Breast augmentation surgery changes breast size and shape, but patients often notice some degree of asymmetry in the early weeks following the procedure. A common concern at the four-week mark is one breast appearing higher than the other. This article aims to clarify why such unevenness might occur during this initial recovery and what to expect.
Understanding Early Post-Operative Asymmetry
It is common for breasts to exhibit some unevenness in the initial weeks after augmentation surgery. This is largely due to the body’s natural healing processes and how implants integrate with existing tissues. Swelling is a universal response to surgery, and it frequently resolves at different rates in each breast, leading to temporary variations in size and position. The breasts may initially appear “high and tight” due to this swelling and muscle constriction, particularly if implants are placed under the muscle.
As initial swelling diminishes, typically by four to six weeks, implants begin a process known as “drop and fluff.” This involves implants settling into a more natural, lower position as the skin, breast tissue, and muscles relax around them. This settling can occur asynchronously, meaning one breast may “drop” faster than the other, contributing to a temporary asymmetrical appearance. The pectoral muscles, especially with submuscular implants, also need time to adjust and relax around the new implants, which can influence their initial positioning.
Specific Contributors to Unevenness
Beyond the normal healing fluctuations, several specific factors can contribute to one breast being noticeably higher or appearing uneven at four weeks post-surgery. Persistent or uneven swelling, where one breast retains more fluid than the other, can make it appear larger or sit higher. This localized inflammation can cause the implant to remain elevated on the chest wall.
Fluid collections, such as a seroma (a buildup of clear fluid) or a hematoma (a collection of blood), can also cause localized swelling, firmness, and displacement. Muscle spasms in the pectoral region, especially with submuscular implant placement, are common and can lead to tightness, discomfort, and an elevated appearance of the affected breast. These spasms may persist for several weeks as the muscle adjusts to the implant.
Implant malposition, where the implant does not settle correctly, can result in one implant sitting too high. This can stem from the initial surgical pocket being created too high, or the implant shifting upwards within a properly formed pocket. While more common later, early signs of capsular contracture, a condition where scar tissue around the implant hardens and tightens, can sometimes manifest as firmness and elevation of the breast. This tightening scar tissue can squeeze the implant, making it feel firm and appear distorted or high-riding.
Pre-existing asymmetry, which is natural in most individuals, can become more apparent or even slightly altered after surgery. The surgery may not completely correct these inherent differences, or in some cases, the implants might exaggerate a pre-existing unevenness. Additionally, factors like improper post-operative bra wear or variations in surgical technique, such as uneven pocket dissection or initial implant placement, can influence how the implants settle and contribute to asymmetry.
When to Seek Professional Guidance
While some asymmetry is expected in early recovery, certain signs warrant prompt consultation with your surgeon:
- A sudden or significant increase in asymmetry that was not previously present, or if the unevenness worsens rapidly.
- Intense pain, widespread redness, or warmth in one breast, indicating infection.
- A fever, especially with other breast symptoms, as this indicates potential infection requiring immediate evaluation.
- Unusual firmness or hardness in one breast, particularly if it feels different or is accompanied by discomfort. This could be an early sign of capsular contracture or another issue.
- Any discharge from the incision site.
- A general feeling that “something is wrong.”
Adhering to all scheduled follow-up appointments is essential to monitor healing and address concerns.
Addressing and Correcting Asymmetry
When asymmetry is observed after breast augmentation, the approach to addressing it depends on the underlying cause and the stage of healing. Often, surgeons recommend an initial period of observation, allowing time for swelling to subside and implants to settle naturally. This waiting period, typically up to three to six months, can reveal whether the unevenness resolves on its own.
For some cases, non-surgical interventions may be recommended. Specific massage techniques, if approved by your surgeon, can help promote even settling of the implants and potentially reduce muscle spasms. Taping or adjustments to post-operative bra wear might also be suggested to encourage proper implant positioning. Medications, such such as muscle relaxants, can be prescribed to alleviate muscle spasms that might be contributing to unevenness. Anti-inflammatory medications may also help reduce persistent swelling.
If fluid collections like seromas or hematomas are identified, fluid drainage may be performed to relieve pressure and restore symmetry. If conservative measures prove insufficient or if a more significant issue, such as implant malposition or capsular contracture, is diagnosed, revisional surgery may be considered. This procedure can involve adjusting the implant pocket, repositioning the implant, or even exchanging the implant to achieve better symmetry. Revisional surgery is typically pursued after a sufficient healing period has passed and the breast tissues have stabilized.