Uneven Breast After Augmentation. Will my Doctor Fix This? Do I Have Pay Again?

Question

I had my breast done on January 5th,2011. Almost 3 months now I still feel that my right breast is bigger than the left one. I also think that they are different shape. When I told my dr about it. He said that my right/b was bigger with one teaspoon and was not a big deal. But I can see that they are different size and shape. I was a B/C. he put 440 on the L and 435 on the R. Will he fix this at no cost or I have to pay for it if I asked him to redo it? my breast were always different size befor

Richard H. Tholen, MD, FACS · Answer

As my colleagues have already stated, your breasts did not start out exactly symmetrical, and the difference now is present, but truly minimal. What is NOT minimal is your anxiety over this, which should be less at least until everything has completely healed, settled, and softened!

	Even when we perform the same exact operation on each breast, EVERY patient has some difference in the swelling, bruising, discomfort, firmness or softness, position, sensation, and shape between the breasts. If you look closely at your pre-op photos with your surgeon, you will almost certainly see some subtle differences you didn't really notice before. But now, after surgery, you're looking much more closely, and your mind "magnifies" each and every slight difference. Did you know that your right chest wall is probably flatter and slightly wider than your rounder and narrower left chest wall? (This is because we each have a heart on the left side, and the ribs curve around this organ). Your breast measurements (if your surgeon recorded them) prior to surgery were almost certainly not identical either.

	I would not recommend any re-operation at all right now, and at 6-12 months, if you still look this good, I would probably recommend against re-operation then as well. If this continues to bother you, your surgeon and you should already have discussed revision or touch-up surgical fees before your first operation. Even if re-operation was "free" I would seriously consider that you could be risking a WORSE result than you have now.

	Remember, the enemy of good is better!

Jerome Edelstein, MD · Answer

Congratulations on your breast augmentation. Your results look great for three months. If there is a size difference, it is barely noticeable. Please note that nobody has perfectly symmetrical breasts. One breast may be different in size and/or shape from the other, and this is normal. I would recommend you wait one or two more months before considering revision surgery. If you would like to proceed with a revision, generally the costs related to it are outlined by your surgeon. All the best.

Martin Jugenburg, MD · Answer

your pictures show a very nice result.  You were not perfectly symmetrical before surgery (nobody is) and you are not now.  Certain features of your breasts do not change by the addition of extra volume (implant), your breasts (with all their asymmetries) just get bigger.  Before surgery you were used to the way your breasts looked and you did not see the differences, or if you did you didn't really pay much attention to them because you were used to them.  Now that you have implants your point of view has changed and you see things that before (although they were there) you didn't care about.  As time goes on you will once again get used to the way these breasts look and it will not bother anymore.

	You must realize that adding two identical breast implants into two non-identical breasts is not going to improve or worsen the asymmetry, it will only change how you see yourself and suddenly you see things you didn't notice before.

	Congratulations on a very nice result.

	Sincerely,

	Martin Jugenburg, MD

Christopher J. Davidson, MD, FACS · Answer

I agree with the other postings that you have a great result. There is always a small degree of asymmetry. I like to say, "they're sisters, not twins." Nonetheless, it is always important to chat about your concerns with your surgeon.

Edward J. Bednar, MD · Answer

It is very difficult to see a difference in size and also it would be helpful to see your before photos-most patients have asymmetries that are difficult to compensate for 100%. Overall the result looks good and you are also only 3 mos post-op. I would advise with your doctor and remain realistic given what you looked like before your procedure. There is no such thing as perfection.

Joseph M. Perlman, MD · Answer

When patients seen in consultation, I tell them, I don't do "perfect", but I do make them look better. As one or the other physician stated, patients aren't symmetric. One of my esteemed professors Dr. Frank Gerow, a brilliant plastic surgeon and will one of the developers of the breast implant, once said to me that if you point out imperfections to a patient before surgery, they are considered an anatomic variant. If they point them out to you after surgery, it's your mistake.
	
	Looking at the photographs, I don't see much of a difference between the two breasts. In terms of size difference, I've always gone by the rules that there has to be at least a 30 mL (1 ounce) difference in volume up to implants for there to be a visible difference.
	
	You may have a visible difference postoperatively that wasn't there preoperatively, if one of the pockets is developing a thicker capsule.

Babak Dadvand, MD · Answer

Thank you for posting the photos. First, this is a very good result and at three months you are still healing. Second, any preoperative asymmetries may persist post-operatively. As plastic surgeons we strive for symmetry, but we cannot guarantee perfect symmetry. I personally don't think you should have a revision as it potentially introduces a set of potential complications, such as capsular contracture, bleeding, and poor healing. Even if these risks are low, they still exist. As far as paying in a revision case,the policy varies from one plastic surgeon to another, so you would have to ask your plastic surgeon what their policy is.

	Hope that helps and good luck!

	Dr. Babak Dadvand

Stephan Baker, MD · Answer

No two breasts are identical.  Review your before surgery photos to remind yourself of your natural pre-existing asymmetries.

	Your photos do not suggest any need for revisional surgery.

Tracy Pfeifer, MD · Answer

I agree with other comments.  You have a very good result.  I personally do not see the asymmetry that you do.  I would caution you not to make conclusive judgements and/or decisions so early in your postoperative course.  your result is going to change more over the next 6-9 months and if you make a judgement now, you could be in error.  Give it time and then after 9-12 months you feel the same way, discuss it with your plastic surgeon.  We all want our patients to be happy but sometimes the risk/downside of additional surgery is not worth a small improvement.  Remember that every time you have surgery, there are associated risks.  So  don't risk a good/tgreat result in pursuit of perfection.

	Tracy M. Pfeifer, MD

Darryl J. Blinski, MD · Answer

From the so kindly posted photos, to me you have an excellent result. Very "minor" differences. The issue is realistic expectations. IF you have saline implants & could additional saline be added to the left- sure. But look at the risks. Infection, capsule formation. And if silicone than a new implant is needed, which has a cost. I would discuss these issues in detail with your chosen surgeon and if you still desire a "fill up" than go ahead, the risk now fall more on your head. From MIAMI

Uneven Breast After Augmentation. Will my Doctor Fix This? Do I Have Pay Again?

Answers (16)