Very Uneven Breasts 2.5 Months Post-op - What's Wrong?

What is Wrong with my Breast ? I Had Breast Argumentation July 15.

Doctor Answers 7

Loss of inframammary fold-implant moves downward after breast augmentation

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What has happened is the inframammary fold on the left has been disrupted so the implant has shifted downward and out of place. I assume you are happy with the right breast since your post states "what is wrong with my breast". The fold serves as a shelf to hold the implant up and in position. The surgeon should never disrupt it unless it is in the wrong position as in a tubular breast deformity.

I do not see any skin incision scars on the breast or armpit in your photo so I assume the implants were inserted via the belly button, a TUBA procedure. If that is the case this is precisely why I have advised patients against the procedure. It has never made any sense to me to make a hole in the fold to place an implant via a belly button incision. You are just setting the patient up for this problem. Furthermore you can only place saline implants using a TUBA procedure while most patients now want the cohesive gel implants. These types of implants will never fit into the barrel of the tube used in the TUBA procedure. A deflated saline implant will fit into that barrel. Once it is in position the surgeon inflates the implant with saline.

Once the fold is disrupted it can be very difficult to recreate it and even if the surgeon does it is never exactly the same as the original fold in terms of holding strength or contour.

Los Angeles Plastic Surgeon

Double-Bubble Deformity

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On the left breast, the inframammary fold (where the breast meets the chest wall underneath) has been elevated. The implant appears to have fallen below this point. This leads to a deformity known as a "double bubble." There are several ways to correct this, but they all require surgery. Essentially, the goal of surgery is to return the implant to its proper position behind the breast and to reconstruct the inframammary fold to prevent recurrence.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Re: Uneven breasts after augmentation - capsulorrhaphy most likely solution

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Unfortunately the inframammary fold on the left side has been lowered to a greater extent than the right resulting in inferior settling of the prosthesis and a double bubble result. That is why the left nipple areola is fitting significantly higher than the right and the distance between the nipple areola and the inframammary crease on the left is considerably greater than on the right side. In order to correct this you would need an open capsulorrhaphy which would shorten that distance, and draw down the nipple areola. This would gain symmetry with the opposite side, and correct the problem. This is not something that is going to correct itself or improve with conservative measures.

Asymmetry after Breast Augmentation

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Breast are naturally asymmetric, without seeing your pre-op photo, an accurate assessment is difficult. However, it looks to me like your left implant has "dropped" more  than the right side. I would discuss this with your surgeon to determine the best course of action.

Reconstructing or revising uneven breasts with bottoming out

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I would agree Dr.s Jejurikar and Rand. You will likely need a reconstruction of the imframammary crease with a capsulorrhaphy. Some surgeons utilize vicryl mesh or acellular dermal matrix to reinforce the repair but I have found that this is not always necessary. Typically, I advise patients to wait at least 4 months after the initial surgery to allow the capsule to form and mature

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Bottomed out breast implant

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Your left implant has bottomed out and slid down below the inframammary crease.  This will not self correct and will need revisionary surgery.

Malposition after breast augmentation

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Unfortunately, it looks as though your left breast implant has slid below the crease at the base of the breast (inframammary fold). As a result, the nipple/areola look to be seated too high on the breast mound.

This far out from surgery, your only real option is revision surgery. Your surgeon would need to recreate the fold with a series of sutures, or in a really severe case, an artifical skin substitue (acellular dermal matrix or ADM). Your best bet is to consult with your surgeon or another board certified plastic surgeon for a more indepth conversation regarding your options.

Best of luck.


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.