Left implant higher than right at 18 days post op? (photo)

My left implant is much higher than my right at 18 days post op, but I was advised that my particular surgeon doesnt do massaging. What should I do ? I would ask him but he's very short in Responses thru text so I don't feel very comfortable asking him..

Doctor Answers 8

Breast asymmetry?

Hello! Thank you for your question! You are still early post-procedure. Your appearance looks typical at this stage and will continue to improve as the swelling subsides and the implants continue to settle into their desired position. This usually proceeds over the next several weeks to months as the lower pole skin/breast stretches to accommodate the implants. Usually, final results will be seen 4-6 months postop.  Follow-up closely with your surgeon for additional restrictions/instructions and the potential use of bras/garments or massage that may encourage the implant to settle appropriately.  It is not uncommon for one breast to settle more quickly than the other due to swelling, dissection, or muscle tightness.  If still displaced after this time, a surgical procedure may be necessary to further open the pocket and bring the implant(s) down or implant exchange/revision. Hope that this helps! Best wishes!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 22 reviews

One implant too high

I would take a washcloth and fold into quarters and place it above the breast that is riding high and get a velcro breast strap and wear it 24/7 to see if you can get the implant to fall.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 54 reviews

Post-Op Healing for Placement of Implants

Breast Appearance – The final appearance, shape, and movement are not exactly the same as normal breasts. The surgically enlarged breasts do not move in the same way as normal breasts. They tend to be firmer. The contours are usually somewhat different than normal breasts. In some patients these discrepancies may be rather noticeable. Although every effort is made to place the implants symmetrically, complete symmetry is rarely achieved. Immediately after surgery, the breasts are swollen and firmer. The final shape and size is approximated after 2 to 3 months, but up to one year may be required for the end result. Massage – Your doctor may require you to move or massage the implants within the breast pockets during the postoperative period. Textured implants do not require breast massage. You will be informed about this at your post-operative visit.Considering the amount of time it takes for swelling to reduce and implants to settle into place, you should be able to see your surgeon in person to evaluate your personal healing process. If you have any concerns or discomforts at all do not hesitate to take your situation to the surgeon to make sure everything is progressing properly. Good luck to you!

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

With one implant sitting so high in comparison to the other at only 3 weeks post-op you need to speak directly to your surgeon

In my opinion, this is a situation that warrants personal communication face-to-face with your surgeon, if for no other reason than to give him an opportunity to fully examine and evaluate you and put your mind at ease.  I think that a surgeon's responsibility to his or her patients does not end simply with the end of a surgical procedure; in fact, at that point it is only beginning.  Any surgeon that commits to operating on a patient should also be willing to commit to addressing her concerns adequately, promptly, respectfully, and professionally.  I'm not saying yours doesn't, but you should be able to expect him to do so.  The fact that you feel intimidated or uncomfortable with talking with him, or that he may only respond with text messages, is of concern to me.  Based on your picture, I think you have cause, and every right, to request a personal encounter to address your concern.  In my own experience, there have been occasions in which one implant may be sitting slightly higher than the other, but based upon the one picture you have provided here, this seems a bit more than the usual early asymmetry that would be within acceptable standards to me.  It appears as though there may be some swelling or fullness extending all the way to your collarbone and armpit area along the contour of the pectoralis muscle, the swelling appears to be of a different shape and extend beyond the apparent borders of your implant on that side, and that to me is very suspicious of a fluid collection around your implant - either a hematoma (blood) or a seroma (serous fluid).  In either event, such a fluid collection needs to be addressed early to prevent later problems with the breast, like capsule contracture.  Thus, I myself would be very inclined to take an aggressive approach toward this breast if you were my patient, and I would at least want to examine you closely in person, if not get an ultrasound or even return to the OR to explore your implant surgically if I couldn't be absolutely sure on exam what was going on.  Of course, I also must acknowledge the fact that your surgeon knows better than I what exactly was done in surgery too.  He knows what kind of implants were used, what size and profile dimensions they are, whether they are above or below the muscle, how completely he released the muscles and if it was done to the same degree on both sides, how much bleeding there was in surgery and if it was roughly the same on both sides, and a number of other similar and very pertinent details about your case.  Knowing these things is very useful in evaluating your breast as it is now and coming up with recommendations on what to do from here.  My best advice is to call your surgeon's office and tell them that you absolutely need to come in for evaluation.  As I said, at the very least you will get peace of mind if nothing is wrong.  I have my concerns though, based upon your picture.  In the unlikely event that your surgeon is not willing to see you for this in a realistic amount of time ( I would say within the next couple of days at the most) for some reason, I would strongly suggest that you find another board certified plastic surgeon who has extensive experience with breast surgery to evaluate you and manage you appropriately, even if that is simply reassuring you that everything is OK.  I am not trying to say that I know for sure what is going on with your breast, but I have enough of a concern that I don't want to see you simply accepting recommendations to give things more time and keep watching this without being properly evaluated early enough to intervene appropriately if there really is a problem that needs attention.   I wish you the best of luck!

3 weeks post op, some advices:

Thanks for the question. Its too early to talk about results.In my practice, after performing a BA I recommend to my patients to limit the movement of the arms for two weeks. After that, you can move your arms taking care and always with common sense. 
In this regard, it's not advisable to carry heavy weights to prevent the implant out of position, and allow the formation of the physiological capsule around the implant, also to avoid pain and breast swelling. Kind regards 

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 145 reviews

Breast augmentation

Thank you for your question and photograph.It is important to address any post-operative concerns with your primary surgeon.  You are still quite early on in your recovery. Swelling after a breast augmentation occurs with 100% of patients, eventually the swelling will go down and your breasts will drop into their pockets, sometimes you heal quicker in one breast than the other and one implant can even drop sooner than the other one.  If one implant is still sitting too high, the use of a breast binder and a foam wedge is beneficial to add downward pressure to that breast. I would continue to wear your surgical bra and perform your breast massages. Your doctor may also prescribe you a Medrol dose pack (steroid) to help with the swelling. I hope this helps.
Best of luck in your recovery!
Sincerely, James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

James Fernau, MD, FACS
Pittsburgh Plastic Surgeon
4.9 out of 5 stars 64 reviews

Implants at different levels.

Thank you for your question. It is early  in healing. Your breasts will continue to change in the coming several weeks. Massage is up to your PS. Most of the patients will look good by 3-4 months. Please follow instructions from PS and re evaluate

Implant not dropping 18 days postop.

Thank you for your question.

I humbly request you to not be discouraged. Large number of women experience differences in their breasts few days to few weeks after surgery and feel awful. After waiting for a few months, they finally get the results they were hoping for. It is too early in the recovery period for you to be concerned.

Implants initially sit high up because the chest muscles and surrounding breast tissues have not become accustomed to the implant resulting in tightness. You have to allow gravity to take effect, and overtime, natural tissue expansion will allow the implants to fall into place causing your breasts to appear more natural, softer, and rounder. Once that happens, the implant will sit directly behind the breast tissue in a natural 45:55 breast ratio, and the nipples will move up higher. Currently, there may be excessive upper pole fullness (> 55:45) in the left side, so in time, this will change.

Please note that it is not uncommon for breasts to heal and adapt to implants at different rates. In fact, the process I described above can occur quicker in one breast over another.

You may have to wait 3-6 months for the final results. So there is a lot of time for the “drop and fluff.” If the breasts still appear different at that point in time, then you may share your concerns with your surgeon and they should be able to fix the problem.

If any implant does not drop with time, then it may be the case that the muscle attachments or the inframammary fold attachments are really strong and they may be preventing the implant from dropping completely. You may require an IMF release in the future to symmetrize the breasts if it does not get better for time.

With persistent inward and downward breast massaging, along with pole wraps, the breasts drop.

Patience is key!

It was unclear whether your surgeon advises against breast massaging or whether they do not provide services for downward breast massaging. Most board-certified surgeons would teach you to do breast massaging so you could do it yourself over the long-term. It is true that we like to be concise and that would explain the short responses, but as a patient, you have the right to ask for further elaboration and resources to learn about breast massaging.

Please continue to have regular follow-ups with your surgeon to make sure your breasts are healing beautifully. Their recovery instructions should take precedence over all else you read here as they are better informed about your surgical details.

Hope this helps.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 414 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.