How Long Does It Take Implants to Look "Normal" After Reconstruction Surgery?

The size of the final implant is determined by the amount of volume placed in the implant during the expansion procedure. Tissue expanders project more than silicone gel implants, and that is why your surgeon was able to place 650 cc implants after using 600 cc expanders. Also, the width of your chest wall limits the size of the implant, as one must be careful to not place too wide an implant in the pocket that it extends into your axilla, or underarm.

It takes about 3 to 6 months before most women see the final size and appearance of their reconstructed breasts, so be patient. It is wise to wear a good, supportive bra, especially when exercising, to help keep the implants in a good position. Also, massage the breast to keep it soft and pliable. Taking an antihistamine, such as an over-the-counter anti-allergy medicine, may help decrease your risk of capsular contracture. I also recommend avoiding isolated pectoralis muscle strengthening exercises, which can result in visible contracture of the muscle with activity if you are very thin. Plank exercises associated with yoga and push-ups are OK.

This is a great question and the answer depends on a number of factors.
Implant based reconstruction can either be tissue expander at the time of mastectomy followed by implant placement at a second operation, or “direct-to-implant” placement at the time of mastectomy. While direct-to-implant is convenient, generally implant sizes are smaller than what could be achieved the tissue expanders although this depends on your preoperative breast measurements.
With regards to surgical swelling, most of it will be gone by 6 weeks but the last 5-10% will hang around for another 6 weeks. That’s why most surgeons will say to wait at least 3 months for what should be closer to your final result in terms of overall shape. For reconstruction, the needs of the cancer treatment dictate the type of mastectomy, lymph node excision, and radiation, all of which have an impact on the reconstruction. I advise patients to give it at least 3 months to heal, and to expect to have some contour irregularities and scar revisions that may need to be addressed at a secondary revision operation with fat grafting, etc. Finally, nipple/areola reconstruction can be performed as the final phase of reconstruction at least 6 months after the last operation.
Of course, the results will continue to change slowly over time (years), as the forces of gravity continue to act on all parts of your body, including the reconstructed breasts. The larger the breast implants, the more force on the tissues and the more rapid the rate of descent/change. In practicality, this may mean you notice that the implants have dropped to a less desirable position at 5-10 years instead of lasting 10-15 years in a good position. For patients frustrated with or having issues with breast implants, revision of implants or replacement with your own tissue both may be options.
Breast reconstruction is an art and a science and requires a skilled plastic surgeon experienced in breast reconstruction. It is important to seek out a board certified plastic surgeon to meet with prior to your reconstruction procedure. It is also too important to note that there are implant-based and your-own-tissue-based options for breast reconstruction. You may also want to make sure that your plastic surgeon is skilled in all methods of breast reconstruction, both implants and tissue, so that you have all options available to you and you can select what you think is best for you and your unique situation.

Thanks for your question. In your situation where your sizer was up to 600cc and the new implant is 650cc I would expect your implants to start to settle around 6 weeks. Start. It may take up to 6 months. If you are interested in larger implants following the healing process you should be able to go as large as you want, pending the implant company makes the size you want.