Is it normal to not have lower pole fullness?

Question

I am 5 1/2 weeks post op from a BA. 475cc silicone under the muscle in one breast and 450cc silicone under the muscle in the other. I am still swollen and they are still high.. My lower pole is not full and all and that worries me. I know it is still early, but is it normal to still be swollen with the lower pole not being full? I was probably a full A to a small be before surgery. i know this takes time, but i over think things and worry so much.

Michael Horn, MD · Answer

It is expected for submuscular implants to sit high right after surgery. With downward massage and time, the upper fullness moves lower to fill out the bottom of the breast. Most changes occur in the first four months, but the breasts will continue to get more natural looking for a year or two after surgery. Don't panic if they still look a bit high at 5 1/2 weeks after surgery. They will improve.

Jerome Edelstein, MD · Answer

It sounds like your breasts haven't settled yet into a more natural position. This generally takes three to four months, or longer if you don't have much of your own natural breast tissue and your skin is tight. By that time, your breasts will have gently rounded out at the bottom to assume a more natural breast contour. This is achieved by gravity and natural tissue expansion to accommodate the implants.

Ronald Levine, MD · Answer

Allow about 4 months for your breasts to even out and assume a more natural breast shape. It's called dropping and fluffing, and it sounds like you haven't had that happen yet which is normal for some patients at just over a month after recovery. I think you may want to ask your surgeon for some advice about helping the dropping and fluffing.

Jourdan Gottlieb, MD · Answer

An explanation of my impression of what we mean when we talk about implants dropping. 

	Submuscular implants are sitting as if they are at the bottom of an envelope. The breast fold, like the bottom of the envelope keep the implants from descending. At the upper pole is a large space under the muscle, and that space goes up to the clavicle (collar bone). Typically the implant position looks fine at surgery. As the patient awakens, the relaxed pectoralis muscle contracts, pushing on the implant. This displaced the silicone (or saline) which bulges into the upper pole, the only direction with room to expand. The lower pole of the breast may seem to empty out. But the implant itself doesn't actually move. As the muscle relaxes over several month, the upper pole no longer bulges and the implant position looks like it did in surgery.

	This process can take up to 6 months. If your surgeon was happy with the implant position at the end of the surgery, it is highly likely that your implants will settle into position, filling out the lower pole, and ending the fullness in the upper pole.

	Thanks for your question, best wishes.

Norman Bakshandeh Day, MD, FACS · Answer

You have said it yourself YOU WORRY TOO MUCH. It is too early after surgery for any thing to be said. Allow 6-9 months to pass before coming to any judgements.

Jonathan Weiler, MD · Answer

I would tell you to relax, it sounds that your implants are in the appropriate place and I tell patients that it usually takes 3-6 months for the implants to settle in their position and provide that lower pole fullness you are seeking, good luck.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Your anxiety/concern is understandable. I think that you are aware objectively that you are too early out of surgery to be concerned about breast implant position and/or asymmetry. For the vast majority of patients breast implants do settle and fill out the lower poles of the breasts; as you know, this process may take (on average) 3 to 6 months (sometimes longer).

	For real reassurance, and to rule out complications that can explain breast asymmetry and/or delay of breast implants settling) continue to follow-up with your plastic surgeon.

	Best wishes.

Steven Wallach, MD · Answer

At this time you are pretty early post-op. You have to give it time to heal and settle down. There is probably a lot of swelling as well.

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

Thank you for your question.  Breast implants placed beneath the chest muscle always take more time to develop lower pole fullness.However I would expect some movement into your lower pole by 5-1/2-6 weeks.  Final descent or settling of sub-muscular breast implants can take 3-6 months but I like to see some improvement certainly in the first 6 weeks.Please consult your plastic surgeon who did your breast augmentation.  Ask the surgeon if breast implant displacement exercises will help and does the surgeon approve of their use.Do not be shy about asking your surgeon about your concerns.  If the implants have moved lower in 5-1/2 weeks than they were immediately postop then this will probably continue and you will eventually be happy.

Sanjay Parashar, MD - Account Suspended · Answer

The lower pole fullness depends upon skin that is available between the nipple and your breast fold. Normally if the skin distance is less it is increased by lowering the inframammary crease/ breast fold. Breast band and regular massage to expand the lower pole will be very helpful at this stage.

Is it normal to not have lower pole fullness?

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