Experiencing some breast asymmetry after augmentation surgery is common. While the procedure aims to enhance breast size and shape, perfect symmetry is rarely achieved, even in natural breasts. Understanding the typical healing process and potential factors is important. This article explores why one breast might appear larger or different following augmentation and when medical attention may be needed.
The Nature of Post-Surgical Asymmetry
Perfect symmetry is rare in the human body, including natural breasts. Breast augmentation can highlight existing subtle differences or introduce temporary variations during recovery. Minor unevenness is often normal as the body heals. Changes in appearance occur over time as tissues settle and swelling subsides.
Initially, breasts may appear high on the chest and feel firm. The implants gradually “drop and fluff,” settling into their final position, which can take several months. This settling process may not occur simultaneously for both breasts, contributing to temporary asymmetry. Most swelling diminishes within six to twelve weeks, but some can persist for up to six months, influencing breast appearance.
Factors Contributing to Uneven Appearance
Initial Swelling and Pre-existing Asymmetries
Several factors can contribute to one breast appearing larger or different following augmentation. Initial post-operative swelling is a primary cause, and its distribution can vary between breasts due to surgical technique, blood circulation, or even sleeping positions. This uneven swelling can make one breast appear temporarily larger or higher, often resolving as healing progresses. It is common for swelling to be more prominent in the incision line, upper breast, and underarm area.
Pre-existing anatomical asymmetries also play a role, as breast augmentation may not completely correct or can sometimes even exaggerate inherent differences in chest wall structure, rib cage, or natural breast tissue. If one breast was naturally larger or had different tissue elasticity before surgery, it might retain some of that difference even with implants.
Implant and Pocket Factors
The creation of the implant pocket, whether subglandular (above the muscle) or subpectoral (under the muscle), is a crucial surgical aspect. Small differences in pocket size or muscle release can affect how implants settle and appear. Implant-related factors can also lead to unevenness.
While saline implants can be filled with slightly different volumes to address minor pre-existing asymmetries, silicone implants come pre-filled, limiting this adjustment. Implant malposition occurs if the implant pocket is too large, too small, or asymmetrical, causing the implant to sit too high or low.
Additionally, anatomical implants, which are tear-drop shaped, can rotate within the pocket, leading to a distorted breast shape and visible asymmetry. Round implants, conversely, generally do not cause visible distortion if they rotate.
Capsular Contracture
Capsular contracture is another potential factor, a condition where the scar tissue capsule around the implant hardens and tightens. This can compress and distort the implant, causing firmness, pain, and noticeable asymmetry, often making the affected breast appear higher or misshapen. Capsular contracture occurs when this capsule becomes overly thick and firm.
When to Seek Medical Advice
While some asymmetry is normal during healing, certain signs warrant immediate medical consultation. Sudden, significant swelling in one breast, especially with increased pain, warmth, or redness, could indicate a complication like a hematoma (blood collection) or seroma (fluid collection). These conditions may require drainage or intervention.
Other concerning symptoms include fever over 100.5 degrees Fahrenheit, foul odors, streaks, or colored discharge from the incisions, which can be signs of infection. Persistent or worsening pain that does not respond to prescribed medication is also a reason to contact your surgeon.
Noticeable changes such as nipple displacement, palpable lumps, or an implant that feels hard or has shifted out of position, particularly after initial healing, should be evaluated. If asymmetry worsens or persists beyond six to twelve months post-surgery, further assessment by a plastic surgeon is advisable.
Addressing Breast Asymmetry
When asymmetry is noted after breast augmentation, the initial approach often involves a “wait and see” period for swelling resolution and implant settling. Most swelling subsides within weeks, though complete settling can take up to six months or a year, especially for submuscular placements. Following all post-operative care instructions, including wearing a surgical bra or compression garment, is important as it aids healing and helps implants settle. Some surgeons may recommend specific massage techniques to encourage implant settling or to manage early firmness, but this should only be done under their guidance.
For persistent or significant asymmetry that does not resolve, various options may be considered. Non-surgical approaches, such as specialized bras or padding, can temporarily help visually balance the breasts. However, these do not address the underlying cause.
If asymmetry results from a surgical issue like implant malposition, rotation, or capsular contracture, surgical revision may be necessary. Revision surgery can involve adjusting implant size, repositioning implants, or addressing scar tissue. For instance, if capsular contracture is present, a capsulectomy (removal of the scar capsule) might be performed. In some cases, different implant sizes might be used for each breast to achieve better balance, particularly with saline implants where fill volume can be adjusted. Recovery from revision surgery is often faster than initial augmentation because breast tissues have already adapted to implants.