2 months po for breast augmentation, flat spot in the inner lower side of my right breast. Is this normal? (photos)

Question

Hello, I am 2 months post up for my breast augmentation, I have 450 saline under the muscle in both breast, since a couple of days ago I have being noticing a flat area in the inner lower side of my right breast that was not there before. I did not have any problems and my implants have been settling great. Should I be concern or could this change with time? Thank you

Gary Lawton, MD, FACS · Answer

At this point in your recovery, it is much too soon to be
worried about the outcome.  It takes time for the implants to settle into
position and the skin and muscle to stretch out to accommodate the new implant.
 It may be 6 months or more before the shape has reached its final
look.  Be patient.Implant massage may help smooth out the flat spot.  Implant
massage is a critical part of the postoperative recovery from breast
augmentation (like physical therapy is a critical part of the postoperative
recovery from knee surgery).  The space for the implant is meticulously
crafted at the time of augmentation surgery, especially when the operation is
performed using the surgical endoscope through the transaxillary approach.
 However, the distance from the nipple to the inframammary fold needs to
stretch out to accommodate the implant (dropping) and the skin and muscle need
to relax to give the desired shape (fluffing).  Implant massage allows you
to manipulate the pocket from the inside to direct the forces in the
appropriate directions to mold the breast shape to the desired outcome.
 If the scar that is actively forming around the implant is allowed to
heal without the influence of breast massage, the fold will not stretch
appropriately (implant stays too high), the scar will attempt to contract in a
linear way over the curved surface of the implant (breast shape will remain too
flat), and the space will attempt to heal smaller and tighter than the implant
(capsular contracture).  Implant massage influences the scar formation on
the inside at the most critical phase of the healing, allowing the space to be larger
than the implant (mobility which creates the natural feel and bounce).

Implant
massage starts at one week at 5 times per day for one minute at a time and
continues at this pace until one month.  I often see the patients weekly
during this time to reinforce the technique and help the patients who need
extra effort to soften the breasts. During this time period, the massage also
breaks up the spasm, relieving the discomfort, particularly upon awakening from
sleep (morning breast).  During the day, every time there is the sensation
of tightness, implant massage breaks up the spasm and relieves the discomfort,
minimizing the need for narcotics.  At one month, the force that can be
exerted is increased but the frequency of massage decreases to 3 times per day.
 As the wound matures, the massage can decrease to once per day forever as
maintenance.  The patients integrate this into their shower routine.

Although
some patients can get away with no massage, it is a common issue for those who
stop the massage and make none of their follow up appointment to suddenly show
up years after surgery claiming that they woke up one morning with a capsular
contracture and implant malposition.  Of course this did not happen
overnight, but was a slow process that could have been prevented with daily
maintenance massage and regular routine follow appointments on a yearly basis
(which we provide for free, forever). With this type of perpetual follow up, it
is possible to identify a problem early that might need a modification in the
massage technique.

Implant
massage involves moving the device up against the wall of the pocket, holding
pressure against the surface of the scar. The specifics are determined on an
individual basis guided by what the patient needs. In some patients it is
simple and of little significance.  In some patients it is a struggle to
get the implants into the right position and to gain softness and mobility, but
with the right technique and the appropriate dedication it is a huge success.  For
the patients that do not participate in the massage in a meaningful way, some
will get away with their lack of dedication because they were going to have
soft breasts no matter what.  On the other hand, some patients will
squander their opportunity to have an excellent result because they don't
believe that the massage is necessary, or because they have been told by their
friends or other doctors that they didn't need to perform massage.
 Regardless, they often require surgery that could have been avoided by
following the postoperative instructions of a surgeon that has performed nearly
10,000 breast implant operations and has seen the healing of each of those
patients and integrated the successes and failures of each one into a
postoperative plan that really works.

I find no use for bands, straps, bras or appliances after
breast augmentation surgery.

Jerome Edelstein, MD · Answer

Hello,Because you have noticed a change in your course of recovery at this time, I recommend that you contact your Plastic Surgeon and ask them to examine you in person.All the best

Ramiro Morales, Jr., MD · Answer

Thank you for your question and picture.  I would keep an eye on this area over the next few weeks to make sure that you are not developing an early capsular contracture.  If the breast feels a little stiffer than before, then this could be the case.  If so, then make an appt. to see your PS for an evaluation.

Bhupesh Vasisht, MD · Answer

In the picture you posted I cannot tell what you are referring to? You might be referring to a flat volume loss or a natural thin area of your breast tissue? This will require a close examination by your surgeon so I would suggest you return to your surgeon and show him this issue. Hope this helps. Good luck.Dr Vasisht

Darryl J. Blinski, MD · Answer

Best to see your chosen operative surgeon to examine area and determine if something can or needs to be done!

Derby Sang Caputo, MD · Answer

Thanks for your question. You must wait a while longer. Changes after a surgery like this can occur up to 12 months later. Always keep in touch with your PS.

2 months po for breast augmentation, flat spot in the inner lower side of my right breast. Is this normal? (photos)

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