Breast augmentation revision advice - how can I prevent a misshapen left breast? (Photo)

I would have to do an examination to give you good advice. If you have a capsular contracture, then changing the pocket may be a good idea. Are you satisfied with your right breast augmentation?

There are times after breast augmentation despite the surgery going well, when the outcome is less than ideal and asymmetric with one implant riding high. There may be various reasons for that and sometimes we just don't know. Was there asymmetry preoperatively? Were the inframammary folds at the same height prior to surgery? It would be interesting to know what the patient had done in the second procedure to allow dropping on the left. Usually this involves lowering the pocket by removing or creating cuts in the scar capsule surrounding the implant and making more space for the implant at the bottom of the breast. Without capsulotomy-this is the cutting of the capsule, the capsule would hold the implant up. In my practice I also tend to close the upper part of the capsule where the implant was riding high with internal long-lasting but ultimately dissolving stitches to help keep the implant down during the healing time. If a diagnosis of capsular contracture had been made with a firm breast, removal of the capsule and exchange of the implant may be necessary. I am not sure I understand the rationale for changing to a tall profile anatomic implant.

Dear foophar,

breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.
While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.


Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Choosing the right implant is critical to getting a natural result. Typically, implants with lower profiles are flatter and can "reach" the upper pole of the breast. In contrast, higher-profile implants project more fullness in the front of the bra. Above or below the muscle, a subfascial breast implant above the muscle is ideal for giving more upper pole fullness while maintaining the pocket created. It is unhindered by the contractile forces of the pectoralis muscle and subsequent animation deformity. In some cases, an "internal bra" composed of absorbable biocompatible mesh can also be used to stabilize a large implant.

Thank you for your question and I am sorry that you have had 2 surgeries and complications.

It is always easier to assess and comment on your situation in person but I do not agree with anatomic implants. Perhaps placing an internal bra will be your solution. Im happy to do a virtual consultation and see if I can help.

Its difficult to truly assess by looking at a picture but I can think of possible 2 reasons- 1) a capsular contracture on your misshapen side or2) that you have natural canvas differences that become more apparent when the breasts are enlarged. Thank you!

It is difficult to advise you on your issue in the absence of physical exam. Depending on the approach to placing the implant, it could be that the left breast pocket was not adequately opened up initially to allow proper positioning of the device. This can occur if the incision is made around the areola or through the armpit. An incision under the breast is less likely to have this issue, but it is possible. I do not encourage change of plane, as this can be a rather bloody procedure, and have the undesired effect of having two pockets - unless the muscle is secured back down to the chest wall, the implant can flip from one pocket to the other. Shaped implants are great as an initial device, but in revision it can be tricky. This is because the texture that is on the implant surface is meant to allow growth of the breast tissue on the implant surface, preventing movement of the implant. In revision cases, the peri prosthetic capsule is very slick, and the surface texture is ineffective in preventing implant rotation. I have seen these implants flip in revision cases, and the appearance is bizarre. I think your best choice is to see another plastic surgeon, and see if a simple solution can be found.

Thank you for your query. I would recommend a dual plane breast augmentation or subglandular breast augmentation as your surgeon has recommended. Anatomic or round shape of the implants is less important than the placement. I often use some autologous fat as well to improve the shape All the best!

Unfortunately, you have not provided your pre-operative photograph. However, it looks like your nipple-areola complex of both breasts are pointing out laterally too much. You will need a circumareola approach to reposition the nipple-areola complexes more higher and medially. You will also need plication of the lower breast. You may be better off with smaller implants to correct the asymmetry. Anatomical implants are textured implants that are associated with BIA-ALCL, which is a form of cancer. I do not recommend anatomical implants.

Best Wishes,

Gary Horndeski, M.D.

Based on this photo it is very likely that you developed most frequent complication of breast implant surgery, capsular contracture. Just a simple implant replacement is not sufficient to correct the problem in most cases. It would be in your best interest to seek a second opinion by an experienced board certified plastic surgeon. Good luck.