Worried about shape of breast looking square off in center of chest. Will they get rounder in center & bottom as it drop?(photo)

Your
question is a good one, and you have a right to be concerned. Thank you for
providing the photos, as they are very helpful in your situation. Your breasts
are a bit widely spaced, and you have some mild constriction of the
inferomedial pole of each breast (a type I form of constricted/tuberous breast).
When there is constriction of the
breast, there is some loss of the round fullness that one typically associates
with a normal breast shape. Pre-operatively, the inferomedial aspect of your
breasts showed a somewhat angulated appearance of the inframammary fold where
the mild constriction is present. Your pre-operative photograph also shows that
your breasts drooped a small amount.



Simply
put, breast augmentation makes breasts larger. If you compare your pre-operative
photograph to your post-operative photographs, you can see the same angulated
appearance of the inframammary fold in the inferomedial position. And if you
look closely, you can see that your current breast shape (following your
augmentation) still resembles your pre-operative shape to some degree.



The
implants, placed in a subpectoral position, have not adequately expanded the
overlying breast because of the intervening muscle, as well as your pre-operative
shape. I am somewhat skeptical that you will see significant improvement over
time. However, since you are early in your post-operative course, you may see
some additional improvement as time passes. Typically implants will settle into
place in about 3 to 4 months. In your situation you may continue to see subtle
changes after a longer period of time.



I
am not suggesting that your implants should have been placed in the subglandular
space, as I would have placed your implants in a subpectoral position as well.
Because of their narrowed (constricted) shape and narrowed base, constricted
breasts do not conform as well to the shape of the underlying implant. The
presence of the intervening muscle, located between the implant and the breast
tissue, limits this conformation further. In addition, it is possible that the
inferomedial origins of the pectoralis major muscle have not been adequately
released. This would also produce some additional constriction and limitation
in achieving more roundedness and fullness in the inferomedial aspect of your
breast.



The
slightly wider space between your breasts may also tend to accentuate the
flattened and angulated appearance of the inferomedial breast and inframammary
fold. The space between your breasts cannot be altered without placing implants
in the subglandular position, and again, I am not suggesting that. I mention
this only because it potentially influences the overall appearance.



Having
additional inferomedial fullness would improve your appearance, and this is
what you desire. However, it is important that your breast implants not be
placed too low. Doing so, will increase the risk of a double-bubble deformity.
So you would like your implants to settle, but not settle too much.



Your
pre-operative photograph shows some mild breast asymmetry. Your post-operative
photographs also show the same asymmetry. As I mentioned above, because of the
constricted breast shape and the tighter inframammary fold, the breast unfortunately
does not conform to the roundness of the implant. You can see this more on the
right breast, where a slight indentation (or contour change) is present in the
region of your native inframammary fold; this is the area/contour you marked
with arrows. Some of this undesirable contour can be altered by decreasing
breast projection and tightening the skin. A peri-areolar skin tightening
procedure could have been performed (and is still an option) to help improve
your breast shape by making it a bit flatter. This peri-areolar skin tightening
will flatten the breast projection a small amount and allow it to conform a bit
better (mimic) to the shape of the underlying implant.



For
now, I would recommend that you just be patient and allow your implants to
complete the settling process. You should probably wait at least six months, if
not longer, before considering revision surgery. If the inferomedial origins of
the pectoralis muscle have not been adequately released, they can be further
divided in a revision procedure. Consideration can be given to a peri-areolar
skin tightening to help improve breast shape. Speak with your plastic surgeon
about your concerns, as he/she can provide appropriate counseling and recommendations
based upon the surgical procedure that
was performed. Best wishes.

Your implant is not filling out the medial breast, and most likely is due to less complete dissection in that area at the time of surgery.  Although it may continue to improve to the point that it does not bother you, it is likely that you will benefit from a revision to achieve an optimal shape.   As others have said, you need to wait at least 6 months to judge final shape, and also to maximize the chances for success with your revision.  Overall you breasts look nice, and in the best of hands, implant revisions are necessary in a small number of patients.

From the photographs I would be pessimistic about significant improvement with time. It is possible but it looks as though you have sub pectoral implants with inadequate release of the infra medial origin of the muscle. This would require a revision. Of course I am guessing that they are sub pectoral.

Thank you for your photographs and questions and I am sorry to hear about your concern with your breast appearance after surgery.  It is difficult to know based solely on pictures what may be taking place.  It does take several months for your final results, once your implants fully drop and the soft tissues overlying the implants stretch and relax.  That said, there are times when surgical maneuvers need to be performed in order to help obtain optimal outcomes, namely releasing part of your chest muscle to accommodate the implants, as well as creating a tight pocket for the implant so that it doesn't move in any unwanted directions.  Speak to your surgeon about your concerns. They know best what took place during surgery and can provide reassurance.  

Thank you for your question and for providing photos.  It is difficult to predict your end result.  I tell all of my patients that it will take at least 4-5 months for your implants to fully settle and for all of your swelling to resolve.  I would advise you to be patient as the shape of your breasts can continue to change over this period of time.  I hope this is helpful.Best of luck,

The breast shape changes after surgery for the first 3-4 months following surgery. This may be an issue with the position of the implant and/or the technique that was used. This may or may not improve over time. Your before photos show that this area was somewhat tight to begin with. Discuss this with your surgeon, but in general, waiting to perform revisional surgery is a good idea as the shape may improve as the implants settle and the tissues relax and soften over time. Six to twelve months shold go by prior to any additional procedure. 

You should never rush into a revision but I agree that the appearance is less than good. Please allow time for settling bUt I think it is likely you will have residual asymmetry of the result. Please discuss in full with your PS

As you have correctly identified, implant position changes over the first 6 months until the implant reaches its final position.  Your preoperative picture shows that you had a constriction of the medial (central) aspect of the lower pole in each breast.  As the implant descends during your recovery this area may fill out more  depending on the surgical technique that your surgeon used.  As far as the scaring and indentation - incisions will also smooth out over 6-12 months.  Preform scar massage as directed by your surgeon.

You did have some existing asymmetry prior to your surgery so they will never be exactly the same.  I would still give it some time before deciding on revision.  The slanted look seems to perhaps be from inadequate release of the pectoralis muscle which may need a revision.  Hope this helps!

Hi there, thanks for sharing your photos. Like you said yourself, you are still early in your recovery and should expect to see a significant difference within the next few weeks as your swelling goes down. Be patient and address any concerns with your surgeon directly. Best of luck. -Dr. Coan