast augmentation. In your situation, it appears the left breast has settled a bit lower than the right. It looks like the right breast is "caught" by the muscle, which isn't allowing it to settle to a lower position. You can do massaging exercises to "push" the implant down into a lower position, however it likely wont be very effective at this point. I'd discuss with your surgeon in more detail. The best option would be a surgical revision, even though I know you're trying to avoid it. It would be a relatively quick procedure with very little downtime, so I'd definitely consider it.

Camille Cash, MD · Answer

It looks from your photos that the left breast has settled and the right is held a little higher.  Exercise is not likely to correct this.  In fact wearing a supportive sports bra is recommended during exercise.   I encourage you to return to your surgeon to discuss options.

Connie Hiers, MD, FACS · Answer

Actually, your left implant is in good position and your right is still sitting higher. I would suggest using oral Accolate and external ultrasound treatments to try and soften your capsule and encourage that implant to drop. Yes, breast exercises could also help.

Pawel Szychta, MD, PhD, DSc · Answer

If you're noticing that your left breast is lower, feels softer in the upper part, and appears larger after your implant surgery&mdash;especially following complications like excessive bleeding&mdash;it could be due to healing issues or changes in tissue and implant positioning. Exercise is unlikely to correct this asymmetry and might even impact the implants further. It's important to consult your surgeon or a medical professional to evaluate your concerns and discuss possible solutions.

Mats Hagstrom, MD (license on probation) · Answer

As a general statement, there are three main variables that determine breast augmentation outcomes.
The first is the patient’s candidacy for the procedure in the first place. The second is implant selection in regards to shape size and type and the third is the surgeons ability to put the implant in the correct anatomic location.
 Patient candidacy is important.
Patient candidacy includes variables like breast shape, breast position on the chest wall, breast divergence, and the degree of breast droopiness.
For example, in your case you have significant breast divergence, which is more on the right then on the left.
Your left breast sits slightly higher on the chest wall in your preoperative pictures, which is true for most people.
The position of the breast on the chest wall is determined by the position of the IMF (infra mammary fold) The IMF is higher on the left side in your before picture.
We can’t see the IMF on the left side in the after pictures.
It’s possible your provider opened the IMF in order to make room for an implant that’s wider than your natural breast diameter.In regards to implant selection, each plastic surgeon will have their own way of guiding patients through the implant selection process.
Regardless of what implant type or shape is used anytime excessively large implants are used the chance of undesirable side effects, complications and then need for revision surgery will go up.
 in many ways, the issues your having are related to implant size.
Implant size and potentially the positioning of the implant are probably the biggest issues excluding the breast divergence, which was directly related to your candidacy. 
It’s important for us to understand if the implant was placed above or below the pectoralis muscle.
The surgical placement of the implant has a big part in what the results look like and the especially the potential for the results to change over time.
When placing an implant behind the pectoralis muscle are usually try to keep pectoralis muscle intact, and attached to the chest wall to allow the muscle to support the weight of the implant against gravity.
 When the muscle is transected the contraction of the pectoralis muscle and gravitational forces can push the implant down. 
If the implant is placed above the pectoralis muscle, then the implant cannot be held in place by the muscle itself. Both above the muscle and below the muscle are appropriate approaches, though most plastic surgeons, myself included, seem to prefer putting the implant below the pectoralis muscle because of the several major advantages. 
It doesn’t look like you’re implants are bottoming out and that’s a good thing.
To make a quality assessment regarding the outcome of any plastic surgery procedure we need quality before and after pictures.
If you don’t have those then ask your surgeon to forward them for you.
Try to keep your arms down by your side when taking pictures.
Take pictures from about 6-8 feet away.
Use the timer on your camera or have someone else take the pictures for you.
Overall, I think the result looks pretty good.
I don’t see any strong indication for you needing any revision surgery.
I think using smaller implants would have made things a little easier and potentially giving you a little more natural outcome.
Implant envy is a real thing and lots of women like big implants.
 Big implants cause a lot of problems.
Best,
Mats Hagstrom MD

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