Have I Bottomed Out, or is My Left Breast Just Not Settled Enough? (Photos)

I got 300 cc silicone gel implants. from the first day out i noticed the left one was further up than the right. now that i'm three months out, not only is my right larger and lower, but a different shape than my left. is it because i have bottomed out, or has my left breast just not settled as much as the right. And what needs to be done to correct this, can it be corrected?

Doctor Answers 11

Possible capsular contracture

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Over 90% of the patients I see in consultation have a right breast that is lower, wider, and larger.  So a bit of asymmetry is normal.  However, in your case you have to be evaluated for a possible capsular contracture or implant malposition.  It is unlikely that an implant will settle more after 3 months.  Both above conditions can be corrected or improved to achieve better symmetry, but it will require surgery.  Best of luck.

Los Angeles Plastic Surgeon
4.8 out of 5 stars 21 reviews

Implant Asymmetry

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Thank you so much for your question and for sending pictures.  I feel that we would need to evaluate you here in the office to make sure that you aren't experiencing a capsular contracture on the left side.  Does the left implant feel more firm than the right?  If so, I would start you off with an oral regimen for capsular contracture that would include high doses of Vitamin E, Ibuprofen, and Singulair for 3 months and see if that helps.  I would also recommend wearing a bandeau garment to help the implant settle into place once the scar capsule has softened.  This would be the first line of defense against a capsular contracture.  Worst case scenario, you would likely require another surgery to release the capsule and re-implant the implant if this protocol wasn't effective for you. It is hard to say by just looking at the images since your one arm is raised, but it is evident from the nipple positioning that the implant on the left side is not where it is supposed to be.  I do not believe this is caused from "bottoming out".  If this is not a case of capsular contracture, I would recommend waiting on any surgery to allow for full healing to take place.  Please feel free to call our office to set up a consultation so that I can further evaluate your situation. Thank you!

Tanya Aya Atagi, MD
Lone Tree Plastic Surgeon

"Settling" after Breast Augmentaton

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The process of "settling" after breast augmentation is usually not synchronous: the 2 sides will "settle" at different times.

I usually recommend some downward manpulation on the side that seems high. Ask your surgeon to see if he/she thinks this will help.

It is possible that a capsule release may be neede to ge the implant position to match. Fortunately, this is a minimally invasive procedure that can usually be done with local anesthesia, minimal discomfort and recovery.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews

The left breast appears to be too high

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Hello, There is always the possibility that a little of both is occurring, but in your case it definitely looks like the left breast needs to come down more. The pocket on that side may need to be opened up more at the bottom. Your right breast seems to be in good position from the photos you provided. All the best, Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Breast implant asymmetry

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Thank you for the question and for sending pictures.

One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).

At this stage in your recovery I think that you're right breast implant is in good position but the left breast implant is “riding  high". It would behoove you to continue close follow-up with your plastic surgeon to make sure you are not experiencing early encapsulation (scar tissue) that may be preventing the implant from settling. Sometimes, frequent  breast massage may assist the implant settling into the pocket that was dissected.

If you find that encapsulation is not the culprit and the implant remains high, revisionary surgery may be necessary. This will likely involve release of the breast implant capsule inferiorly.

I hope this helps.

Left Implant Not Settled

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It looks to me as though the left implant is higher than the right and has not settled. The right looks to be in good position. It is unlikely that the left will settle enough to achieve symmetry and you will probably need revisional surgery to lower it. The good news is that it is relatively easy to lower an implant. Good Luck

Brian Klink, MD
Vacaville Plastic Surgeon
5.0 out of 5 stars 100 reviews

Most women start out asymmetric

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Unfortunately to answer the question accurately, it would be helpful to know if you had any breast asymmetry before surgery and how much.  That being said, implants are typically fully descended after surgery by the 3-4 month mark.  Your right implant appears to be a good position.  Your left implant appears a little tighter and higher.  Several things may be going on:

1. The implant position at the time of surgery was not low enough and the pectoralis muscle wasn't adequately released to allow descent (if your implant is under the muscle.)

2. You have developed a capsular contracture of the left implant

3. The left implant is just slow to descend into position

If the implant is slow to descend, you may benefit from downward displacement exercises with a breast band for support to put constant downward force on the left implant alone.  This can help push the descent process along faster.

If the implant is just stuck up high, a capsule release procedure can help put it into the best position, but this is a surgical procedure with risk and recovery issues.

I would bring your concerns up to your surgeon for reassurance and to develop a gameplan in case revision surgery is necessary.

Good luck,

Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 69 reviews

Uneven Breast Implants at Three Months After Surgery

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It is not uncommon to have a breast augmentation look beautifully balanced at sugery and to be uneven for a while early during recovery.  Often with the use of an implant stabilization band and massage the implant will settle down to where it was placed at surgery.  This usually occurs by three months, but I have seen it take 6. The difference in position of your two implants is pretty significant.  I doubt it will drop much further.  You and your surgeon will need to review your pre op photos for symmetry and see if there are any features missed in the first operative plan.  You will likely need a simple procedure to lower the pocket position so that your breasts are a better match. Hope you get the result youi want.

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 117 reviews

Will probably need revision surgery to Correct Assymetry

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The one breast implant is positioned higher than the other. This is not bottoming out, because the one is too high. This can be fairly easily corrected with surgery. Probably will not settle on its own now.

Rodney A. Green, MD
Cleveland Plastic Surgeon
4.8 out of 5 stars 24 reviews

Bottomed Out, or is My Left Breast Just Not Settled Enough?

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Without an examination or at least looking at your Before photograph it would be presumptive to say. As Plastic surgeons we are limited to placing the central part of the breast implant right behind the nipple regardless of its location. In cases of significant asymmetry before surgery it is impossible to achieve full symmetry after a simple Breast Augmentation.

IF the left implant was this high immediately after surgery there is a chance the pocket was not fully and symmetrically created. If this came on or worsened after surgery that would suggest Capsular Contracture. Either way while gravitation MAY pull the implant down somewhat such a deformity can only be corrected with another operation.

Peter A. Aldea, MD
Memphis Plastic Surgeon

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.