What Can I Do About Uneven Nipples and Raised Scars from BA? Is the Placement of my Scar Normal? (photo)

I got my BA done about 1 year ago, through the areola and fully under the muscle (375cc high profile gel silicone). My left nipple sits higher than my right, making it sometimes an issue to wear certain bras. I can feel my scar raised and a little hardened under the skin. There is slight numbness around my scar and nipple. When i flex or lift something, I feel my muscles tightening and harden over my breasts and they look weird. Is that normal? Mostly, I want to get rid of my scars. Thanks!

Doctor Answers 7

Breast asymmetry

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It is difficult to tell much from your photos.  Firmness in your breasts could be from an insufficiently developed pocket for the implants or the formation of a capsular contracture (thickened scar tissue that contracts around the implants).  The fact that your implants move when you flex your chest muscle is not unusual since the implants are under the chest muscle and therefore behave more like the chest muscle.  The scars are difficult to see in your pictures.  If they are raised and firm after a year then they will probably not change much on their own.  You may need to have them revised.  In my practice, this could be done under local anesthesia in the office.  The asymmetry of your areolae, in my mind, is the result of the left implant sitting too low.  If you measure from your nipple to the fold under your breast on each side, I bet the distance will differ by about a centimeter or so.   If you press your finger at the bottom of your left breast, I bet it will not only push that implant slightly higher but it will also cause that nipple/areola to rotate downwards and be more even with the right side.  If that is the case and the resulting look makes you happy then I think you will need a second operation to reconstruct the fold under this breast to a higher level.  This can be done using stitches inside the pocket.

Atlanta Plastic Surgeon
4.6 out of 5 stars 26 reviews

Pocket will need to be sutured back up

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Thank you for the question and the photos.  Most of what you are seeing in terms of nipple position asymmetry is related to the asymmetric breast implant pockets. The right breast (in the photos) with the higher appearing nipple has a breast implant pocket that is lower and likely also wider to the side than the other breast. Repair and tightening of this pocket will correct many of the issues that you are seeing.  This procedure is called a capsulloraphy (capsule repair)  The link below is from one of my patients that had the breast implant pocket repaired.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Asymmetry and Managing Scars One Year Following Breast Augmentation

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It may be best to begin by consulting with your surgeon for an evaluation because you may benefit from a #revision. Breast revision surgery is performed for a number of reasons and factors related to the patient’s initial breast surgery. One reason is asymmetry. However, there's no guarantee the #asymmetry will simply be resolved with one breast revision. There are various reasons breasts can appear uneven or asymmetrical; which have to be taken into account when your surgeon determines the appropriate approach and technique for your #revision surgery. Typically, it's best to wait 6 to 12 months depending on the reason for #revision.  Matters such as sagging or drooping  and size change will not improve with time.

To manage scars following the procedure, I suggest #scar maturation products to my clients. Such as BioCorneum or Embrace, to name a few, are recommended. But, it's best to speak to your surgeon about healing concerns.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

What Can I Do About Uneven Nipples and Raised Scars from BA? Is the Placement of my Scar Normal?

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Your result is acceptable. Since in your posted before photo you were slightly asymmetric than an increase from an implant placement can ONLY magnify they asymmetry. But again in your case I see a minor issue. As for the hypertrophic scarring, bet you wish the initial incision was infra mammary now that you determined you have scar issues. You could try a scar revision under local anesthesia. 

Is the Placement of my Scar Normal?

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Thank you for your question and the posted photos. Nothing he is as useful as him in person examination particularly when considering revisional breast surgery. In the preop photo the left nipple and areola appear higher and the ones on the right. It is hard to assess the size since the arm positions are different but if the left breast were larger before surgery it is not surprising that it is still larger after surgery. Same goes for the higher appearance of the nipple and areola on the left.

It would be useful to no the finger implant feels firm particularly the one on the right. That might explain the difference in shape which can be caused by capsular contracture.

As far as the scar is go they certainly can be improved by scar revision interestingly they appear completely normal in 2 week postop photo.There are some markings outside the edge of the scars that I can't explain. I wonder if these might be skin reaction to any scar creams he might have tried.

As far as the movement breast with flexing that occurs all the time with some muscular implants. That can be corrected by moving the implants to the plane above the pectoralis muscle. However there are disadvantages that accompany the implant position.

Should you consider revisional surgery I would suggest scar revision and release of the lower outer portion of the right implant capsule to improve your symmetry. He would have to carefully weighed the pros and cons of change in implant position. All the best.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Deformity of sub muscular implants while the pectoralis muscle is engaged can be fixed.

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Some patients are bothered by deformation of the breast implant by activation of the pectoralis muscle when the implant is behind the muscle. This can be corrected by movement to a sub glandular pocket.

Breast Augmentation Revision Concerns

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     You will need an exam to determine if the breasts are soft.  Provided that they are, a pocket revision may be performed to improve the look and symmetry a bit.  Kenneth Hughes, MD Los Angeles, CA

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.