Will my 390cc implants get me to a D? Will the implant drop into my tubular breast? (Photo)

Question

I've recently (and I mean seriously recently- 2 days post op) had 390cc silicone implants (NAGOR) under the muscle placed in mildly tubular breasts. First I wanted to see at this stage whether it looks like I could end up with a desired result going from a 34B to a D, secondly whether there is the likelihood of the implant actually dropping into place as it stands and thirdly I have two types of post op bras one is mildly compressing the other is 34D but very tight what should I do? Thanks

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

It is very difficult to determine the best lift you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implants

M. Scott Haydon, MD · Answer

Thanks for your question and congratulations on your surgery. The original shape will probably result in a longer recovery with regard to dropping of the implant. There is more resistance in the lower pole of a tubular breast with constriction. The massage and stretching will help but your surgeon needs to be the one to direct this. Looking at your chest, I don't think you could have gone much bigger. The inferior tightness will push everything up and more volume will simply spill out into your arm pit or try to cross the midline. Best of Luck!

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

It depends on your chest wall measurements and existing breast tissue as implant size does not accurately correlate to a bra size.  It also depends on the brand and style of bra you wear as size varies from manufacturer to manufacturer.

The best way to assess and give true advice would be an in-person exam.

Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon

#RealSelf100Surgeon

#RealSelfCORESurgeon

Tom J. Pousti, MD · Answer

Congratulations on having undergone the breast augmentation procedure.  Your plastic surgeon will always be your best resource when it comes to accurate assessment and advice.

Generally speaking, breast implants will "drop" into the pocket that was created during surgery. The rate of breast implant "settling" may depend on factors such as size of breast implant pocket dissected, tightness of the overlying skin/muscle layers, and size of breast implant utilized. Normally, it takes about 3-6 months (for some patients longer) to see the final result. Sometimes, especially for patients who start with constricted breast anatomy, breast implants settling may take a longer period of time.

Also, in my opinion, the "drop and fluff” phenomenon does hold some validity; as breast implants “settle”, many patients feel that their breasts actually look larger. Similarly, it takes a few months for the breasts to "soften" in most cases.  Most of my patients tell me that their breast implants feel "part of them" somewhere between 3 to 6 months after surgery was performed.

There is definitely a physiologic and "psychological" (body image)  adaptation process that occurs, at differing rates for every patient, for patients who undergo any type of aesthetic surgery, including breast  augmentation surgery.  Understandably, patients often experience significant emotional "ups and downs" around the time of surgery.

Best wishes for an outcome that you will be very pleased with (regardless of specific cup size achieved).

Marc J. Salzman, MD, FACS (retired) · Answer

Generally speaking, especially early in the post-operative phase of healing, it is not uncommon to have one or both implants appear to be high up by the clavicle. Although the “pocket” may be made correctly, the implant may not have access to the bottom for several reasons. If the overlying muscle or skin is tight, this will move the implant to the path of least resistance which is up and towards the underarm where there is little or no pressure. As the pressure relaxes, the implant will drop down to the bottom. Smooth implants, because their surface is slippery, may move faster downward than a textured implant with its rough surface. Because these variables mentioned above can be different for each side, it's not uncommon that one side will drop faster to the bottom of the pocket than the other. Similarly, sometimes one breast will swell more than the other or be more painful than the other early in the postoperative phase. After the first month or two, usually things will even out. It wouldn't be, in my practice, until four months or so has passed that I would entertain going back to the operating room to “touch up” the location of the breast implant in the pocket. Sometimes specialized bras or straps as well as massage and stretching protocols may be helpful in allowing this process to happen more quickly. Each plastic surgeon will have different thoughts on what the best protocol is for the patient. Your operating plastic surgeon will be your best resource to have this information passed on to you. I recommend that you faithfully follow up and follow the instructions of your chosen plastic surgeon. Congratulations on your surgery, and good luck on an uneventful recovery.

Brooke R. Seckel, MD, FACS (retired) · Answer

Congratulations on your breast implant surgery.  Your plastic surgeon is truly the best person to answer your question and relying on  Internet advice can only confuse you.  See her plastic surgeon and ask when you may start breast implant displacement exercises which in my opinion are important to help the implants dropped and in particular to help expand a constricted breast.

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