One Over The Muscle, One Under The Muscle And After Revision Surgery It's The Same And I'm Still Not Symmetrical! What Do I Do?!

I first had a tuba augmentation which left me with one implant over the muscle and the other one under the muscle. After 6 years of asymmetry getting worse due to the left side (over) I went in for a revision. My new doctor kept the pockets already made and just sutured the sagging breast up higher however the breast fold is still an inch lower than the other side and the upper pole of each breast have a totally different shape from each other. Suggestions on a solution for me please?

Doctor Answers 8

Different implant positions

You need to have your implants placed in the same location, either above the chest muscle or below it. Otherwise, you are in for a lifetime of revisions as each implant behaves differently based upon where it is located. Implants placed above the chest muscle will sit quietly and behave like breast tissue. Implants placed below the chest muscle will move with the muscle and behave in concert with the chest muscle. Unless you place them in the same position, they will not behave the same way.

Atlanta Plastic Surgeon
4.8 out of 5 stars 24 reviews

One Over The Muscle, One Under The Muscle And After Revision Surgery It's The Same And I'm Still Not Symmetrical! What Do I Do?!

You need to heal for about 3 months or so. Then you need to be examined to determine the cause for the existing asymmetry. There are a multitude of possibilities here for the present look, and you need a breast revision expert to help you. Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Breast implant augmentation asymmetry TUBA

The pocket should be changed on the over the muscle side to under the muscle, and without knowing what was found during surgery, it is hard to suggest what to do. There may be no other solution than to see if your original doctor is willing to fix this, or then find a new doctor who feels comfortable changing the plane of the implant after confirming that it is still over the muscle based on physical examination. Make sure you check the credentials of whomever you choose, making sure they are board-certified and have a specialty in breast revision surgery. Also, make sure they have many before and after photos to demonstrate their previous work. Good luck...

Deborah Pan, MD
New Haven Plastic Surgeon
4.8 out of 5 stars 30 reviews

Different pockets and different looks.

The simple answer is this: move the left implant under the muscle. What your photo demonstrates is the most obvious difference of a submuscular implant versus a subglandular implant. The subglandular implant edge is obvious in the upper pole and the breast has a "rounder" appearance overall. The right breast has a smoother slope in the upper pole and less of the cleavage appearance. As for the fold, it can take several months before everything settles out. Hold off on a revision until you are at least 3 months post-op.

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

One Over The Muscle, One Under The Muscle And After Revision Surgery It's The Same And I'm Still Not Symmetrical! What Do I Do?!

The only posted photo that demonstrates the breasts despot appear asymmetric to me. Please re post better photos!

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Breast Revision Surgery

You have obvious asymmetry to your breast, but there are several additional factors that need to be determined before deciding on the best solution. First, do you have any capsular contracture in the left breast-this could account for it sitting higher. Second, did you get any improvement with the pocket plication immediately after surgery, and if so, how long before it stretched again. Third, were your breast symmetrical before your first surgery. If the folds were markedly different, they may never be made equal. Revision surgery using some internal structural support in addition to tightening the pocket may be beneficial.

Don W. Griffin, MD
Nashville Plastic Surgeon
4.8 out of 5 stars 72 reviews



If you don't have symmetry now then waiting for the breasts to settle won't help either. Having said that, I would wait 3-6months for everything to settle before I considered another procedure. This way you are not hitting a moving target.

Good Luck.

Pouria Moradi, MBBS, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 89 reviews

Breast Augment

I would suggest waiting until you are healed than having revision surgery if you are still unhappy. I would suggest putting both implants under the muscle and obliterating the old pocket

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
4.9 out of 5 stars 72 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.