This is a 44 year old patient who is 5’5″ and 114 pounds who was interested in a breast enhancement after her two children. She has asymmetrical breasts and her ribs are also different side to side. The right breast is larger and it is placed more laterally than the left side. Her ribs are sloped more on the right than the left.
She was augmented with 325cc smooth silicone implants of moderate profile placed through an incision beneath the breast. I also reduced some breast tissue on the right side and did a breast biopsy for a suspicious lesion. The idea of reducing breast tissue on the right size and using the same size implants is to make the same size breasts.
In the second photograph taken after her augmentation, you can clearly see that the right breast is lower and lateral and the left one is sitting up a bit higher than is ideal. To make the situation better, I took her back for a breast implant revision. I moved the right breast implant up and medial by securing the pocket internally with sutures and I lowered the right implant a tad so it would drop to a better location.
In the third photo, you can clearly see that the situation is better. There is much better symmetry than the first procedure. This case is good because it helps illustrate that trying to get things perfect can be a challenge. She has different breasts left to right that are sitting on different foundations (her underlying ribs). The forces acting on her breast implants are different side to side because of her anatomy. I was able to “adjust” her result so that it is certainly much better but there will always be a tendency for her right breast implant to move down and to the side because of gravity and the fact that her ribs are more sloped on the right side. Think of it as a beach ball on a hill instead of level ground–the ball will always want to move down the hill because of gravity.
The key to her long term success with my revision is a supportive bra day and night that will keep her implants where they need to be. She is very proud of the appearance of her breasts. This is why I make adjustments when appropriate rather than tell a patient that a result is “normal.” What woman doesn’t want her breasts to be as good as possible?
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