Lopsided Breast After Breast Augmentation Surgery:

One of the most common complications after Beverly Hills breast augmentation
surgery is asymmetric breasts or implant mal-position. This occurs when the implant is
in an incorrect position on the chest wall. The usual causing factor is imperfect pocket
formation during initial surgery. This may include incorrect position of the implant
superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-
boob”) or laterally (falling outward into the axilla). Beverly Hills cosmetic surgeon Dr.
Khosravi at Aesthetic Professional has corrected these problems for many patients.

Symmastia (or medial mal-position or “uni-boob”) occurs when the breast implants
move too far toward the midline--the two implants may actually touch one another in
the center of the chest. If the horizontal muscle that is connected to the sternum and
goes across the implant is cut overly aggressive during surgery, then the implant can
move toward the middle of the chest and cause Symmastia. That usually happens when
the surgeon attempts to alter chest wall anatomy and trying to increase cleavage for
patients. This outcome is made worse by use of larger implants in thin patients, and is a
problem for implants over or under the muscle, though sub muscular implant
placement allows the muscle to provide some softening of the transition to the cleavage
area from the augmented breast mound. Correction involves use of internal sutures of
the capsule around the Beverly Hills breast implants. Often, it is necessary to expand
the breast implant pocket laterally (outwardly) to allow for correct placement of the
implants.

Bottoming out involves inferior migration of the implants. This causes the nipple areola
complex to appear too high on the breasts. Also, the distance from the areola to the
inframammary fold is too great. This is corrected by “raising” the inframammary fold
using internal sutures. This is done after careful measurements are made from the
areola to the “new” inframammary fold.

Some post operative breast augmentation patients present with lateral (outwardly)
displacement of the breast implants. This can be corrected using an internal suture
technique decreasing the size of the pockets and moving the implants toward the
midline.

The following pictures show a patient who was presented to my Beverly Hills plastic
surgery practice after having a past breast augmentation with another surgeon. She was
complaining of mal-positioning of her breasts after surgery and requesting for
correction. She underwent another surgery with her surgeon, and for a second time that
correction was unsuccessful. When she was presented to me she still had the mal-
positioning after two costly surgeries.
I planned for revision and reconstruction of the pocket. She also requested revision of
implants for larger one that she was willing. I corrected that by using an internal suture
technique decreasing the size of the pockets and moving the implants toward the upper
pole.
After four months she kept the results and mal-positioning did not return that used to
appear right after previous surgeries.
M. Ryan Khosravi, MD
Plastic & Reconstructive Surgeon in Beverly Hills