6 weeks and 3 days post op. Do they look normal in progress? 605 cc silicone gel round implants above muscle no lift. (photo)

Want to know if im going to get that nice round perky shape? I believe i still have more dropping to do because the bottom of my breast still very soft. I have another appt on the 12th of this month i dont want to be calling the ps office all the time though they are very professional i dnt want to bother so i read alot and compare my progress here but im starting to get very impatient. Does it look like i need a lift? My ps said i didnt at the time of my exam but that i may down the road?

Doctor Answers 6

Do I need a lift?

One of the more common scenarios that we as aesthetic plastic surgeons deal with in cosmetic breast surgery is the patient from either weight loss, or post pregnancy has a little bit of drop of the breast off of the chest wall that we call ptosis. The question then becomes in the patient's mind, can we just fill the space with an implant and create a youthful looking breast. It all depends on what the patient's perception of youthful is. My patients, more than likely, would like to have upper pole fullness of the breast without the necessity for wearing a push-up bra. In these situations, a breast lift plus an implant both centers the nipple and areola complex on the breast while replacing the lost volume with an implant. Most patients’ hesitation in doing the breast lift as well as implants, are the potential for bad scars. In my experience, we talk a lot about the scars of a breast lift preoperatively, but hardly ever in the postoperative phase. It seems to me, that when the breast is up high on the chest wall, youthful and perky, that one does not even see the scars. Most of the time, these incision lines heal uneventfully anyway. In the small chance that the scars are more red or thicker than one would like, we have many options in lasers, light sources, and laser assisted drug delivery techniques to mitigate against unsightly scars. Sometimes, patients who I've seen have seen other physicians who have recommended simply placing a large implant to "fill the space". This seems to be a very temporary fix for the situation in that the stretched out soft tissue that the implant is placed into, usually will allow very rapid descent of the breast, such that in just a few months, it looks like a bigger version of the breast that they first started with. They will then sometimes have a secondary mastopexy, and at that time, I would often recommend that they replace the very large implant with a smaller one. In my opinion, a large lift, meaning taking out as much of the stretched out skin as possible, and placing a more modest size implant will make a breast that will remain perky and up on the chest wall for a long period of time. In my opinion, perky breasts, not necessarily large breasts, look youthful. Patients will then ask, "why then does Dr. so-and-so tell me that I can just have implants?" My answer to this is very simple. It is far easier in most plastic surgeons’ skill sets to place a large implant then do a breast lift with an implant. The simultaneous lift and implant procedure is a little more challenging in that you're trying to do opposite things at the same time. One, you're trying to make the skin envelopes smaller and at the same time make the breast larger. One easy way to decide whether a lift is good for you, is to see your image in 3-D on a Vectra camera system. In our office, we can then compare two images: one with mastopexy with implants and the other with implants alone. In that way, both the patient and plastic surgeon can see what the difference in the look of both procedures are. Usually when implant is placed only, and a breast lift was really needed, what the patient will see is a breast that is falling off of a properly placed mound that's higher in the chest wall than the breast is. The breast seems to be falling off the implant. They will commonly squeeze the end part of their breast and ask, “why hasn't the implant filled this space out?” For me, the in between operation is to use a tall shaped implant. These anatomically shaped implants can create the illusion, that although the nipple has not really been raised, that the nipple is now more centered on the breast. While these implants do cost more than round implants, it still less expensive than adding a breast lift. All things considered, it's best to consult with a few talented and busy cosmetic breast surgeons to get different opinions. Good luck with your decision.

Louisville Plastic Surgeon
4.6 out of 5 stars 38 reviews

Augment outcome

First, you should not hesitate to reach out to your surgeon as that is what you paid him for. Secondly, you are so early in the healing process that the outcome cannot be assessed from your current status.  Personally, I would not place 600 cc implants above the muscle as that is a recipe for sagging. Intrinsically, you would not get "perky" by virtue of the large implant.

Breast augmentation

It is always nice to see preop photos.  At 6 weeks, the implants may still drop some more. At 4-6 months you will have to be evaluated to see if a lift might be necessary.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

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6 weeks post op, some advices:

Thanks for the question.In my practice, after performing a BA I recommend to my patients to limit the movement of the arms for two weeks. After that, you can move your arms taking care and always with common sense. 
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Thanks for the pictures.  Its hard to really evaluate without seeing your pictures from prior to your surgery to see if part of the problem isn't that you actually needed a lift along with your implants.  However at 6 weeks, its too early to really evaluate the full results.  They might still settle in a lower position with some time and give you the desired look.  Wait about 6 months for final results.  At that time if not happy, then you might be a good candidate for a breast lift.

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6 weeks and 3 days post op. Do they look normal in progress? 605 cc silicone gel round implants above muscle no lift.

Thank you for your question and for sharing your photographs. Unfortunately without a series of before surgery pictures it is difficult to determine whether or not you would have benefitted from a breast lift, but for now allow your implant results time to mature.  600cc implants placed above the muscle are large and will place stress on your breast skin causing some sagging to take place.  Once your results mature at around 6 months assess your outcome.  If your breasts are not perky than you can have a breast lift performed in a second stage.  Hope this helps. 

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.