Nine weeks post op...shouldn't they have dropped more? (Photo)

Question

I'm almost 9 weeks post op and am having some anxiety over my augmentation. I went with Mentor gummies, high profile, 555 cc's. If you look at my pictures, they are sloping down and not showing any fullness, almost round. I know everyone has differently but all the pics I've seen, all have dropped into the pocket by now. Help!!

Larry S. Nichter, MD, MS, FACS · Answer

Follow you plastic surgeon's advice, you are still early. If you were my patient, I would most likely recommend use of a superior elastic band and downward massage. Discuss your concerns and ask for recommendations from your plastic surgeon. After 3-6 months you will have a better idea of your final appearance.

Gary Lawton, MD, FACS · Answer

Implant massage is a critical part of
the postoperative recovery from breast augmentation (like physical therapy is a
critical part of the postoperative recovery from knee surgery).  The space
for the implant is meticulously crafted at the time of augmentation surgery,
especially when the operation is performed using the surgical endoscope through
the transaxillary approach.  However, the distance from the nipple to the
inframammary fold needs to stretch out to accommodate the implant (dropping)
and the skin and muscle need to relax to give the desired shape (fluffing).
 Implant massage allows you to manipulate the pocket from the inside to
direct the forces in the appropriate directions to mold the breast shape to the
desired outcome.  If the scar that is actively forming around the implant
is allowed to heal without the influence of breast massage, the fold will not
stretch appropriately (implant stays too high), the scar will attempt to
contract in a linear way over the curved surface of the implant (breast shape
will remain too flat), and the space will attempt to heal smaller and tighter
than the implant (capsular contracture).  Implant massage influences the
scar formation on the inside at the most critical phase of the healing,
allowing the space to be larger than the implant (mobility which creates the
natural feel and bounce).

Implant massage starts at one week at 5
times per day for one minute at a time and continues at this pace until one
month.  I often see the patients weekly during this time to reinforce the
technique and help the patients who need extra effort to soften the breasts.
During this time period, the massage also breaks up the spasm, relieving the
discomfort, particularly upon awakening from sleep (morning breast).
 During the day, every time there is the sensation of tightness, implant
massage breaks up the spasm and relieves the discomfort, minimizing the need
for narcotics.  At one month, the force that can be exerted is increased
but the frequency of massage decreases to 3 times per day.  As the wound
matures, the massage can decrease to once per day forever as maintenance.
 The patients integrate this into their shower routine.

Although some patients can get away
with no massage, it is a common issue for those who stop the massage and make
none of their follow up appointment to suddenly show up years after surgery
claiming that they woke up one morning with a capsular contracture and implant
malposition.  Of course this did not happen overnight, but was a slow
process that could have been prevented with daily maintenance massage and
regular routine follow appointments on a yearly basis (which we provide for
free, forever). With this type of perpetual follow up, it is possible to
identify a problem early that might need a modification in the massage
technique.

Implant massage involves moving the
device up against the wall of the pocket, holding pressure against the surface
of the scar. The specifics are determined on an individual basis guided by what
the patient needs. In some patients it is simple and of little significance.
 In some patients it is a struggle to get the implants into the right
position and to gain softness and mobility, but with the right technique and
the appropriate dedication it is a huge success.  For the patients that do
not participate in the massage in a meaningful way, some will get away with
their lack of dedication because they were going to have soft breasts no matter
what.  On the other hand, some patients will squander their opportunity to
have an excellent result because they don't believe that the massage is
necessary, or because they have been told by their friends or other doctors
that they didn't need to perform massage.  Regardless, they often require
surgery that could have been avoided by following the postoperative
instructions of a surgeon that has performed nearly 10,000 breast implant
operations and has seen the healing of each of those patients and integrated
the successes and failures of each one into a postoperative plan that really works.

I
find no use for bands, straps, bras or appliances after breast augmentation
surgery.

Ronald A. Lohner, MD · Answer

Without preop photos, these answers are somewhat difficult.  A lot depends on your preop status and photos which we do not have to evaluate.  In general, implants drop in about 2 to 3 months, but certainly results can change (for the better) over at least 6 to 9 months.  Massage, a bandeau and time are certainly key at this point.  Revisionary surgery is not an option presently. Stay focused and try to be patient.  I believe that these rather large implants will continue to settle significantly over time. Best of Luck

Terrence Murphy, MD · Answer

Your photos show that the implants may still be somewhat high but that may not be a bad thing at this time in your post op course.  The weight of the implants is likely to still bring them down some.  The final position of the implants can take months to be established and you don't want them too low.   A band may help and you may want to ask your surgeon about this. Likely in time though you will get the result you seek.

Nine weeks post op...shouldn't they have dropped more? (Photo)

Answers (4)

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