Uneven breasts and nipples after augmentation (photos)

I had a BA 17 March 2016, so am 6 months post op. 250cc right, 275 left. I am concerned about BOTH my breasts, the right seems to be sinking lower & lower, the left remains tight, stiff and harder to the touch. I know my breasts were different sizes to begin with. I am just concerned if the healing process is going as it should. My surgeon discharged me 3 months ago with an all clear, despite the unevenness. Do I have capsular contracture? Is one bottoming out? One nipple is also a lot higher.

Doctor Answers 3

Post Op Concerns

Thank you for your question and photos. The first photo, pre op, appears to be a reversed view- if so the one nipple which was lower to begin with is still lower. It may appear more obvious to you now with more volume behind them. You do not appear to be bottoming out based on these photos however it is not uncommon for implants to drop at slightly different rates- especially when you began with volume differences. I recommend that you meet with your Plastic Surgeon in person so that they can examine you and address your concerns. If one feels significantly more firm beyond 3 months I would also advise that you have that assessed in person.
All the best

Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Concerns over final symmetry of the breasts

I am really sorry for the way results have turned out for you. This must be difficult, but hopefully my answer could be helpful in deciding on the next steps.

Thank you for your photos – it seems that before surgery, your breasts were fairly the same, and the nipple position was similar as well compared to how it is after surgery.

However, without images showing how your breasts changed after surgery over time, it would be hard to tell what is going on. An in-person exam is highly important to provide better advice.

From the pictures, I believe your problems mostly lie with the left breast which is higher up with the nipple higher as well.

Please note that it is not uncommon for breasts to heal and adapt to implants at different rates.

For some of my patients, breast implants continued to settle with aggressive breast massaging and pole wraps for up to 12 months. So although you have crossed the time to achieve final results (3-6 months), there may still be time for the left implant to drop and become symmetrical with the opposite breast.

There are multiple reasons for the left implant not dropping, but it may be the case that the muscle attachments or the inframammary fold attachments are really strong and they may be preventing the implant from dropping completely. You may require an IMF release in the future to symmetrize the breasts if it does not get better for time.

Now allow me to give you some information about capsular contracture and bottoming out so you can better understand how it applies to your case.

In general, capsular contracture (CC) can occur at any time, but most cases are documented in under 12 months (i.e., anywhere from 3 months to 12 months post operation). This is because it takes time for the fibrous tissue capsule to form around the implant, and then it will have to scar down (contract).

Now I need you to know that there are 4 grades/levels of capsular contracture:

  • Grade I — NORMAL - the breast is normally soft and appears natural in size and shape.
  • Grade II — the breast is a little firm, but appears normal.
  • Grade III — the breast is firm and appears abnormal.
  • Grade IV — the breast is hard, painful to the touch, and appears abnormal.

If your breasts do not appear abnormal, or painful, then you do not require surgery.

In fact, grades 1 and 2 CC do not require surgery, and can be fixed with breast massaging and singulair.

From your description of the left breast being tight, stiff, and harder to touch – it could potentially be grade 2-3 capsular contracture and this could require a surgical tear or complete removal of the capsule that formed.

In terms of bottoming out, it is common when the inframammary fold is released and not firmly sealed and reinforced. It can be prevented with supportive bras that work to apply upward pressure to the fold at the bottom of the breast. Here are signs to look for:
  • A weak inframammary fold will result in downward breast implant displacement once the breast implant slips below the natural or surgically lowered inframammary crease overtime.
  • Bottomed out implants end up too low on the chest wall with the inframammary scars travelling up onto the breast skin.
  • The nipples will not only point upward, but also be positioned higher on the breast mounds.
  • There will be no pain, but you may notice thinning of the skin at the bottom of the breast, which will allow you to more easily feel the breast implant.

To correct “bottomed out” breasts, a surgeon would need to secure the implant in an elevated position and then reinforce the implant capsule at the bottom of the breast with a suture technique. There may be a need for Acellular Dermal Matrix, a soft-tissue graft, in the repair. A smaller implant is often advisable, if the original was too large. In fact, receiving an implant larger than indicated by your breast characteristics and boundaries increases the risk of malposition. 

Considering all the information I provided, it is essential for you to have a follow-up with your surgeon to diagnose a problem. Their advice and instructions should take precedence over all else you read here as they are better informed about your surgical details.

Hope this helps.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 469 reviews

Uneven Breasts

Oopie, you should make an appointment with your plastic surgeon to discuss your result. It is certainly possible for a breast augmentation to exacerbate pre-existing asymmetry, but things may also still be healing. Based on your photo, you do not appear to be bottoming out. Capsular contracture can only be diagnosed on exam. Again, consult with your surgeon to discuss your concerns.

Mark Sisco, MD
Northbrook Plastic Surgeon
5.0 out of 5 stars 5 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.