One of the known complications of breast augmentation surgery is asymmetry between the two breasts after surgery. Of all potential complications with breast implants, such as infection, bleeding or other issues, asymmetry is the most common. It is the most common reason in my practice, accounting for over 90% of revisional surgeries, for a return trip to the operating room.
Why does breast implant asymmetry occur? First and foremost, it usually exists before surgery. And in many cases, breast implants will not make an existing asymmetry better. In fact, it often will make it worse after. (magnifying the problem as the breasts have gotten bigger) Therefore, it is critical that a good examination is done first so that the asymmetry is identified. Many times, the differences between the two breasts are quite small and can easily be missed. While there is often not much one can do about the breast differences, it is important that patient and plastic surgeon alike be aware that it exists so everyone will understand why any asymmetry is there after the breast augmentation procedure.
In some cases of brest asymmetry, a breast implant may make it better. In other cases, it may make it worse. How can you know what will happen? My experience is that if the horizontal position of the nipples is even, then the differences between the breasts with an implant may make it look better but certainly no worse. If the breasts are different and the nipples are horizontally at different levels, then the differences between the breasts will likely look even worse after surgery. Whether one needs to consider some additional procedure with the breast augmentation, such as a breast lift, is an option. Many patients think that placing a bigger implant in the asymmetric smaller breast will make up the difference. But this will usually not be helpful as one would think. That only works, as previously stated, if the nipples are at even horizontal levels.
Other reasons for breast asymmetry after breast augmentation is that the implants were inadvertently positioned in slightly different pocket locations or the patient’s healing process caused a shifting. It is impossible to determine the exact cause in these cases where the breasts were fairly even to start with. Regardless of the reason, the need to perform revisional surgery exists if the patient wants a more symmetric result.
Potential breast augmentation patients need to be aware of the risk of asymmetry after breast augmentation. It is not a rare risk, occurring in about 3% to 5% of my breast augmentation patients despite my best surgical efforts and preoperative awareness of it.
Dr. Barry Eppley
Indianapolis, Indiana