Smaller Breast is Now Larger and Very Firm Post-op

I was very flat to start with only a AAA on the right and nothing on the left. My surgeon put in 250 mentor plus, leaving the right at 250 and pumping the left to 315. Two days post op, the left is much larger and firmer. Could too much have been put in? Also will it always feel firmer than the right? Thanks.

Doctor Answers 10


If your surgeon over  filled the left implant and they were the same type of implant, then yes, it will always feel firmer.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Enhancement

If its a hematoma you would be in extreme pain and that side would be dramatically swelling, if that didnt happen than it is quite normal for the smaller side with a bigger implant ti hurt more

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

VIDEO; Exercises to help soften implanted breasts

Placing a larger implant into a smaller breast will always make that breast feel firmer and harder. Generally speaking, it may take 9 months to see the skin soften and the breast settle. Implant displacement exercises, performed more on the left side,  may help expedite the process if recommended by your surgeon. I have attached a video.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 reviews

The amount of saline injected in the left implant is the most likely cause of your problem.

There are a few possible explanations for your situation. You say that your surgeon placed a Mentor 250cc  moderate plus implant filled to 250cc on the right and 315cc on the left. This implant is ideally designed to fill to a maximum of 300ccs so it has been slightly overfilled. Overfilling is a common and acceptable technique, However, in doing so the implant becomes more firm and tense then when filled to the company recommended volumes. This overfilling very well might explain why the left feels so much more firm and if so this breast will remain like this unless a surgical revision is performed. The fact  that  your left breast is now larger may also have to do with how much the left implant was filled. It is possible that less saline was needed in this implant to balance your size differential.  Again, to alter the saline content of this breast a formal surgical revision is necessary. There is also a possibility that you have had some excessive bleeding in the left breast that would account for the firmness and size issues. If so, this would require immediate attention and a reoperation to evacuate this accumulation of blood. Your surgeon should be able to recognize this situation. In the absence of this latter complication the most likely explanation relates to the volume of saline in the left implant. A possible and relatively simple solution would then be to undergo a revision with the intent of removing saline from the left implant.

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

Overfilling Saline Implants

The use of adjustable saline implants can be very useful to achieve symmetry. When an implant is overfilled the characteristics of the implant change.  There can be a slight change in shape  as well as a change in the feel of the implant.  It becomes firmer.  The tradeoff in your case is more even and larger breast with one being slightly firmer.

Dr. ES

Implant Stiffness is the Cost of "Over-Filling" an Implant

Regarding: "Smaller Breast is Now Larger and Very Firm Post-op
I was very flat to start with only a AAA on the right and nothing on the left. My surgeon put in 250 mentor plus, leaving the right at 250 and pumping the left to 315. Two days post op, the left is much larger and firmer. Could too much have been put in? Also will it always feel firmer than the right? Thanks

Sorry to hear about your predicament.

As Plastic surgeons we are forced to do the best we can with the "hand" or condition our patients "deal" us. I am sure most surgeons would prefer operating on identical breasts but that is seldom the case. Asymmetry in everything is the rule of nature. As your question exemplifies, the trouble starts when the patient was not properly educated or did not understand her options in such cases.

With MILD breast asymmetries, the use of saline implants is a definite PLUS. With the patient being seated upright on the OR table minor volume differences between the breasts (after implant placement) can be significantly improved with differential filling of the implants; IE putting a little more on the smaller side than the larger side.

BUT - the more symmetry is gained, the stiffer the implant becomes. You cannot add more volume to an implant and not get more fullness and stiffness. By your account, an extra 65cc of saline were added to the formerly smaller breast (implant). That would account for the stiffness.

The other choice would have been to use temporary OR implants and based on the appearance, put a larger implant on the smaller side without overfilling it. In many cases, we would do it with silicone gel filled implants which are lighter and ripple less than saline breast implants - a considerable advantage in women who by definition do not have a large amount of breast tissue to cover ripply saline breast implant.

I would wait a few months and see how they settle. If you are still unhappy you may wish to replace them with sizer guided silicone gel implants.

Good Luck.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 109 reviews

Changes Soon After Breast Augmentation

With different breast implant fill volumes, you will see some difference in the size and shape of the implants rleated to the degree of difference.  However, a significant change with firmness, often bruising on one side and a difference from the original, you cannot rule out or exclude a hematoma - bleeding into the breast pocket. I would contact your surgeon for a definitive answer as this can only be evaluated in person by a trained professional.

Best of luck

Vincent Marin, MD, FACS

La Jolla Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 47 reviews

Please send pictures

It is impossible to give you a good answer without picture or examination. Have you called your doctor?

Please discuss your concerns with your plastic surgeon.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

Larger firm breast

You may have a blood collection, especially if this is significantly different from how it was right after surgery. I hope by now you've hurried back to see your surgeon! Good luck!!

Verne Weisberg, MD
Portland Plastic Surgeon
4.5 out of 5 stars 17 reviews

Very Firm Breast 2 Days Post-op Could be Hematoma

It is difficult without a photo, but significant asymmetry and differential firmness could represent a hematoma and you should contact your plastic surgeon right away.  There are other possible explanations, but if it is a hematoma it should be treated without delay.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 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.