Severe asymmetry - wondering what my options could possibly be. (photo)

Hello and thank you for your question.
Based on the photographs provided, the folds look fairly symmetrical. It does appear that you have some bottoming out with an elongated nipple to imframmary fold distance. You may benefit from revisional surgery with removal of excess skin along the lower poles and possible mesh placement for improved support. Good luck.

It does look like you're experiencing bottoming out on both sides. This happens when the implant drops below the natural fold, creating too much fullness in the lower pole and stretching the nipple-to-fold distance. If you're planning to remove the implants without replacing them, keep in mind that achieving symmetry can be a bit more complex — especially if one side had a larger implant and more tissue thinning. That said, a natural, balanced result is possible.Depending on your goals, options may include:A stabilizing mastopexy revision (lifting and reshaping the breast without moving the nipple)Fat grafting to restore volume and improve symmetryOr implant exchange with improved support, if you still want upper pole fullnessYou can absolutely achieve a natural result — whether using your own tissue or implants, but you might need more than one surgery.

Without a history/physical exam/in-office ultrasound, it is challenging to make official recommendations. Just from the photos, it appears that you have some pocket malposition, potentially too wide of a breast implant, and breast tissue/skin laxity. At the minimum, I would recommend breast revisionary surgery that would include tightening the internal implant pocket, placing a new implant, performing a breast lift.

Your photos show a bit of bottoming out, with a long nipple-to-fold distance and low position of the implants. I would suggest a revision using a Galaflex internal bra. This will support the implants and stabilize the inframammary fold`.

Dear fufu12,

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

It appears that the problem may be that you have inferior malposition of your implants, which is bringing the lower pole down with it. It is possible to do an inframammary fold repair, but the success rate of those depends on how you do it...and is certainly lower when an implant remains. Removing your implants and doing a revision of your breast lift would be another option.

Your implants have bottomed out and now your nipples are pointing upward. An option is to plicate the inferior portion of the capsule to push the breast up higher. Another option is to perform fat transfers to the upper poles of the breast. Another option is to use a circumareola approach to cut out excess skin inferior to pull the nipple-areola complex down to center over the most projecting part of the breast.

Best Wishes,

Gary Horndeski, M.D.

Hi @fufu12, thank you for your question and for showing us your photos. It is feasible that you can initially have a breast implant removal with breast reconstruction. In my case, I use my BRALAN reconstruction technique where I reposition the breast tissue, either too much or too little, to give an anatomical and elevated breast shape, with an L-shaped scar. Later if you want to improve the volume, you can evaluate a breast fat transfer. Consultation with a plastic surgeon who is experienced in this procedure is essential to ensure optimal results. Best wishes!

Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP)

It appears from the photos that the breast shape can be improved by tightening the bottom portion of the breasts. This will correct the nipple position. The next step is to visit with a board certified plastic surgeon near you to learn more.

Your implants have bottomed out some and are sitting too low. the inferior pockets can be tightened, and mesh may be needed. I do not recommend going up in size with heavier implants.