Do I need a revision? (photo)

I am a little over 6 months post op I'm 550cc mentor silicone gummy bear on both sides. They look dramatically lopsided to me my cleavage is uneven without a bra, my doctor says pre op one of my shoulders sat lower and that's why it looks that way. If I switched to saline and did two different sizes would they look more even??? He also said I can get a donut lift and that might help, Please help I'm not sure what to do

Doctor Answers 13

Need a Revision?

The reason your breasts look different is because one implant sits higher than the other. It is not uncommon for one shoulder to be higher than the other, although this primarily effects nipple position. It is your surgeons job to recognize these asymmetries and to account for them when marking you before your surgery. 

This could be simply be a problem of implant malposition or, given the shape of your left breast, it could be a result of capsular contracture. In either case surgical revision would be indicated. Switching to a saline implant would be of no benefit and only put you at increased risk of a palpable implant or visible rippling. A donut lift would accomplish nothing other than putting additional scars on your breast. A second opinion might be a consideration.

Kirkland Plastic Surgeon
4.8 out of 5 stars 53 reviews

Need revision

Thank you for your question and pictures.  I would say you could benefit from a revision.  To tell you exactly what you need would require an in person exam to evaluate the breasts and take measurements but your inframammary fold heights are off and one breast appears to be tighter (and possibly encapsulated) relative to the other.  I would get some second opinions from board certified plastic surgeons who perform a lot of revision breast surgeries.  Best of luck to you!

Milind K. Ambe, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 42 reviews

Breast Implant Revision

Thank you for your question.  An in person exam would be required to accurately define the issue here.  One of your folds is higher than the other and one breast appears tighter and higher than the other.  This can be the result of either pre-existing asymmetry, capsular contracture, or over-dissection.  Revision is possible at this point in time.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck.

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 20 reviews

Do I need a revision?

Looking at your single photo suggests to me that you may have a capsule contracture on the higher tighter looking side which in the photograph is the left side.  One would need to see your preoperative photographs and examine you in person to formulate a plan.  If your left side is encapsulated then a partial capsulectomy may allow that implant to drop and more closely match the opposite side.

It always helps to get a second opinion so meet with another ABPS board-certified plastic surgeon as well as your operative surgeon to help you in making a decision to move forward.  Good luck.

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

Revision for asymmetry depends on the cause

There are several things that can contribute to the asymmetry that your photos show:

  • Pre-existing asymmetry, but it is difficult to comment without a pre-op photo
  • Capsular contracture - cannot be diagnosed from a photo alone
  • implant rotation 

The plan would be based on the extent to which these factors and/or others are present.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 54 reviews

Breast Asymmetry


From the photo, it appears your asymmetry is mostly due to asymmetric inframammary folds, and how they are affecting implant shape and position. Neither switching to saline, using different sized implants, or performing a donut lift will help.  You need to visit a few ABPS certified/ASAPS member surgeons who specialize in revision breast surgery. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 90 reviews

Do I need a revision?

It looks like revision may be helpful but we would need to see preop photos and current photos with your arms at your sides in order to make any useful comments.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Do I need a revision?

In answer to your question, it depends on how much the asymmetry bothers you.  Your nipple areola's appear adequately symmetric, it is mainly the location of your inframammary folds that are asymmetric.  This can be due to a number of reasons, it could be that you were asymmetric prior to surgery, it could be that the breast with the higher fold is now encapsulating, and it could be that the breast with the lower fold the implant has settled more.  I do not agree that you need a peri-areola lift.  I recommend that you be examined in person to determine what your best options would be.  Good luck!

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 107 reviews


Unfortunately, without a preoperative photo to compare to its difficult to ascertain what is going on. There is some blunting of the right infra-mammary crease compared to the left. Size wise the right does look a little bit larger. I wouldn't  counsel any of my patients to trade saline from gel implants in order to get better symmetry. We've had good success in our office with fat grafting to make up the small degree of asymmetry. Best of luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 55 reviews

Breast revision

Thanks for your question -

It can be difficult to judge without an exam but it does seem like your left side infra-mammary crease is asymmetric and that the implant pocket itself is tighter on the left.  These can be signs of capsular contracture.  Typically this issue or other causes for your asymmetry can be successfully resolved with a small revision.

I hope this helps!

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 50 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.