Breast implant still not dropped at 8 weeks Post op, when should I be more than a little concerned? (photo)

Question

Hello. I had Brachioplasty and breast augmentation on December 18th. I had gummy implants placed under muscle through the incision down from armpits 405cc in right and 445cc in left. I have been wearing the band for over a month now day and night but implants have still not dropped. And the past 5 days I have been having very achy hurting in breasts especially the left one, should I be concerned about this or is it maybe just implant trying to finally drop into pocket?

Daniel Barrett, MD · Answer

Hi Dmwdhumphrey,
  
I understand your concern and it is quite normal to be concerned about the outcome following a breast augmentation surgery. However, you are still in the early stages of the healing process at 8 weeks post op. 
  
You will need to be patient at this moment and follow what your surgeon has instructed you to do post operatively. 
  
At the early stage of the healing process, the tissues around the implants are still swollen. Once the swelling subsides and the implants drop to their final position, you will be able to see the final result of your breast augmentation surgery. 
  
Dropping of implants is part of the healing process and this occurs after the tissues surrounding the implants slowly relax, allowing the implants to settle into their final position. It can take about four to six months for the implant to drop down to their final position. Also, your breasts can drop at different rates. 
  
But if you are still concerned, you can always visit your plastic surgeon and discuss your concerns. This way, you will be reassured. Also, if after six months, you are not satisfied with the appearance of your breast, you can visit your plastic surgeon and discuss the possibility of revision surgery. 
  
Lastly, follow your plastic surgeons post-operative instructions and advice for faster healing and recovery.
  
Daniel Barrett, MD, MHA, MS
  
Certified, American Board of Plastic Surgery
  
Member, American Society of Plastic Surgery
  
Member, American Society of Aesthetic Plastic Surgery

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  You are still in the very early stages of healing.  It can take 6-8 months for the breasts to settle completely.  At this point I typically recommend my patients to massage their breasts several times a day for about 2-3 months.  Each surgeon though will have their own protocol on which they would like their patients to follow.  I would suggest seeing your surgeon and addressing your concern with them and following their recommendations. Best of luck to you.

S. Larry Schlesinger, MD, FACS · Answer

Please send pre operative photographs.  This will help your online RealSelf plastic surgeons to better answer your question.  If your breasts were pre operatively constricted or tuberous breasts, then they may not drop and fluff.  On the other hand, if your plastic surgeon was trying to make the perfect hand in  glove fit for your new breast implants, then continuous use of a bando above your breast implants plus time, gravity and no bra, no bra, no bra will allow your breast implants to ultimately fall into their appropriate pockets.  Since your breast implants are both out of the pockets, then it is unlikely that a one sided error was made on both sides, such as having a single strand of muscle not allowing the implant to drop.  I personally feel that 8 weeks is a reasonable time to wait for some progression into the appropriate breast implant pockets.  However, the recent pains you mention may indicate that the implants are now pushing their way into the pockets and success may just be around the corner.At this point, I would have a face to face examination and discussion with your Board Certified plastic surgeon.

Douglas L. Gervais, MD · Answer

Post-op photos are helpful, but pre-op photos help us evaluate your situation and therefore you get more accurate advice. You may have needed a lift, have contracted infra-mammary creases or tuberous changes. A thorough in person exam is also needed.  From your photo alone it appears your implants (right more so than the left) are too high. Is this from inadequate release of the lower pole or early capsular contracture is uncertain. In my experience, one of the most common issues I see with the trans-axillary approach is difficulty in releasing the lower pole tissues. I would expect to see more improvement with placement of your implants at 8 weeks but sometimes implants take longer to "settle". Please follow up with your surgeon. Good luck. Dr. Gervais.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question and photographs.  Most patients following an augmentation start seeing settling of their implants approximately 6-8 weeks after surgery, but for others it may take longer.  It would be useful to see before images to ensure a lift was not required, but I would recommend allowing your results to mature for at least six months.  Hope this helps.

Marcus Davis, MBBS, MRM, FRCSEd (Plast) · Answer

Many thanks of your question and picture.
Without an in-person examination I cannot definitively advise you, however it can take several months for the implants to completely drop when placed under the muscle.
This said, looking at your pictures it appears that the distance between your nipple and the breast crease underneath it is not very long and it does not appear to have been lifted of the chest wall sufficiently to create the pocket for the implant to sit in, hence your implant may be being held high as a result. If this is the case then your implant will not drop. One of the difficulties when placing the implant via the armpit is dissecting the pocket enough inferiorly and towards the midline (centre of your chest.
I would advise that you stay in regular contact with your operating surgeon (and their support team) for assessment, advice and reassurance.
Best wishes,
Marcus

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