Why Doesn’t My Breast Implant Revision Look Right?

Q: Dr. Eppley, I had breast implants placed, 500cc silicone gel implants placed under the muscle, four months ago. After surgery my right implant was seen to be lower right after surgery and it stayed that way. Then three weeks ago, I had the implant revised and tucked up higher. I am concerned now as it doesn’t look right. The bottom part of the revised breast looks square like a straight line across the bottom. It does not look like the other side. Attached are some pictures of my breasts before and after. What do you think?

A: Let me share with you some general

thoughts about the type of breast implant revision that you had. Unfortunately breast implant asymmetry is not rare, averaging around 5% to 7% in most practices. It can be caused by the patient’s own pre-existing breast asymmetry (often unrecognized), over dissection of the implant pocket, disruption of the IMF (inframammary fold) ligamentous attachments or stretching of the pocket due to the weight of the implant. Regardless of the cause, bottoming out of a breast implant is more of a challenge in which to have a successful revision than when the implant is too high. This is because a new IMF must be established and then it must stay stable as it heals. Inevitably when the revision is done, the bottom pole of the breast and its new fold level is rarely going to match perfectly with the other side. Some plastic surgeons prefer to set the new IMF at the horizontal level of the other side, others choose to make it higher with the expectation that there will be some rounding of the lower pole of the breast as it heals and settles. Either way, the new fold will often look like a straight line rather than a rounded curve like the other side. This shape is often unavoidable. Whether it will round out somewhat or stay the same is impossible to say at this early point. It is going to take up to 3 months to see how its shape evolves. What matters most at this point is that the horizontal level of the implants are fairly even. If that stays that way then it would be best to leave it alone. While that may not be the ideal shape you want, further efforts at manipulation may cause other problems (longer scar, infection) that may not be worth the risks and trade-offs.

Dr. Barry Eppley