Should I Have Expected This??

[Ready4SomeBoobs]

I started out a VERY assymetrial AA on the right and small B on the left.... PS said probably about 175g different! I got 300cc implant on the larger left side and a 400cc implant on the smaller right side. I am closing in on 3 months post op and I am still not happy with them They are def. more symetrical than they were but the larger left is STILL larger and more round and full... I LOVE IT.... (A mid DD) and the right is STILL smaller and less full/round looking... (A mid Dish) When I measure there is about an inch difference between them and I am upset about that....

Should I have expected this? Should I bring it up with the PS? Should I expect it to be fixed at a lower price? IDK

Thanks!!!

[Dr. Mele]

Dear Ready4SomeBoobs:

Asymmetry is a difficult problem, especially when the difference is more than a cup size. Volume is one problem, but the smaller amount of skin can sometimes be the bigger problem. The greatest asymmetries are seen with Poland's Syndrome.

Poland's Syndrome is the absence of a breast. Sometimes it is only the breast tissue, sometimes the nipple is missing, sometimes the muscle is missing, and other problems can come with it.

For patients with severe asymmetry, I use a tissue expander to increase the volume on the small side as the patient's normal breast develops. This way adolescence is a little less uncomfortable. Once the normal side is fully developed the tissue expander is overfilled about 20% and left in place to try to stretch the skin. A second operation is required to replace the expander with a breast implant to match the volume as best as possible.

This is likely be overkill for your situation, and a tissue expander is probably not necessary, but I wanted to explain that correcting asymmetry is harder than just picking the correct volume. Even if the current implant is small, you are getting some benefit from leaving it in place. The skin can get adjusted to the larger volume and hopefully grow. The scar that is maturing around the implant can soften. The injury of surgery can resolve. Because of this, I would let the breasts heal before making the switch to improve your outcome.

I would definitely discuss you dissatisfaction with your plastic surgeon. I am confused by the statement that there was a recognized 175 gm difference preop, yet only 100 cc difference in implant volume. Since we are mostly water 175 gms is about 175 ccs. Sometimes things look different in the operating room when you are laying down, and I'm not saying that adding 75 cc's is the right answer. This needs to be reevaluated after the swelling has resolved.

A good goal for now would be to make a plan. How long to wait? What are the end points to waiting? What might need to be done? What the charges will be? Etc. Hopefully, you can come to an understanding. The only good thing I can tell you is that exchanging implants is usually pretty simple with a quicker recovery. Since there is less asymmetry now, picking the correct size should be a little easier; however, it is normal to have some asymmetry, so the goals, that you and your PS set, need to be realistic.

Asymmetry is a difficult problem, even if you were right in front of me, so I don't know if any of what I said applies to your situation. If you are looking for specific advise, it would be best to get a second opinion. The physical examination is really key to determining the best course for you.

For anyone else reading this, it is important to bring these issues up before surgery. If there are no problems, all you've wasted is a little time. Asking will give you an idea how your plastic surgeon reacts to problems, and if a problem develops there will be fewer surprises to worry about. If you know what to expect ahead of time, if something unexpected occurs, you and your surgeon can then quickly focus on what it is going to take to make you happy. BTW - Making patients happy is what Plastic Surgery is all about.

[Dare]

Ready4SomeBoobs,

Hope your surgeon can help you achieve your goal. You deserve to have as close to symmetrical results as is achievable. Good luck!

Dr. Mele,

What a fantastic, thorough, & thoughtful response! Tissue expander, of course! Makes perfect sense, so why haven't I read about that technique being used on here for asymmetry before? Sadly, I think a lot of surgeons just place 2 different sized implants thinking getting someone sort of close to being symmetrical is enough, without taking into consideration the difficulty of finding bras that fit, or the desire, (and reasonable goal), for a woman to have better than sort of symmetrical results. Of course no one should expect perfection, but I don't read many posts on here from women whose surgeons are willing to really go the extra mile to ensure the best results possible. Nice to see you make that your goal with each patient.

I went on several consults before my surgery, all reputable surgeons here in Portland, with many years of experience, and all board certified in plastic surgery. I ended up going with the surgeon that had your attitude...seeing me as an individual and explaining why she would use the size, profile, fill, etc., that best fit my body and my goals, rather than a cookie cutter philosophy. I had one very popular and overbooked surgeon curtly respond, when asked if I could see pictures of his patients, "I don't really do that, but you'll look fine, it's not like you're a stripper and have to look perfect, right?" As though wanting to look the best I can for me and my husband was somehow not worth the effort he would put into making some other girl look good for strangers. Yea,

Pardon my rambling, but basically I'm just saying it's extremely refreshing to see a response from a surgeon that obviously puts care in doing the best technique possible for each individual patient. You're not even getting paid...this isn't a genuine consult, so kudos to you! Thank you for being here

[Ready4SomeBoobs]

Thank you VERY much for such a thorough response... I saw my PS today and did make mention of it but didnt press it and wasnt quite as honest as I should have been about my feelings BUT he did say that in bras and clothes you cant tell which is true and that since I had a Benelli on one side only the difference in nipple appearance can affect your overall view of the size and shape of the breast....

I thought about the 175g comment too but didnt learn until after that 1g is about 1cc.... They are VERY close so I am going to wait it out a bit more and my husband says he cant tell anyone so maybe it is just me but I think we should have gone 125-150cc probably though I am not sure if a surgery for 25-50cc extra is worth it really...

In any case THANK YOU!!!!