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 (42)

Breast Implant position

+11
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 42 reviews

Breasts Too High After Augmentation

+6

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
5.0 out of 5 stars 37 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 48 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 48 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 20 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 40 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 5 reviews

3 weeks is too early to judge

+1
3 weeks is too early to judge your final result. I recommend 3 months before you start considering the questions you have asked. The only exception is if one breast is particularly firm, immobile or painful. 

Barbara Persons, MD, FACS
Lafayette Plastic Surgeon
5.0 out of 5 stars 5 reviews

Breasts Too High After Augmentation

+1
It's difficult to predict how the implants will settle, but it's important to remember that implants tend to ride high initially and will descend over the course of six weeks to three months. Sometimes implants will descend over the course of six months. I think that it's too early to tell whether a revision will be required. Consultation with your surgeon will help answer your questions as you work through this process. Many surgeons will have patients were a bra with a built in elastic strap that is secured over the top of the breasts. This holds the implants down during the healing process.

Austin Hayes, MD
Portland Plastic Surgeon

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