Philip C. Kierney, MD

I find that the great majority of the women that I meet for Breast Augmentation prefer the clinical appearance of implants that are placed below the pectoralis muscle, and thus select the submuscular position for their implant-based surgery.  These ladies tell me that post-operative below muscle implants tend to appear more natural and more aesthetic than do implants that are placed above the pectoralis.  The upper elements of the pectoralis major muscle generally provide a greater degree of soft tissue coverage and buffer of the underlying implant thus allowing the breast & implant together to present with a more contoured and smooth clinical appearance.  We also find that implants placed below the pectoralis muscle are softer than implants placed on top of the pectoralis muscle resulting in more natural & more appealing feel of the breast. 

The photo you have submitted for assessment presents your breasts appearing to be fairly balanced at this 2-month post-operative time.  I get the sense that possibly your left implant is slightly elevated relative to your right implant.  I believe that on occasion implants that are not clinically balanced in position with one another may result in the breasts themselves appearing to be of different different sizes or volumes.  Without the benefit of additional photos (including your pre-operative photos) to review, it is difficult to determine this precisely for you.

At this time it may be best to allow another few months to pass and then follow-up with your plastic surgeon as suggested.  It is very possible that your breasts and implants will continue to recover and settle as you wish thus making revision surgery a "non-issue."  I usually advise our patients to try to wait until 5-6 months of healing have taken place before committing to a revision surgery.  

Best wishes as you allow your recovery to continue.  

  

Swelling following breast augmentation is generally progressive for the 2-3 weeks after surgery.  Since you are only 5-days following surgery, it is likely that you have some element of predicted swelling active now.  So I think that normal swelling may be contributing to the greater cup size appearance to your breast than you may have initially expected.  It is possible that you may experience even more swelling and temporary breast volume increases over the next couple of weeks.  

Our patients typically see most swelling begin to resolve and go away about 1-month or so following breast augmentation.  This may take a bit longer for some women.  Typically I advise selection of new bras and related garments at about 3-4 months following surgery as the great majority of the swelling has gone away.  The implants themselves have also typically settled appropriately into their pockets at that time. 

Capsule formation represents a normal scarring that occurs around an implant, and tightening of the that capsule scar is referred to as "capsular contracture."  If your 10-year old breast implants have begun to project or stick out more over time and taken on a progressively more firm quality, then the implants predictably have been affected by some element of capsular contracture.  Capsular contracture is frequently suspected when the implant, and consequently the breast, begins to change in its appearance or position.  The underlying implant can feel firm or tight, and the implant may appear to be positioned higher on the chest or stick out from the chest more than it did previously.  Capsular contracture sometimes can make an implant appear excessively round with clear, exaggerated outer margins.  Some women find this type of clinical change undesirable and ask about management options.

Capsular contracture does not always require treatment if its effect is not bothersome to the woman.  Surgery is typically felt to be the best treatment, and consists of removing the indwelling implant as well as the associated offending scar capsule.  The old implants are then replaced with new implants of the patient's choosing.  The newly selected implants can frequently be placed back in the old pre-existing implant pocket.  In some circumstances conversion to a new "below muscle (pectoralis major)" pocket or to a new "above muscle" pocket is believed to help reduce the risk of contracture recurrence.   The creation of an entirely new pocket may result in slightly more recovery time for you.  

I advise wearing a soft form-fitting bra following breast augmentation surgery.  We start the use of a bra as soon as surgery is completed and the patient is still in the operating room.  Immediately following the placement of sterile dressings onto the incisions we place a bra on our patients.  It is our finding that placing the supportive bra as soon as surgery is complete aids in maintaining the precise nature of the pocket that was surgically developed for the patient's selected breast implants.

Continued use of the bra after surgery is also helpful in reducing any discomfort that may arise related to the surgery itself or as a consequence of post-surgical breast swelling.  Wearing a form-fitting bra during the first several weeks following breast augmentation can help to maintain the shape and dimension of the implant pocket which is important to both final breast implant positioning and breast shape & appearance.  We also find that early post-operative use of a surgical bra helps to maintain the long-term positioning of breast implants, thus reducing the risk of implant migration to lower or more outward positions on the chest than is desired.