The most common complication in breast augmentation is breast asymmetry after surgery. I don’t know what the national average rate of revision surgery to correct breast asymmetry after implant placement is, but in my practice it’s around 5%. Clearly, one can see that this risk is not uncommon. Breast asymmetry after augmentation occurs for two reasons, differences in the breast that existed before surgery and differences in implant placement or healing after surgery.
Pre-existing breast asymmetry is by far the most common reason in my experience. Many women have some degree of difference between their breasts, some admit it… others don’t. Sometimes those differences are significant… often they can be quite subtle. I make an important topic to look for it and point it out. It doesn’t take much of a difference to get bigger when the breasts are enlarged with implants. In some cases, a small breast difference can be much larger after surgery. In other cases, a small difference in the breasts is improved by breast enlargement. How can you know which one will occur with a particular patient?
The horizontal position of the nipples is the critical part of the anatomy to consider. If there are differences in the two breasts 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 can be improved. However, if the breast differences are associated with nipples that are at different horizontal levels, there is a good chance that the breast differences will not improve with implant enlargement. In fact, it is very likely that the differences in the breasts will look worse or become more obvious. Breast implants will make the mounds look larger and more symmetrical, but the position of the nipples on the breasts will be more different horizontally. This can create a ‘crooked’ or ‘silly’ look to the breasts, as the nipple positions become more crooked as the breasts get larger.
There are methods to improve the asymmetry of breast implants and nipples after surgery, but it is important that higher-risk patients understand their anatomy to begin with. It is understandable that patients expect perfect breast symmetry after implant placement, but this is not a realistic goal in the patient who was not symmetrical to begin with.
