**6 Days Post Op** Breast Augmentation**implant Placement High and Unnatural -- HELP?

Six day post-op is much too early to panic! At this point you should be concentrating on healing.  Once you start the exercises, everything will look much better. It takes time for the swelling to decrease and for the implants to settle down. The best thing to do is discuss your concerns with your surgeon.

Hello! Thank you for your question! You are still early post-procedure. Your appearance looks typical at this stage and will continue to improve as the swelling subsides and the implants continue to settle into their desired position. This usually proceeds over the next several weeks as the lower pole skin/breast stretches to accommodate the implants. Follow-up closely with your surgeon for additional restrictions/instructions and the potential use of bras/garments or massage that may encourage the implant to settle appropriately. If still displaced after this time, a surgical procedure may be necessary to further open the pocket and bring the implant(s) down. Hope that this helps! Best wishes!

The artificially supported volume of the breast implants should change as swelling subsides. This may take a number of months however.

Thank you for your pictures.  This can be a common problem for transaxillary implant placement especially for surgeons with minimal experience with this approach.  You need bandeau treatment (a band across the upper pole of the breasts)

Dr. ES

It is too early to tell as all implants ride up high in the early post op period. You need to wait several months for these to settle down. One of the problems with the armpit incision can be implants that won't fall far enough.

Breast implants will "settle" to some degree and too much fullness in the top of the breast may be very normal in the immediate stages post operatively. However, we all have seen this as a permanent result in some before and after photos.A common error that leads to an unnatural appearance after breast augmentation, even with implants of an ideal size, is inadequate lower pole dissection and/or inadequate release of the pectoralis major origin just above the inframammary fold. As a result the implants sit too high and appear excessively full in the upper poles (the area above the nipple-areola complex), while the lower poles - which should be the fullest area of the breast - are underfilled. Inadequate muscle release may also result in bizarre-appearing breast implant animation when the pec major muscle contracts. In some cases this may result in one or both of their implants jumping up literally to the level of a patient's collarbones - an alarmingly unnatural look, and one that is totally avoidable  A shaped form stable breast implant can give the patient the lowest risk of fold and ripples in the lower pole, the lowest risk of a visible transition between natural breast tissue and implant  (sometime refereed to as a double bubble) and the lowest risk of breast implant malposition with the breasts bottoming out. I think there is a performance difference between form stable breast implants. Consult with plastic surgeon who have experience and expertise perfuming this particular procedure. In many breast augmentation patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola. Ideally the implant should be centered directly behind the nipple-areola complex (NAC). In profile, the natural-appearing breast is not convex in the upper pole, and an excessively convex and overly full upper pole is a dead giveaway that a breast implant sits below the skin. In addition, inadequate release of the inferior origin of the pectoralis major will allow the muscle to hold the implant in too high a position, and may even cause the implant to displace upwards (as high as the collar bone in some patients) when the muscle contracts. Patients with this problem require reoperation to release the inferior origin of the pec major and/or the inframammary fold. Likewise, if the inframammary fold is lowered too far, the augmented breast will appear 'bottomed out', with an excessively full lower pole, an empty upper pole, and a nipple/areola that appears to sit too high on the breast - another situation with a distinctly unnatural appearance, and one that requires surgical correction: repair of the inframammary fold(s).  

At 6 days post-op, it's really too soon to worry about shape.  I'm not a big fan of the transaxillary incision because of this exact reason.  Make sure you talk with your surgeon and go over your concerns, perhaps ask about a breast band and massaging.  Every patient and situation is different but breasts can change shape anywhere between 3-6 months so try to be patient and re-evaluate then with your surgeon.  ac

This could be due to the effect of the muscle being in a contracted state or the inferior pocket was not dissected open enough to allow the implant to "fall" into place. Only time will tell.//

It is not unusual for the implants to ride high after a submuscular breast augmentation.  The good news is time, weight and gravity are on you side.  As long as the pocket was dissected properly the implants will drop.  Massage will help to push the implant down.  If you are having muscle spasm a muscle relaxant may be beneficial. 

as they will settle.  Your doctor should be advising you on strategies to help get them to come down.  And as I am not an advocate of the armpit approach, I cannot be objective in your case but know implants will settle.  Your doctor wants you to have the best results possible so stay the course.  Revisions can always make things better and its hoped you won't need any.