If my implants are submuscular then why are they so high? Will they drop? Why the band?

Question

I got silicone filled implants (aec-xtralane 350cc) and tummy tuck 17 days ago. The dr told me that due to my hemo 12.5, she probably due subglandular. I asked her to confirm placement after, she said they're SUBMUSCULAR. I don't get why they are so high IF in fact they're submuscular and why I have to wear a band (hurts) to help them drop. Are they that high bc they were filled after? Will they really drop? I'm so concerned they'll always look like this. Not happy.

Leland Deane, MD, FACS · Answer

I share your concern. There seems to be a major disconnect in communication between you and your surgeon. The postoperative appearance will change eventually over the course of several months, but the extent of that change, whether you will be happy, and the possibility of eventual deformities, are all things that your surgeon and you should be discussing every step of the way. Good communication is the most essential thing here. From your photos, it is difficult to tell what is going on; you will need to speak with your surgeon. Certainly, determine early on whether the implants have been placed in a 'sub muscular position' or not. Sorry for your troubles. Hope this helps.

Leila Kasrai, MD, FRCSC · Answer

At 17 days post-surgery, your implants are sitting high because tissue expansion hasn’t occurred, yet. This will take about 4 months or so, during which your implants will gradually become less compressed and fall into place for a more natural result. The band will help make them drop, but if this hurts please notify your surgeon.

David Tauber, MD · Answer

After breast augmentation the tissues begin to stretch from the weight of implants and the breasts begin to settle. This “drop and fluff” often occurs in the first few months after surgery as the edema finally escapes and the soft tissues relax. During this time there can be small irregularities and contour deformities present throughout the breasts. In addition, slight asymmetry is often the rule opposed to the exception - especially as most breasts are asymmetric to begin with. A post-operative bra and superior strap are used to control the implant position during the early healing process. Sometimes breast massage is used to apply pressure to the implants and encourage the implants to drop faster. See the link below for more information.It will take up to 6 months to see a final result. Close follow-up with your surgeon is essential.

Austin Hayes, MD · Answer

Thank you for your question and congratulations on your surgery. Although I can't comment on the details of your specific procedure, I will say the breast implants placed under the muscle tend to be high immediately after surgery. They settle over the course of the first 3-6 months. Noticeable settling is seen in the first week and then again at the six week visit. The subsequent few months will lead to even more settling. As the implants settle, the appearance of the breast improves. A nice round contour forms at the bottom and fullness moves from the top to the bottom of the breast.

Ronald Schuster, MD · Answer

Breast augmentation is extremely common and recovery can vary from patient to patient based on the anatomy of the breast (tight / small vs loose / large), the implant (round vs shaped), surface (smooth vs textured) and placement location (submuscular vs subglandular). It is this last variable that probably has the most effect. In nearly all cases the lower portion of the breast has to stretch gradually to allow the implant to fill it out. As the lower portion stretches the implant will "drop" into place. Until this happens the implant will appear to be too high. In addition, in the majority of times the implant is placed submuscularly. It is beyond the scope of this to discuss the merits of the different placement location. Regardless, a woman's breast normally extends down below the lowest portion of the muscle (pectoralis major). In small breasted women it is not too big of  a deal if the implant is placed entirely beneath the muscle. But in larger breasted women, those who have lost volume after breast feeding, or in those who have an unusually high muscle, if the implant is placed entirely beneath the muscle, the implant can be trapped and unable to come down. That is why most surgeons will place the implant in a partial submuscular , or dual plane, position. Implants in the subglandular position have less of this as an issue and is often why surgeons might prefer a textured implant in this location. Textured implants won't tend to drop as much. The dropping can take a good month and I have seen it take as much as three months to finish. Massage and wearing a light compression band across the upper breast can help but you should check with your own surgeon.

Steven J. Rottman, MD, FACS · Answer

Thank you for your question. You are still early in the post-operative period. It typically takes 3 - 6 months for the swelling to subside and and implants to settle into proper position. Please discuss your concerns with your board certified plastic surgeon. Also, make sure you follow all of your plastic surgeons post-operative instructions regarding level of physical activity and use of a support bra. Hope this helps and good luck with your recovery.

Miguel Mota, MD · Answer

This is a common issue with sub-muscular placement. Sub-glandualar implants do not rid up and they settle much faster, but It is very common for implants placed under the muscle to be high and stay that way for weeks until they eventually drop. You are actually the norm not the exception, so you don't have to worry. This is usually not a problem and by looking at your photos it seems you will have a great result! 
Following your PS's instructions and using the band will help them drop much faster.
Best of luck,
Dr. Miguel Mota

Joe Gryskiewicz, MD, FACS · Answer

Hi Tata,At least you know that you are submuscular, probably a dual plane approach like Dr. Wallach mentions to you, below.   Keep your PS in the loop and keep wearing your band to coax them to drop.  You can pin the band to your bra strap to make sure it stays high, above the implant itself.  Wear it 24x7 except to bathe or shower. All the best, Dr. Joe

Christian Subbio, MD · Answer

Try to be patient.  The implants will continue to relax and drop over the first few months.At this stage, you are still early in the healing process.  The final result for a breast augmentation or Lift is never really judged until several months from the procedure.  Typically, I will wait 6 months before I assess the results.  Of course, it can be difficult to be patient while awaiting a result for such a long time, especially when you are excited.  But, keep in mind that living human tissues are different than sculpting with plastic or sewing with cloth.  Those substances are fixed and don't change much with time.  Human tissues, on the other hand, stretch, spread, settle, and change as they go through the different stages of healing.  This process takes time and as it proceeds, your result will change until the healing is complete.This is why plastic surgeons will always advise patience for the first few months after these procedures.  In the meantime, keep in close contact with your plastic surgeon and he/she can assure you that things are proceeding in the right direction.I hope this info helps!Best of Luck, Dr. SubbioPhiladelphia/Newtown SquareBoard-Certified Plastic Surgeon

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.   It is very normal for submuscular implants to ride high initially.  Usually over the next 2-3 months the implants will drop and look much better.  I recommend that you maintain close follow-up with your surgeon.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

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