In short. Implant surgery can reveal a difference that was always there, or create one. How that is assessed, and what correcting it involves.
Key points
- Most patients have photographs from before the operation, and comparing them is far more informative than trying to remember.
- What the comparison usually shows is that the difference existed before the implants were placed.
- That does not make the current result acceptable and it does change the conversation: the question becomes what can be done about the difference rather than why the operation caused it.
Asymmetry after breast implants is common, and its causes fall into two groups that are corrected in entirely different ways. The first is that the difference was always there and the implants made it visible. The second is that the operation created it, or that the two sides settled differently after it.
The difference that was always there
Almost everyone has some asymmetry of the chest before any operation. Placing implants behind both breasts enlarges both, and enlarging both makes an existing difference easier to see rather than harder. Patients often describe this as the implants having caused the asymmetry, when the more accurate description is that the implants revealed it. The distinction matters because the correction is different: a difference that was always there is addressed by treating the two sides differently, which is the subject of the rest of this site.
Compare old photographs rather than memory
Most patients have photographs from before the operation, and comparing them is far more informative than trying to remember. What the comparison usually shows is that the difference existed before the implants were placed. That does not make the current result acceptable and it does change the conversation: the question becomes what can be done about the difference rather than why the operation caused it.
The difference the operation created
Three mechanisms. The pocket in which an implant sits can heal in a slightly different position on the two sides, so one implant sits higher or further out. The implant on one side can be a different size, which is sometimes deliberate and sometimes not. And the tissue over an implant can behave differently on the two sides, particularly where there has been a collection, an infection or a healing problem on one of them. Each of those has a different correction.
Why the timing of the assessment matters
Because implants settle over months and the two sides settle on different schedules. A difference assessed at six weeks is frequently a difference that will have resolved by six months, and intervening early means operating on a transient finding. A difference that is stable and still present at around six months is the appropriate point at which to assess it properly and decide what, if anything, to do.
Findings that should not wait for six months
- A change in the shape or firmness of one breast, or a capsule that is tightening.
- Redness, warmth, pain or a collection around one implant, which is assessed promptly.
- A difference that appeared suddenly after a period of stability, rather than gradually after surgery.
The honest summary is that most post-implant asymmetry is either an old difference made visible or a difference that will settle, and that a minority needs an operation to correct it. Establishing which group a patient is in requires an examination and a period of observation, not an immediate decision.
Frequently asked questions
Why did my breasts become uneven after implants?
Two reasons are common. The first is that the difference was always there and the implants made it more visible by enlarging both sides. The second is that the two sides settled differently: implants sit in a pocket created for them, and pockets heal on their own schedules, so one may sit higher or more laterally than the other for months. Which of the two it is decides what can be done.
Is it too early to judge?
Usually yes for the first several months. Implants settle, the tissue around them adapts, and the two sides do not do so at the same rate. Judging symmetry in the first weeks after an augmentation is the most common source of unnecessary worry in this area. A difference that is still present and stable at around six months is the point at which it is worth assessing.
What does correcting it involve?
It depends on the cause. Where the pocket has healed in a position that differs from the other side, changing the pocket is the correction. Where the difference is volume, the implants themselves may differ or may need to. Where the tissue over one implant behaves differently, that is a third problem with a third answer. All of it starts with establishing which of those is present.
Risks & Limitations
- No operation produces a matched pair. The two sides start differently and heal on different schedules, so a small residual difference in size, shape or position is the expected outcome rather than a complication.
- The recovery is that of the larger of the two operations in the plan, not an average. A lift carries scars that an augmentation does not, and a longer period for those scars to mature.
- Where the difference is partly in the chest wall, that part cannot be corrected from the breast and will remain after the operation.
- Scars are permanent, and a plan that treats the two sides differently leaves scars of two different kinds.
- A difference that is new, changing, or accompanied by a lump, skin change or nipple discharge is assessed as a diagnostic question before any surgical planning.
- Changes in nipple or skin sensation may occur, are often temporary, and may be lasting. Where an implant is used, its own long-term considerations apply.
When to Seek Care
- A new lump, a change in the skin over either breast, discharge from the nipple, or a change in the nipple itself &mdash — have it assessed promptly rather than waiting for a cosmetic appointment.
- Fever, spreading redness, warmth or discharge from a wound, or a wound that is opening.
- A breast that becomes hard, swollen, painful or red around an implant &mdash — contact the team the same day.
- Calf pain, swelling or tenderness in one leg, or shortness of breath or chest pain &mdash — seek emergency care at once.
- Chest pain, breathlessness or a racing heartbeat after surgery &mdash — seek emergency care at once.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) - breast surgery and patient safety guidance
- National Institute for Health and Care Excellence (NICE, UK) - guidance on breast surgery and on venous thromboembolism prevention
- Cochrane Library - systematic reviews in breast surgery and wound care
- British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) - patient information on breast surgery
- Chinese Medical Association Plastic Surgery Branch - clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.