320cc Subglandular Silicone, 3 Wks Post-op. I Know They'll Drop, but Will They "Fluff" Too? (photo)

Question

Hi there, I was curious about this "dropping and fluffing" phenomenon. Do implants over the muscle (particularly subglandular like mine) fluff like unders do? I'd love for that to happen since I am one of the many that kind of enjoyed the size I had with swelling. Thanks in advance for your help!

Richard H. Tholen, MD, FACS · Answer

Gravity "works" 24/7, and tissues always stretch with time and the relentless pull of gravity, especially when there's more weight (implants) to "pull." At 3 weeks post-op your scars are still very immature, and can be expected to soften, stretch, and mature over an average of 7 months. Maybe more, and maybe less, but still over many months, not weeks!

	Since your incisions are still pink and a bit firm, and your scars are still maturing, you can reasonably expect that your internal capsule scars are healing/maturing at much the same rate. Once your skin incisions are completely pale, flat, and soft, then your capsule is likely completely healed as well, and after that, implant position is subject only to aging and gravity over the longer time span--the former takes months to occur, the latter years.

	So the ultimate answer is that it depends on your present appearance, your goal appearance, and what you look like at 6-12 months post-op. Talk with your surgeon. If you are still noticeably high after healing has completed and all scar tissues matured (6-12 months) and you really want to drop your implant positions a bit, a simple operation to open up the lower pockets a tiny bit is possible!

	But if you take "fluffing" to mean that your implants will somehow "expand" or look larger as time goes by, this depends on the degree of skin and muscle stretch that allows the "high, tight" look to become more teardrop and "natural." But any degree of "looking bigger" is often offset by true volume reduction as swelling decreases. Everyone is different!

	BTW, "fluff" is not a medical term, and usually relates to what certain adult film "assistants" do in order to keep the male actors "ready for filming." Ahem. So let's just say drop and soften, shall we? Best wishes! Dr. Tholen

Jeffrey J. Roth, MD, FACS · Answer

Thank you for the photo. Dropping and fluffing are not scientific terms.  If you are referring to the implants dropping and then filling out the lower pole of the breast, yes that will usually happen.  You are still early in your post operative course.  Breast implants tend to start dropping into place after 3 to 4 weeks.  They usually will get to their final position in 6 to 12 months.  One will usually drop faster than the other, and the shape may go through changes. I would wait a while before getting sized for bras.   Please follow your Board Certified Plastic Surgeon's post op instructions. For example; we like message, but some surgeons will have you wait, or do it in a specific manner.  Please let them know your thoughts and concerns.

Young R. Cho, MD, PhD · Answer

Thank you for your question.. Drop and fluff refers to post-operative period in which the breasts begin to descend and fills out the lower half of the breast.  It may take several months for this to happen and can be encouraged with breast massage and compression.  It may appear that the breast enlarges as the lower aspect of the breast fills out (at the expense of the upper portion of the breast)

Jerome Edelstein, MD · Answer

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.

Ryan Neinstein, MD, FRCSC · Answer

Those are not great terms to use, implants under the muscle will come down in a few months and implants under the breast tend to stay still. Both will have swelling that will come down

Kenneth Hughes, MD · Answer

Subglandular implants may drop after 3 weeks.  However, submuscular implants tend to do more dropping than subglandular.  I am uncertain of the reference to fluffing.

Camille Cash, MD · Answer

Congratulations on your breast augmentation! During the next several months the swelling from your surgery will resolve.  The implants will drop and fill out the lower portion of the breast.  The tissues will become overall softer.  Continue to follow the post operative instructions from your surgeon.

Jourdan Gottlieb, MD · Answer

Dropping:  Submuscular implants are sitting as if they are at the bottom of an envelope. The breast fold, like the bottom of the envelope keep the implants from descending. At the upper pole is a large space under the muscle and above the ribs, and that space goes up to the clavicle (collar bone). Typically the implant position looks fine at surgery. As the patient awakens, the relaxed pectoralis muscle contracts, pushing on the implant. This displaces the silicone (or saline) which bulges into the upper pole, the only direction with room to expand. The lower pole of the breast may seem to empty out. But the implant itself doesn't actually move. As the muscle relaxes over several months, the upper pole no longer bulges and the implant position looks like it did in surgery.

	 

	This is not a phenomenon that is seem with implants placed above the muscle. There can be some lowering of the implants as the lower pole skin stretches in response to the weight of the larger breasts. 

	I am not familiar with the term fluff. I looked for a useful definition on various websites, but the definitions are all over the place, and not helpful, so I will pass on that half of your question. 
	All the best.

Steven Wallach, MD · Answer

Submuscular implants tend to sit higher initially because of muscle spasm than those in a subglandular pocket.

320cc Subglandular Silicone, 3 Wks Post-op. I Know They'll Drop, but Will They "Fluff" Too? (photo)

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