1 year PO - Uneven Nipples and Breast Tightness - should I get a second opinion? (Photos)

Question

I am 1 year PO and happy with size and shape of my implants. I am very unhappy with my nipple placement. They are very asymmetrical. I got 295 cc in the left and 345 cc in the right UTM natrelle SRF implants. Recently, my right breast has been feeling internally tight and when I squeeze it I can feel what seems to be a bubble at the base of the implant, but the implant still feels soft to the touch. My left breast feels cohesive with my body but my right one feels like a foreign object/implant. My original surgeon is no longer practicing and another surgeon recommended I accept the nipple placement since there was asymmetry prior to my procedure. They also mentioned the tightness could be related to muscle soreness. Would another opinion be worth it? I’m looking for guidance and advice on if there is anything I can do to improve these concerns, or if I truly need to accept my body.

Zoran Potparic, MD · Answer

There are several issues that may be reason for your asymmetry and hard breast. First, you had asymmetry before surgery; one breast was lower, including IMF and nipple; neither you nor your surgeon payed attention to that, possibly? Second, sensitivity and hardness of implant/breast may be a sign of breast capsule contracture and may further contribute to asymmetry. I would recommend in person evaluation with a board certified plastic surgeon with a good reputation in  breast surgery. Good luck.

Harry T. Haramis, MD, FACS · Answer

All breasts are uneven left to right  before and after any surgery. This includes size, shape, folds, nipple areolae, muscle, chest wall, shoulder tilt, so forth.

They will never be identical, especially without a bra or clothing. Your post op shows better symmetry.

Also, after augmentation, healing may be different side to side. Some firmness may be a tight pocket or mild capsule and should be followed.

Nipple areolar position is close, folds are more even, shape and size post op. Any additional surgery to adjust areolae still risks asymmetries. Additional scars would be required as trade off, depending how bothersome your results are.

Further exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.

Emre Guvercin, MD, FEBOPRAS · Answer

At one year post-op, your results are considered mature, so significant nipple asymmetry is unlikely to improve further on its own. While pre-existing asymmetry can persist after augmentation, that does not mean nothing can be done&mdash;especially if the difference bothers you daily. Nipple position is influenced not only by pre-op anatomy but also by implant pocket creation, tissue redistribution, and how each side settled, so revision options may exist depending on whether the issue is implant position, pocket asymmetry, or breast tissue support. Regarding the right-sided tightness and the “bubble” sensation at the base, even if the implant feels soft externally, this could represent early capsular contracture, pocket irregularity, implant malposition, or muscle-related distortion&mdash;none of which should simply be dismissed without proper evaluation. A breast that feels like a “foreign object” compared to the other side is not something you are obligated to accept. Since your original surgeon is no longer practicing, seeking a consultation with an experienced revision breast surgeon is very reasonable and appropriate. A thorough physical exam, and possibly imaging if needed, can clarify whether this is muscular, capsular, or positional. You do not have to “just accept it” if it affects your confidence or comfort&mdash;getting a second opinion is both justified and advisable.

John Reilly, MD, FACS · Answer

Hello, let's take the concerns one at a time. If one breast feels more tight than the other a common consideration would be capsular contracture, when the expected thin scar around the implant becomes thicker and it can give a feeling of tightness on one side and sometimes even on both. There are no reliable medical treatments to stop the progression or prevent it and it would usually require surgical intervention if it continues to  worsen. Any decision for treatment would be based on the level of symptoms. Feeling a "bubble" at the bottom of the implant can simply be folding of the implant or depending on the technique, which wasn't mentioned, the bottom part of the breast implant is only covered by the overlying tissues and it is more easily felt in that location than anywhere else especially if it's under the muscle with the muscle having been released from that area. That needs to be confirmed by the examining surgeon. In regards to the overall appearance I think they are very acceptable considering you had some asymmetry prior to the augmentation and that very few people have exactly level nipples. They are certainly within the variation commonly seen. Best of luck.

Jacob Carlson, MD · Answer

One of the frustrating things about breast augmentations is that this is no way to significantly change the position of the areola on the chest. Any pre-existing asymmetries can become more obvious when an augmentation is performed, whether that is with an implant or which fat transfer.
In terms of ways to address your concern about the areola position - changing the position of the areola(s) will require additional incisions. Since the discrepancy in position of the areolas is fairly small (based on your pictures, I would estimate that the nipple position on the higher side is within 2 centimeters of the lower side), the higher side could be lower by making an incision around the areola. That obviously creates a circular scar around that areola. If that is acceptable to you, that is one way to change the areola position on one side.
If having a single circular scar around one areola is unacceptable to you, the surgeon could place scars around both areola and minimally change the position of the lower areola, thereby creating similar scars on both breasts.
Alternatively (and I personally wouldn't recommend this option), the areola that is positioned higher, could be lower by excising more skin from the lower pole of the breast along the inframammary fold. That would essentially make the inframammary scar on that breast longer - and likely extending so far along the inframammary fold that the scar would be visible near the center of your chest.
Regarding your concern about "tight" feeling - if your surgeon hasn't already performed a physical exam, it might be worthwhile to evaluate for capsular contracture. It is very possible that it is related to muscle tightness/spasms, but if it is capsular contracture, it is much better to try to manage that earlier rather than later.

1 year PO - Uneven Nipples and Breast Tightness - should I get a second opinion? (Photos)

Answers (5)

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