Why is one breast larger than the other after surgery?

I hope this doesn’t sound crazy, but it’s been 2 weeks since I had my breast augmentation and my right breast is visibly larger than my left. My surgeon used the same silicone implant on both boobs that was supposed to make me go from a small B to a nice full D cup. Should I be concerned or should I wait longer to see if they start to look more uniform?

100laura

F, 26, Pennsylvania

It's not unusual for patients to note that one breast is larger than the other after breast augmentation, particularly patients with very little natural breast tissue. If your breasts were the same cup size before augmentation and the implants inserted were also both the same volume, the most likely reason for a difference in size is swelling. You mentioned that it has been two weeks since your surgery so it is probable that swelling is causing asymmetry in your breasts.

Swelling takes some time to resolve. It usually takes four to six weeks for most swelling to subside before you can make any aesthetic judgments about your new breasts. Even then, the appearance of your breasts will continue to change for the first year after surgery, with diverse factors influencing the time it takes for your breasts to appear symmetrical and proportionate. That being said, most patients are very satisfied with their results after three months.

There are things you can do to help diminish the swelling in the meantime: if your surgeon approves, you can wear a compression garment. Compression bands help to minimize swelling by exerting very light consistent compression on your new breasts. This helps to accelerate recovery and also encourages the breasts to settle more quickly. You can also use massage to help position the implants: it can take time for implants placed underneath the chest muscle to descend, and they may then descend at different rates causing asymmetry. Push the breast up 20 times and release, then push the breast towards the midline of the body 20 times and release. Perform these exercises three times a day for the first year after surgery.

Also, be patient: it takes time for the final results to appear. If you do feel concerned, however, contact your surgeon to discuss the asymmetry so they can put your fears to rest and rule out any serious, rare causes of postoperative unevenness in the breasts such as hematoma formation, implant migration or capsular contracture.

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Breast Augmentation before image performed by Dr. Jonathan HeisteinBreast Augmentation after image performed by Dr. Jonathan HeisteinBreast Augmentation before image performed by Dr. Jonathan HeisteinBreast Augmentation after image performed by Dr. Jonathan HeisteinBreast Augmentation before image performed by Dr. Jonathan HeisteinBreast Augmentation after image performed by Dr. Jonathan HeisteinBreast Augmentation before image performed by Dr. Jonathan HeisteinBreast Augmentation after image performed by Dr. Jonathan Heistein

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Asymmetry in the breasts is common for several weeks to several months after breast augmentation surgery. Soft breast tissue swelling and fluid collection can create distortions, making the breasts look uneven. This lack of symmetry will correct over time as the implants settle and heal from surgery. In some cases, plastic surgeons may also use postoperative compression garments to minimize swelling or encourage swelling to subside more quickly. For the majority of patients, as the swelling goes down, breast asymmetry improves. However, there are several other issues that can also cause breast asymmetry.

Another factor is that the implants may settle and descend at different times and that also can cause unevenness. Patients who have had their implants placed under the chest muscle will notice that the breast shape and size changes in the immediate postoperative period. The breasts may initially appear high on the chest and overly full in the upper pole of the breast, but after six weeks should begin to descend to a lower, more natural position and develop a more rounded appearance with better projection. Until both breasts have reached the place where they will sit on the chest and develop lower pole fullness, some asymmetry is possible. Massage is recommended by most surgeons to help relax the pectoral muscles and encourage the implants to descend and achieve a lower position and more natural appearance.

Finally, some patients have natural asymmetry in their breasts prior to surgery. In some cases, perfect symmetry may not be attainable because of deformities in the chest wall, asymmetry in the nipple-areola complex or unilateral breast sag. If this is the case for you, however, your plastic surgeon should have identified the issue prior to surgery.

In a very small proportion of cases, implant malposition persists beyond the recovery period and a revision procedure is necessary to correct the slight differences in or different sizes of the breasts. In your case, at two weeks after surgery, it is highly likely that your asymmetry is due to swelling and the issue will correct itself within several months without the need for a secondary procedure. If you do feel anxiety about the difference in breast size, however, contact your surgeon. They know the specifics of your case and will be able to offer advice and guidance to reassure you as you move through your recovery.

Dr. Frederic Corbin has 1 Breast augmentation before & after:

Breast augmentation before image performed by Dr. Frederic CorbinBreast augmentation after image performed by Dr. Frederic Corbin

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Without knowing much more information about you, your breasts before the operation, the implant, and the surgery, it's impossible to answer your question.  Be sure to discuss your goals and concerns with your own board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified. 

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Dear 100laura:

There are several reasons why there could be a discrepancy of your breast size following breast augmentation.

  • Preoperative breast asymmetry.
  • Unknown rib/chest wall differences
  • Seroma or hematoma collections in the pocket.
  • Unequal implant settling in the pocket.
  • Unequal implant size or shape (see your implant card)

Arrange a follow-up evaluation for the surgeon to check your breasts for any of these or other concerns.

I wish you well.

Sincerely,

Dean Kane, MD, FACS

410-602-3322

DrDeanKane.com

https://drdeankane.com/?s=breast+augmentation+asymmetry