Can You Explain the Upper Pole Fullness/swelling After Breast Augmentation Surgery? (photo)

My question says it all. I notice that after breast augmentation, pretty much all woman has a period of this "bulgy" look at the top of the breast. Some say its the implant that hasn't dropped yet, or muscle not relaxed, and some say its from swelling..What exactly is happening in that area? I am completely pleased with my result, but from the side it looks funny (from that upper pole uneven look after surgery) How long does that normally last? What is it exactly that causes that?

Doctor Answers 11

Can You Explain the Upper Pole Fullness/swelling After Breast Augmentation Surgery?

Thanks for the photos posted. Reasons for early upper pole fullness are: Muscle spasm or contraction not allowing dropping of the implant, swelling, seroma/hematoma, poorly dissected inferior pocket. If over 2 months post op than I would be concerned for poor inferior dissection. Only treatment is revisional surgery. 

Breast Implants “Riding High” After Breast Augmentation?

Thank you for the question and pictures.

Although some of the “bulgy” look at the top of the breasts  after breast augmentation may be related to swelling,  most of the is related to the location of the breast implants. The breast implants are “riding high” because the pectoralis muscle is contracting and maintaining the breast implants higher on the chest wall.

I see this phenomenon routinely after breast augmentation surgery;  it may take several months (and even up to one year) for the breast implants to fully settle (" drop and fluff”). Although many patients may not believe it, the breasts often appeared larger as the implants settle.  I think that “downward” massage  may be helpful in expediting this process.

I hope this helps.

Implants have not fallen

Thanks for the excellent pictures. How long ago was your procedure, I do not think I saw that in your question.  Your implants are riding high.  If it is within the first several weeks, they can continue to drop on their own and you can speak to your surgeon about massage or a device called a bandeau to help them fall.  If you are several months out, they may not fall much further.  Please speak to your surgeon.

Drop and Fluff

When implants are first inserted, they sit high up because your tissues are tight and gravity hasn't taken effect. Over time, natural tissue expansion occurs to allow the implants to fall into place. By this time, your breasts will have taken on a more natural contour, where the lower breasts become softer and rounder. Please wait at least four months for this to happen.

Upper pole fullness after breast augmentation

Upper pole fullness after breast augmentation is common after submuscular augmentation especially. It is my belief that the muscle, having been elevated off of the ribs has a period of time where it goes into spasm, forcing the implant up. Combined with perioperative swelling, it is typical for the implants to ride high for approximately 2 weeks postoperatively and then typically drop one night while the patient is sleeping. I believe the muscle simply relaxes and stops having spasm. If the pocket was well dissected in the lower part of the breast the implant  usually falls to where it belongs  This is a progressive phenomenon over approximately 2 months. Relatively final results are seen at that point in time. We use an indwelling pain pump which is placed through the skin and lies under the muscle. With this IV catheter functioning like a soaker hose with a four-day continuous flow of local anesthesia, I now see this quite rarely. The muscle doesn't spasm as much in the presence of the local anesthesia  I do use a bandeau bra early postoperatively to  help  insure that the implants stay low.

David Janssen, MD, FACS
Oshkosh Plastic Surgeon
5.0 out of 5 stars 7 reviews

Upper Breast Fullness

There are several reasons why the breast may have excessive upper fullness:

1) Early after surgery there is a component of swelling.  Swelling usually peaks approximately        two to three days after surgery and then gradually subsides over the next 10 days or so.

2) It takes time for the tissues on the lower aspect of the breast to relax and allow the implant to settle as a result of gravity.  When the implant is placed beneath the muscle it takes time for the muscle to stretch and to let the implant fall.

3) It is important to have the appropriate distance between the crease beneath the breast and the nipple so that the implant can be "centered" behind the nipple.  This distance will depend on the size of the implant.  If the distance is too short for the size of the implant then the implant will tend to stay high and produce the bulging look that you mention.

Sometimes you just need to be patient for the normal settling process to occur.  On other occasions a bandeau may be helpful to encourage the implants to settle.  A discussion with your surgeon should help to answer your questions.

Richard Kofkoff, MD, FACS
Saint Louis Plastic Surgeon
5.0 out of 5 stars 53 reviews

Upper pole fullness?

Upper pole fullness usually refers to the rounded, full look implants will give to the breast.  The "bulgy" contour that you are referring to in your photos has to do with the implant not having settled just yet.  If you are within the first few days to weeks after surgery, your implants will continue to "settle."  However, if you are several months after surgery, you may not observe any other changes or "dropping."  I would discuss with your plastic surgeon.  Good luck!

Anureet K. Bajaj, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 13 reviews

Upper pole fullness after breast augmentation

If you had your surgery under general anesthesia the chest wall muscles were paralyzed during the procedure. Very likely your surgeon felt that you had good positioning of your implants under the muscle. As you recover from anesthesia however and continue through your immediate postoperative recovery the muscles often contract and tighten pushing the implants in the direction of least resistance which is upwards. This results in a higher location of the implants and the appearance of fullness in the upper portion of the breast. Very commonly as the muscles relax and the lower part of the breast stretches the fullness settles down to the bottom of the breast leaving a satisfactory outcome. It would be helpful for you to perform massage exercises daily pushing the implants toward the bottom of the breast. If you are within 2 weeks of your operation it would be helpful to wear a compression band at the top of your breasts to help promote downward pressure. If you're condition persists after 6 months it's unlikely you will notice much change and may require revisional surgery. Good luck

John J. Edney, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 86 reviews

3-6 Months Before Reaching Normal Position

The period of time immediately following breast augmentation surgery is characterized by rapid change.During this dynamic phase of healing, swelling, muscle spasm and the healing process itself all contribute to changes in the appearance of a woman’s breasts.
In some cases, superior implant malposition can result from swelling and muscle spasm when implants are placed beneath the pectoralis muscle.Based on your pictures, I believe this is a distinct possibility.In other cases, superior implant displacement may be due to inadequate dissection of the muscle insertions of the inferior portion of the breast pocket.
With time, assuming adequate pocket dissection, these implants will usually drop into a more normal position.Sometimes, the use of a bandeau superiorly and massage may facilitate this process.It may take 3 to 6 months for these implants to drop into a normal position.If no progress has occurred by then, revisional surgery may be necessary.This would involve recreating the lower portions of the breast pocket.
It’s important to have good communication with your plastic surgeon.Make sure he is aware of your concerns.He is familiar with the specifics of your surgery and will be able to give you appropriate direction.

Can You Explain the Upper Pole Fullness/swelling After Breast Augmentation Surgery?

Hello! Thank you for your question! You are still early post-procedure. Your appearance looks typical at this stage and will continue to improve as the swelling subsides and the implants continue to settle into their desired position. This usually proceeds over the next several weeks as the lower pole skin/breast stretches to accommodate the implants. Follow-up closely with your surgeon for additional restrictions/instructions and the potential use of bras/garments or massage that may encourage the implant to settle appropriately. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 14 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.