I had HP 500cc smooth silicone implants placed under the muscle, crease incision, 8 wks ago. I chose HP b/c I had a small BWD (11.5cm), but a large frame, 5'8, 160lbs. Per dr, I wore a tight sports bra & no massage for 5 wks. Now massaging & they are fairly soft & move around in the pocket, but I'm worried they won't drop. They have a large gap so I have no cleavage. Should I have gotten a wider implant? Will a band help stretch the lower pole? I can feel the implant in bottom of the crease.
2 Months After BA, Implants Too High, Too Far Apart...will They Drop? Did I Choose Wrong Implant? (photo)
Doctor Answers 10
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Will my implants ever drop?
Thanks for your question and your photographs.
While you're implants are still high, there is still time for them to drop. It's hard to say without examining you but they look as close to the midline as they may get because you have a wider sternum to begin with. If you're implants are under the muscle your surgeon will likely have tried to place them as close to the middle as possible without taking off the insertion of the pectoral muscle on the sternum. If you violate the insertion of the pectoral muscle this can lead to breadloafing or synmastia.
I would suggest that you discuss massage and even wearing a band in the upper poll to encourage the implants to drop and settle. Be patient as it takes longer for a high profile implant to see its full projection and soften its upper poll fullness.
While it is too soon to consider a revision if they remain high it may be comforting to know it is very easy to lower a implant. It is much more difficult to elevate one.
You should have not received high profile implants!
Thanks for including photographs, as they clearly show that 500cc implants are NOT "too big" for your frame in order to achieve a proportional result. However, your wide cleavage and high upper pole also just as clearly show that you would have been better served with same-size, lower profile (certainly at least moderate plus, but moderate would be better if the diameters fit your breast pocket dimensions) implants.
BTW, this also shows that this 11.5cm breast base measurement (used as the "reason" for choosing HP implants) is deceiving. Your breasts do look in your pre-op photos as if they have a narrow base, but if the pocket dimensions need to be larger to accomodate wider implants, AND your breast tissues and pectoralis muscles can be redraped appropriately over wider implants, then wider-diameter moderate or moderate plus implants would have been a better choice.
Your present implants may indeed continue to drop into position as time goes by, but if they remain high and re-operation is needed, please consider same-size (or even slightly larger, if desired) implants in the widest profile that "fits" your pockets, which will have to be enlarged to achieve better position anyway. Best wishes! Dr. Tholen
Yes a band MIGHT help, but may not be necessary.
They will probably stretch and drop on their own, just give them time. Also, after skin and muscle stretch, you will probably have more cleavage.
You do not want the implant wider than your natural breast.
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Breast Augmentation Results 2 Months after Surgery?
Thank you for the question and pictures.
It is still too early to judge the final results of your breast augmentation surgery. I would recommend that you continue to follow-up with your plastic surgeon and comply with instructions.
I would suggest that you reevaluate the results of surgery somewhere between 6 months and one year postoperatively. It is possible that revisionary surgery may be necessary. This may involve lowering the breast implant pockets and/or use of different size/profile of breast implants.
Unfortunately, without direct examination it is not possible to be more specific.
At two months your implants still look too high, but it is still pretty early and they have a ways to go. Give it more time.
Breast Implant Position
You are only two months out, and yes you are higher than we would like. There is nothing to do right now but wait for at least another two months. If you were my patient, I would be concerned about whether they are going to 'settle into position', I must admit to you. On the other hand, if you were my patient, I would have never attempted to put 500cc HP implants into you. Without the benefit of a physical exam, I would guess it would have been closer to a 275 moderate plus profile.
Although there is a great difference between those two implant sizes, my decision would not have been based on personal and subjective things such as my sense of 'proportion'. In fact, my decisions regarding implant size are based completely by a reproducible, objective measurement system designed to minimize complications associated with inappropriately sized implants, and thereby minimize unplanned re-operation.
I would like to address your comments. Massage has a very limited utility, mostly relaxing the tissues immediately after surgery. Other than that, there is no evidence to suggest that massage will make implants drop or prevent capsular contracture. There is a wide gap now because you had very little tissue between your breasts before surgery, and there is no implant that will improve that situation without severe consequences. Your current implants are almost 2 cms wider than your breast base now, it would not be prudent to place wider implants, and as I already said, it would not be helpful to narrow your gap anyway.
If your implants do 'settle in' and you find them acceptable that would be wonderful. However, you should know that these implants will cause significant stretching and thinning of your tissues over time, ultimately leading to rippling. I would get a second opinion from a doctor with an excellent reputation in revision breast surgery if your breasts are still not looking the way you hoped in a few months.
Best of luck.
Implants too high?
On the preoperative photos, you appear to have a tight lower pole.
Often the fold does not want to release fully right away, and this may take some time.
Often more modest implants or higher profile implants may avoid some of that issue.
Don't rush back to surgery!
Implant Position High...
I agree that the implants are still a little bit too high. The cleavage has certainly gotten better as has the implant position. They should continue to settle over the next couple of months and a superior band may be of benefit. If the implant stays in this position, then a lowering of the implants may be necessary. Good Luck!
Implant position after 2 months is not the final position yet
Implants continue to settle for a prolonged period of time, especially if placed under the muscle which takes time to relax and stretch out. Your implants should come down a little more. As to the spacing between your implants, I don't think they are misplaced. Your breasts are naturally far apart and thus the implants are supposed to sit behind the nipple which are not close together --- to create a better cleavage and have the implants sitting closer together would give you a very bad result.
Although you might like the view of a cleavage when wearing a low cut shirt, as soon as you'd take your shirt off you'd scare people away with funny shaped breasts.
Martin Jugenburg, MD,FRCSC (Toronto Cosmetic Surgery Institute)
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