What Causes Frankenboobs Aka Spongebob Squareboobs? (photo)

Question

I am 4 days post-op from a BA (425 and 475 HP silicone implants, dual plane, inframammary incisions) and have the dreaded squareboobs. My surgeon said I would have trouble with swelling because of well-developed pecs. Is that why this occurs? Is there anything I can do to improve my condition or hasten my progress? It's unsightly and painful! My pre-op stats: 33 years old 5'8" 140 lbs grade 1 ptosis no children

S. Larry Schlesinger, MD, FACS · Answer

The ace wrap that you are wearing post breast augmentation to decrease the amount of swelling, and also the potential for post operative bleeding, unfortunately has all of its vectors of force pushing upward displacing the fluid in your implants upward.  The pressure of your pectoralis muscle and your tight skin on your silicone breast implants are also causing the fluid to go upward, but the bottom of your implants are either in the bottom of the breast implant pocket or very close to the bottom of the pocket.As the pectoralis muscle relaxes and as gravity pulls on the implant, there will be a downward migration of your silicone within the implant itself causing a phenomenon known as "dropping and fluffing".  If you were my patient, to speed the process and to have less of the dreaded square boob phenomenon, I would recommend an ace wrap at the top of your breasts rather than over your breasts, use a 4" rather than a 6" ace wrap, and pull ABDs at the anterior aspect of your armpit to decrease the chance of injury to the anterior axillary line.Ace wraps in this area need be worn for only 5-6 days before the implant forces its way into the lower portion of the breast implant pocket.That being said, I suggest you discuss your concerns with your personal Board Certified plastic surgeon as he or she may have their own techniques for modifying squareboobs.

Jerome Edelstein, MD · Answer

Please wait until about three to four months after your surgery to assess your results. By this time, your breasts will have taken on a more natural contour, where the lower breasts become softer and rounder. Natural tissue expansion occurs to allow this to happen, with the help of gravity. At the moment, your breasts are compressed by the tightness of your tissues, including your muscles.

Jacob Freiman, MD, FACS · Answer

So far nobody answered your question. The reason for "frankenboob" is because the area under the pectoralis major muscle is very tight and it squeezes the round implant making it appear long. Over time, everything stretches and the implant settle in the lower part of the pocket. At this point they will appear more normal as long as the surgery was done correctly.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.

	What you are experiencing occurs routinely to some degree after breast augmentation surgery done in the dual plane position.  I think that this appearance is related to the contraction of the pectoralis major muscle on the breast implants ( keeping the breast implants riding high while the breast tissue remains “low”).

	You will find that, as the breast implants “settle”, the appearance of the breast will improve significantly.  As this occurs, the breast implants and your own breast tissue become more uniform and the breast appearance rounds out nicely.  Some patients referred to this process as “dropping and fluffing”. It may take several months ( and even up to one year) to see the final results of surgery.

	In my practice, the  use of a “bandeau” and displacement exercises/massage is helpful. Ask your surgeon about his/her thoughts about these practices.

	 In the meantime, continue to be patient and follow up with your plastic surgeon.

	 Best wishes.

Mario Diana, MD · Answer

Thank you for your well-documented note.

	Dual plane implant position is designed to avoid the issue you are facing.  However, the size of the implant versus the breast width will affect the process and final outcome.

	Think of the implant "filling" the breast envelope and you can see that ideally the width of the implant has to be at least the same or smaller than the width of the breast itself.

	When the implant is placed under the pec muscle, the insertion of the muscle further reduces the width that allows the implant to "settle" and fit the relaxed breast envelope.

	The amount of muscle release or relaxation performed at the time of the implant insertion will determine the initial shape as well as the final position of the implant in the pocket: if sufficient release has been performed, the implant will soften in position after the muscle relaxes.

	You will experience a significant change in appearance over the next three months, in particular with appropriate exercises and possibly with the use of compression in the upper chest.

Leonard T. Yu, MD · Answer

Your breasts appear misshapen due to the swelling under your muscle. This is common with this type of placement. Things will improve with time...several months...a stabilizer band and displacement exercises will help to decrease the fullness on top. Discuss this with your surgeon. As things heal, your lower breast will fill out, but it it doesn't, it would be easy to revise things later to help create the desired shape. The main thing to do now is to be patient.

Jourdan Gottlieb, MD · Answer

I would bet that in surgery, while you were asleep or sedated, that when your surgeon sat you up the implants look well positioned.

	The breast implants, and placed under the pectoralis muscle sit in a pocket much in the same way that an item dropped in the bottom of a long envelope would sit. He can't go any lower but can go higher. The lower part of the pocket is the inframammary fold and this is a fixed point. During and after surgery if you were to try to push down on the implant it would have nowhere to go. the upper part of the implant is sitting in a large empty space between your pectoralis muscle and the rib cage. During surgery it is rather easy if one tried to push the implant all the way up to the collarbone.  

	As you awaken from your anesthetic those muscles which were well asked during surgery are reactivated. they don't actually move the implant but they displace the fluid upward making the implants appear to be too high.  It takes several months for the pectoralis muscles to relax to accommodate the implant and the appearance will improve.

	It is not clear how to hasten this process. Some surgeons, myself included, use a post-op bra that includes a pectoral strap which exerts some downward pressure on the implant to counteract the upward forces from the muscles. Implant massage should also help. 

	Thanks for the question and for the photos. Patience. Best wishes.

What Causes Frankenboobs Aka Spongebob Squareboobs? (photo)

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