Asymmetrical breasts one year after surgery - would moving the nipple to the left under local be the best option? (Photo)

Question

the right side has dropped more than the left, the left side is swollen and higher than the right, The line between the breasts is not symmetrical. I don't know which one is the problem, on the right side I feel the filling moving when I raise my hand or carry something heavy and the filling seems to have leaned a little to the right and I have pain in the right nipple , I went to see the doctor and he told me that a local surgery can be performed next to the nipple to move it a little to the left and that the symmetry is because my breasts were not symmetrical before. Now I am confused, should I allow him to do the operation or is there a solution other than what he said

Yucel Sarialtin, MD · Answer

Hi, thank you for sharing the details (and photos).
Based on your description&mdash;one side sitting lower, the other appearing higher/swollen, a feeling of implant movement when lifting your arm or carrying weight, and new nipple pain&mdash;I would be cautious about doing a “nipple shift under local anesthesia” as the first step.
In most cases, nipple position is a reflection of breast/implant position underneath. If the main issue is implant malposition (for example: bottoming out, lateral displacement, pocket looseness, capsular issues), moving the nipple alone may not correct the real cause and can leave you with persistent asymmetry.
What I recommend before any revision decision:
Full in-person exam + review of your operative details (implant type/size, placement over/under muscle, incision, pocket technique).
Ultrasound (and sometimes MRI) to check for:
fluid collection/late seroma (especially if one side looks swollen),
implant integrity, and
pocket/capsular findings.
Confirm whether the asymmetry is mainly from:
right implant dropping/lateralizing,
left side remaining high/tight (capsular tightness), or
a combination.
Typical solutions (when implants are the main driver) are pocket revision procedures such as capsulorrhaphy/capsulotomy, fold adjustment, and sometimes implant exchange. These are usually done under general anesthesia, because proper pocket control is key for long-term symmetry.
When is a nipple/areola move under local reasonable?Only if the implants are already well positioned, and the remaining problem is a small nipple–areola asymmetry that truly cannot be corrected by adjusting the pocket. Then a minor periareolar adjustment may be considered.
Because you are also describing pain and swelling, I would prioritize imaging and a second opinion before consenting to a nipple-only procedure.
Wishing you a clear plan and a safe revision strategy,Op. Dr. Yücel Sarıaltın, MDPlastic, Reconstructive & Aesthetic Surgeon – Istanbul

Daniel Barrett, MD · Answer

Dear Tasteful273841,

breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.
While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ira H. Rex III, MD · Answer

From your photographs, it seems the left implant is lower than the right, causing the left nipple to point upwards.  It is hard to say without an in-person examination, but I think if this 1 thing was fixed you may have better symmetry which would be well within normal expected breast asymmetry and would not need further attention.  In these complicated situations, sometimes another opinion is worth the effort.

Leila Kasrai, MD, FRCSC · Answer

You mentioned swelling and pain which are concerning. These should be discussed with your surgeon, as they could indicate an issue with your healing.

Warren Schutte, MD · Answer

It appears that you are bottoming out on the left side causing the lower pole to look lower and nipple slipping higher (this could be your right side if your image is transposed). I would recommend in person consultation, but it appear that you need an Inframammary fold capsulorrhaphy to tighten the pocket and this should bring down the NAC some and raise the IMF fold. Again, in person evaluation/assessment is needed to assure that this is a proper plan.

Gary M. Horndeski, MD · Answer

Asymmetry is one of the hardest things to correct in plastic surgery. It appears that the nipple that is pointing outward has a larger pocket that extends too low. You may need inferior pocket plication to correct the asymmetry of the implant position. You would need a donut mastopexy to pull the nipple-areola complex inferior and medial.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

Without before surgery images it would be hard to evaluate whether current asymmetry is due to augmentation related issue, or some form of asymmetry was present before surgery? However, it appears that breast whose areola is higher needs some correction; it looks that IMF fold may be lower on that side? Lifting IMF may be one of the options to achieve more symmetry. In person examination is necessary to give you better advice. Good luck.

Brian K. Reedy, MD · Answer

Thanks for your question! If we are looking at the photos, I think the right breast is the problem. It appears to be bottomed out and substantially larger than the left. I don't think the nipple areola would be as much of a problem if the implant was in the correct place/position. I would suggest an in-person evaluation. Good luck!

Camille Cash, MD · Answer

It appears that your one implant has bottomed out.  Surgery is needed in order to correct this.  Sometimes bioabsorbable mesh can be placed to help prevent this from happening again in the future.  I've included a video that I hope you find helpful.

Tuan A Truong, MD, FACS · Answer

Thank you for your question. From the photos, it appears the left breast (right side looking at the photo) has bottomed and lowered the IMF. You can see from the scar that it has risen in relation to the other side. Discussing these issues with your surgeon may help delineate whether it is an asymmetry related prior to surgery issue, or a post-surgical issue. If the answers are unsatisfactory, a 2nd opinion can be sought. The nipple may still need to be corrected once the breast size and position are more symmetric. Good luck on your journey!

Asymmetrical breasts one year after surgery - would moving the nipple to the left under local be the best option? (Photo)

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