Breast Implant Asymmetry

An unfortunate outcome after breast augmentation can include breast implant asymmetry or malposition. This is when the breast implants appear to be in different positions on the chest wall. The asymmetries vary from barely detectable while closely studying the breasts in a mirror, to easily detectable, even while wearing a bra and clothing. The more obvious asymmetries may require a revision cosmetic surgery for correction. The type of corrective surgery and its sophistication depends on the degree of breast asymmetry and its cause.

Upper pole fullness

If your breast implants appear to have an unnatural fullness to the upper half of the breast, they may have either failed to descend, or have risen up. This can be treated by lowering or releasing the tissue that is holding up the implant on that side. The implant will now rest in its new lowered position.

Lower pole bottoming out

A more challenging problem occurs when the breast implant is placed too low or settles over time. This may occur due to excessive weight of the implant, poor breast tissue elasticity, or from the implant pocket being made too low. With all of these situations, the fullness in the bottom of the breast is known as lower pole ‘bottoming out’. Typically, a “corrective” or “revision” breast implant cosmetic surgery is performed where the breast’s infra mammary fold is reconstructed on the affected side. You will usually have to wear an underwire support bra for at least one month to allow this newly created fold to heal. It is this fold that will now support and hold up the breast implant to keep it in the proper position. If proper support is not maintained, the newly reconstructed fold may fail, resulting in the recurrence of bottoming out.

Nipple misdirection

Another type of asymmetry involves the position of the nipple (and areola) on the breast mound. Ideally, the nipple areolar complex should be near the most projecting point of the breast mound and fairly symmetrical. Sometimes after surgery, the nipple position can appear to be much more asymmetrical than the starting point. There are many factors that may contribute to this. One factor is the position of your nipple areolar complex on the breast itself. If it's naturally positioned towards the outside, cleavage, or bottom of the breast, then additional surgery may be needed for this to be corrected.

Another factor is breast implant size. Choosing an implant size that doesn’t fit the dimensions of your chest wall may place the nipple areolar complex in an unnatural position. Here, correction is made by changing to a more appropriate implant size. A third factor is implant placement. When the implant is placed too high the nipple tends to point downward. If the implant is too low, the nipple points upwards. If the implant is too far to the middle, the nipple points to the side. Finally, if the implant is too far to the side, the nipple points to the middle. This can be disturbing and require revision breast implant surgery for correction.

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