Breasts Too High After Augmentation

I had a breast augmentation three weeks ago (Mentor high profile silicone texturized implants, 350 CC's). I am a little worried because they are too high, and I do not see the breast fold. I wonder, will they come down eventually? Should I consider a revision, and if so, when? I have read that breast massages are very good to let them down, but I also read this is not recommended in texturized implants. Can you give me an advice?

Doctor Answers (34)

Breast Implant position

+12
In many breast augmentation patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola. Ideally the implant should be centered directly behind the nipple-areola complex (NAC). In profile, the natural-appearing breast is not convex in the upper pole, and an excessively convex and overly full upper pole is a dead giveaway that a breast implant sits below the skin. In addition, inadequate release of the inferior origin of the pectoralis major will allow the muscle to hold the implant in too high a position, and may even cause the implant to displace upwards (as high as the collar bone in some patients) when the muscle contracts. Patients with this problem require reoperation to release the inferior origin of the pec major and/or the inframammary fold.
Likewise, if the inframammary fold is lowered too far, the augmented breast will appear 'bottomed out', with an excessively full lower pole, an empty upper pole, and a nipple/areola that appears to sit too high on the breast - another situation with a distinctly unnatural appearance, and one that requires surgical correction: repair of the inframammary fold(s).
The horizontal position of breast implants also requires a great deal of attention, both in pre-operative planning and in the operating room. Excessive lateral dissection of the implant pockets will result in augmented breasts with an excessively wide space between them in the cleavage area, and the appearance that the breasts are abnormally far apart. The result may (or may not) be tolerable in the upright standing or sitting position, but when the patient lays down in supine position (on one's back) the implants may fall far to the side and produce little to no anterior breast projection in this position. Patients with the problem almost always want it corrected, and the treatment once again is surgical: a lateral repair of the implant space, to restrain the implants from falling off to the side.
Inadequate lateral dissection, on the other hand, will result in an augmentation with an abnormal 'side by side' appearance. It is lateral projection of the breasts beyond the lateral border of the chest wall (in frontal view) that, along with the concavity of the waist profile and the convexity of the hip profile, produces the appearance of an 'hourglass figure'. While one does not want to over dissect the lateral extent of an implant pocket, careful attention must also be paid to ensure that lateral breast projection is not inadequate.
Breast implant base diameter is also of crucial importance. The base diameter (the side-to-side dimension of the implant) must be ideal for the existing horizontal dimension of the breasts preoperatively, as well as the breadth of the anterior chest in general. Obviously, a given implant volume and base diameter that works well for a small-framed patient that is 5'3" will be completely inadequate for a broad-chested patient who is 5'10". One wants to increase cleavage area fullness and lateral breast projection in most cases, and an implant of inadequate base diameter may accomplish only one of those goals, while too wide an implant will be overprojecting in both directions. Careful evaluation of all of these breast and implant dimension issues is necessary if the ultimate goal of the surgery is a natural-appearing breast augmentation.


Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 38 reviews

Breasts Too High After Augmentation

+5

I think this an interesting case to receive follow-up on. The native inframammary fold appears high with a short and (at least mildly) tight inferior pole. The markings on the chest wall suggest that the inferior pocket was created for proper implant positioning. Certainly at 3 weeks post-op it is common to have implants positioned high since they have not had enough time to settle into place. If smooth surface implants were placed, there is certainly a good chance that these implants would settle into a lower position over several months, with potential stretching of the of the inferior pole skin occurring afterward; and this could be enhanced by implant displacement exercises and the use of a compression band over the upper pole.


It is my impression that most plastic surgeons do not have their patients perform displacement exercises with textured implants. Mentor’s Siltex texturing is not as aggressive as Allergan’s BioCell texturing, and often does not exhibit the same tissue ingrowth and adherence. So perhaps these implants will still settle into the lower pocket. However, the textured surface does provide friction, and I wonder if that is enough friction to prevent the type of descent needed in this situation.


So, were displacement exercise performed, did these implants settle into place, or was a pocket revision necessary?

Kenneth Dembny, II, MD
Milwaukee Plastic Surgeon
5.0 out of 5 stars 17 reviews

Breast Implants Can Take 6 weeks to Drop However Watch for Double Bubble on Left

+4

Thank you for your question.

I agree your Breast Implants do look high but it can take 6 weeks to 3 months for the Implants to drop.

Hopefully your surgeon has instructed you on breast implant displacement exercises which can help.

I am a little concerned that a "double bubble" may be forming on the left side. This would result from making too large a pocket to accommodate the implant.

See your surgeon and discuss these concerns.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
4.5 out of 5 stars 29 reviews

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Implants Too High!

+4

I agree, your implants are too high on your chest wall.  Having said that, I would be patient, the implants will "drop" or settle into place over time.  I would wait at least 3 months and 6 months would be better.  If the implants are still too high, than you will need to have them repositioned into a lower position.

It appears to me that you have a "high crease", the distance between your nipple and the inframammary crease is too short.  The surgeon should have lowered your crease during the procedure, it does not appear that happened.  I would be surprised if you do not need a secondary procedure to correct this.  You should be up front with your surgeon and ask who will bear the cost of any corrective surgery, this should be settled before you need to make the commitment of another operation.

Good Luck,

David R Finkle, MD

David Finkle, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 45 reviews

Breast Implant displacement exercises for high riding breast implants following augmentation

+4

SEE VIDEO BELOW BY CLICKING "MORE":

Yes, massage of texutred implants is controversial. However, others beleive that the Mentor texturing may be different from the Allergan in that less tissue adherence occurs.

I generally encourage my paitents to perform breast implant displacement exercises and you should discuss this with your surgeon.

My recommended regimen is below

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

Post Operative Care After Breast Augmentation

+3

The care for breast augmentation patients is quite simple. One can either wear a sports bra or no bra. I have patients do upper arm exercises on the same day . Patients can shower within 24 hours. They can resume most of their activities in 7 – 10 days except for strenuous activities where their heart rate is above 100. Implants may be slightly higher in the initial phase for several weeks, but they will come down if the pocket has been properly dissected . Generally breast massages begin at 3 – 5 days if they are Smooth saline or silicone gel implants. Massages should be done 3x a day for the first year. Follow the 3-10 -10 rule: 3 times per day - 10 times - for 10 seconds in each breast using an inward, toward the midline, motion and then an upward motion. After a year, massages can be done once a day.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 15 reviews

Breasts too high after breast augmenation

+2
Your breasts will definitely settle with time as they are fresh post op and swollen.  Where or not they will settle enough to have a smooth upper pole/transition on the chest depends on if the doctor made the correct measurements and selected the correct size. 

Good luck

Rady Rahban, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 25 reviews

Breasts High After Augmentation

+2

It is often the case that after breast augmentation, the implants seem to be too high. Your breast size is larger now and this results in the experience of breasts that feel too high, especially with high profile implants. Without doubt, they will come down and appear more natural with time. This is objectively true as gravity takes effect and the weight of your implants settle in. Massaging the implants is controversial and may or may not have any effect on the long term result of your breast augmentation. I do not emphasize massaging implants in my practice. I would not consider a revision for this reason until 6-8 months after your procedure.

James H. Rosing, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 3 reviews

Breast Massage if implants are too high.

+1
Dear Mexmeva,
Thank you for your post. 
There are many reasons why one would want to do breast massage after surgery. These include,
1. to try to massage an implant into place that is assymetric with the other side,
2. to try to massage implants down that are too high,
3. to try to massage a constricted area of the breast to loosen up, as in tubular breasts, and finally
4. to try to prevent capsular contraction around the breasts.
As you probably have guessed, the type of massage for these different issues will be different as we are trying to accomplish different things. If the massage is done incorrectly, or past the point of symmetry when trying to lower an implant, then yes, it can cause bottoming out or widening. Follow these guidelines to avoid this. Your implants will get softer naturally as the swelling goes down, so you should always follow your particular doctors recommendations regarding massage. These are the instructions I give my patients:

1. When the implants are assymetric, or appear to be at different levels or height, then the massage is different from side to side. This occurs sometimes if the implants are placed under the muscle and one muscle is released slightly different from the other side, or the muscle is naturally larger or different shape from the other side. Sometimes massage is performed to one breast only, and sometimes to both breasts but in different directions. You should ask your surgeon for specific instructions as every situation is different, but in general, think of the breast as a 'circle', and massage with significant breast on the opposite side of the circle that you want the implants to go. You have to feel an actual stretch in the tissues in the area that the implant need to go for this to be of benefit, otherwise you are not really accomplishing anything. If the massage is in the direction of the incision, I usually protect the incision with steri-strips in order to keep the scar from widening in the early first 3 months during the massage. The massage needs to be finished in the first three months and started early, otherwise it will have little to no benefit. Look at the breasts and analyze the symmetry and where the deficient areas are to make a nice smooth beautiful contour, and stop once that goal is achieved. If done indiscriminately then you can go too far and bottom out. Make sure you are paying close attention and stop once the desired contour or position is reached. Once this is reached, I recommend good support with an underwire bra that hits you precisely in the crease that was made while positioning the implant.

2. When the implants are high, and have not dropped, but are symmetric, some physicians use a tension band on top of the breasts, some ask the patient to go without a bra and allow gravity to slowly move the implants, some do a similar massage to the above but doing exactly the same thing on both sides. Consult with your physician on this.

3. When there is a constricted breast like tubular breasts, I sometimes have the patient massage as in #1, sometimes have them massage both sides of the 'circle' to loosen the constricted skin, and usually leave the patient out of a bra if both sides have tubular breasts or constriction at the bottom, or if only one side is constricted, have the patient wear a bra, but cutting out he cup on the side that is constricted, so that only the normal side is supported.

4. Finally, maintenance massage. I disagree with surgeons who want to keep the pocket or 'capsule' of the breast where the implant is contained larger than the implant. This aids in the implant becoming more and more displaced over time, with more separation at the cleavage point especially when you lay down, and can also cause sagging of the breasts. I actually use textured implants as a way to fight the implants moving inside the capsule of the breast so that they stay 'perky'. Natural 'perky' breasts stay in place when standing up or laying down, so 'perky' implants should do the same. I think the implant should fit in the capsule or breast pocket like a glove, and actually be adhesive to it. Thus there is a 'perfect' amount of massage that is necessary to keep this capsule flexible, but not wider than the actual implant and thus allow for movement of the implant and thus sag. I like grabbing the breast and pressing the opposite sides of the 'circle' toward the center, causing the central or nipple area to bulge out. I have my patients do this pushing the top and bottom together, the sides together, and then both diagonals together. This puts more pressure on the central portion of the implant, rather than the sides to allow the implant to continue to be adhesive, but the capsule to not widen. I ask my patients to develop a routine and do it in their morning shower, this way it becomes habitual and they won't forget, as this is a lifelong routine that should be performed.


Best Wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 26 reviews

High implants after augmentation

+1
You do appear high for a textured implant.  I typically place the textured implants lower than a smooth implant because they tend to settle a little less.  Breast implants can fall dramatically so unfortunately the only answer is to wait and see.

Pramit Malhotra, MD
Ann Arbor Plastic Surgeon
5.0 out of 5 stars 31 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.