Breast Implant Revision
Thank you for your photos and questions. The photos suggest that you have pretty large implants with some bottoming out and expansion of the right pocket across the center of the chest. My impression is that larger implants are not the solution and would make your condition worse. These issues could be addressed with pocket revisions but an in-person exam is necessary to confirm these impressions and come up with the best plan suited to your problem. Breast implant revisions can be very challenging and I hope you eventually get the result you want!
Rotated breast implants
If the implants are rotated, revising the pocket called a capsulloraphy is often necessary. I don't know where you are in your post op course but if you can press on the implant and move it you might be able to move it to the right location with some compression if early in your post op course. A small band over the area will help. Otherwise, you will require surgery.
The right pocket repair or a bigger right implant?
From the photos, I agree that your tight breast implant infra-mammary fold needs to be reconstructed. Going larger will likely lead to other problems such as synmastia. I would suggest remaining same size and just repairing the pockets to improve the look and symmetry of your breasts.
Look for an experienced and well trained plastic surgeon certified by the American Board of Plastic Surgery. See more than one consult and make a well informed decision.
Thank you for the photos and question and YES the pocket does need to be revised and can be in the hands of an expert. So go on some complimentary consultations, look at photos of similar patients and find your surgeon.
Bottomed out implant
It appears to me that the right implant pocket is elongated causing the right breast to bottom out. When a breast implant migrates below the
original placement location with the bottom of the implant just above the
infra-mammary crease, we call this “bottoming out.” There are several causes of
this downward migration of the breast implant. Usually, some attempt had been
made to lower the crease to accommodate a breast implant whose base diameter is
larger than would otherwise fit in the natural breast. In doing so, the
anatomic attachment of the skin of the breast to the chest wall can be
obliterated. There is then nothing to hold the implant up. With the weight of
the implant, and constant gravity, maybe lack of support by lack of wearing a
bra continuously, the implant can settle downward. One of the earliest
symptoms, I see in patients seeking revision,has been the feeling that the
breast has to be constantly adjusted or just feels heavy. We look for the
incision line, which was previously placed at the crease, to have migrated
upward onto the breast. When we see this early on in the postoperative phase,
it will never get better with time and will require a secondary repair. While
some plastic surgeons may rely on suturing techniques only, I have found that
unless we un-weight the implant by making it smaller or strengthen the tissues
below by making them less stretchy, that the same implant, with just sutures placed on the bottom of the
pocket, will, over time, recur it's bottomed out position. I have used part of
the capsule as well as the lining of the deep muscles and tissues over the ribs
in the capsule beneath the breast implants to rotate upward to hold the breast
implant in a higher position and therefore obliterating the extra space that
has been created between the correct infra-mammary crease and the one created
by the downward displacement of the implant. I call this a three flap technique,
as the skin, the capsule and fascia (lining of muscles), as well as a dermal
flap all contribute to creating a hammock like support of the lower portion of
the pocket. When these tissues are insufficient to hold the implant up, or a
previous attempt has been made with sutures, I will oftentimes rely on the
addition of another type of tissue called an acellular dermal matrix of which
my preference is Strattice. This Strattice ,or pigskin, does not stretch and
can be sewn in to the bottom of the new location of the crease to support it
just like a hammock would. Although this is costly, I consider this an
insurance policy against having to redo this again. I would recommend that you
try and find a plastic surgeon with experience in revisionary cosmetic breast
surgery. Good luck.