Explore Plastic Surgery - Dr. Barry Eppley

The single most common complication in breast augmentation is asymmetry of the breasts after surgery. I don’t know what the national average rate of revisional surgery is to correct breast asymmetry after implant placement, but in my practice it is about 5%. Clearly, one can see that this risk is not rare. Breast asymmetry  after augmentation occurs because of two reasons, differences in the breast that existed before surgery and differences in the placement or healing of the implants after surgery.

Pre-existing breast asymmetry is by far the common reason in my experience. Many women have some degree of differences between their breasts, some recognize it… others do not. Sometimes those differences are significant…often they may be quite subtle. I make it an important issue to look for it and point it out. It does not take much of a difference to become magnified when the breasts are enlarged by implants. In some cases, a small breast difference can be a much bigger one after surgery. In other cases, a small breast difference is actually improved by breast enlargement. How can you tell which one will happen for any particular patient?

The horizontal position of the nipples is the critical piece of anatomy to note. If differences in the two breast exist but the nipples are at the same horizontal level, it is likely that the breasts will not be significantly different after surgery. In some cases, they may be actually improved. If the breast differences are associated with nipples that are at different horizontal levels, however, there is a good chance the breasts differences will not be improved by implant enlargement. In fact, it is highly likely that the breast differences will look worse or become more apparent. The breast implants will make the mounds look larger and more symmetric but the position of the nipples on the breasts will become more horizontally different. This can create a ‘cockeyed’ or ‘walleyed’ look to the breasts as the nipple positions become more askew as the breasts have become larger.

There are methods to improve breast implant and nipple asymmetry after surgery but it is important for the higher risk patient to understand what their anatomy is to begin with. Patients understandably expect perfect breast symmetry after implant placement but this is not a realistic goal in the patient who wasn’t symmetric from the beginning.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Despite the tremendous popularity of breast augmentation, and the relatively common occurrence of differences in most women’s breasts, there is little public knowledge about what occurs when both are mixed together in a surgical enhancement. All plastic surgeon’s made a good effort to point out a patient’s breast asymmetries beforehand, and that breast asymmetry is likely to continue to exist after surgery, but I have found that most patient’s still have misconceptions in this area.

 
First and foremost, I have found that many women don’t even know that their breasts are not ‘even’. Many do when the differences are more significant but in small differences it is often not even perceived until it is pointed out. Secondly, breast augmentation may either improve or worsen the breast asymmetry dependent upon what type of asymmetry it is. In my Indianapolis plastic surgery experience, if the asymmetry involves different positions of the nipples before surgery, it is quite possible an enlargement of the breast will make it worse. In this cases, a superior nipple lift may be considered in the more ’southern’ nipple if it is the one not at the right height. If it is a more ‘northern’ nipple, then there is no real solution to that problem short of keeping the implant higher on that side and living with mound asymmetry but with the nipples centered on the breast mound. (either choice is not great). If the nipples are fairly even and the differences are mainly in mound size (amount of skin, level of the inframmary crease), then an implant enhancement may improve the asymmetry by different fill volumes or sizes between the two sides. This is a more desireable situation and , while some asymmetry may still exist, it is likely to be better than dealing with nipple aymmetry.

 
With all of the options available in breast implants today, saline vs silicone and different projections, it is tempting to get too clever by making changes not only in implant volumes but in styles or projections as well. While this may work in some cases, it is equally possible that you may merely create a different asymmetry problem. I have found it best to usually keep it simple using some differential volumes of implants is some cases but generally not mixing implant projection styles.
In short, if breast asymmetry improves after augmentation that is a bonus but is not assured. It is not possible with any degree of certainty to predict final breast shape outcomes in asymmetry. The goal is improvement in shapes, but not perfection. To use a great quote (to whom I cannot remember to give credit), ‘this is sister surgery not twin surgery’.

 
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis