Can Breasts Still Even out and Drop 4 Months After Augmentation?

Question

Hi, I am 4 months post op and my left fluffed out and is bigger on the bottom while the right one sits higher has more fullness on top and is not full on buttom---I am guessing it hasn't fluffed? I am super worried that they will stay this way..I do not think I have capsular contracture, since my surgeon said they are healing nicely but I FEEL LIKE EVERYONE IS BLIND...what is so nice about 2 different boobs...will they ever drop or is 4 months post up already too long of a time?

Otto Joseph Placik, MD · Answer

Be careful what you ask for! These are relatively large implants for your petite frame. It is still early and I tell my patients that it may take 6-9 months for implants to settle or as you describe with the term ('fluff").My guess is that your right breast was the smaller breast and the skin is taking more time to stretch and relax, Preferential breast implant displacement exercises may help in this regard. 
	 

	With time, please be advised that they may continue to drop given your thin body habitus and relatively small lower pole.

Jeffrey J. Roth, MD, FACS · Answer

Thank you for the photo.  Breast implants tend to start dropping into place after 3 to 4 weeks.  They usually will get to their final position in 6 to 12 months.  One will drop faster than the other, also the shape may go through changes.  Please follow your Board Certified Plastic Surgeon's post op instructions. For example; we like message, but some surgeons will have you wait, or do it in a specific manner. Please also let them know your thoughts and concerns.

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

The two breasts commonly heal quite differently. One breast may swell more, feel more uncomfortable, or have a different initial shape. After complete healing, they will be more similar and natural. You must have patience, but if this causes concern, ask questions of the doctor or the nursing staff.The final results are mostly present including "dropping of the implant" when implants are below the muscle within the first 3 months for most and certainly by a year. Breast implants initially after surgery when placed in a submuscular position often give superior fullness that corrects itself with time, the "fluff and drop" phenomena. In reality the pectoralis major muscle takes a while to adjust its size to accommodate the implant as well as occasional muscle spasm which keeps the implant projection higher than its final resting shape. As the muscle relaxes the projection of the implant often increases and the breast shape improves. Massage and use of a superior placed elastic strap can often make this process go faster.

Young R. Cho, MD, PhD · Answer

Thank you for your question and for sharing your photos.  During the post-operative period the breast are swollen, and the breast implants appear in a much higher position.  Over time they descend and fills out the lower half of the breast. In addition, it is not uncommon for one breast to be more swollen than the other and may even out with time (unless they were asymmetric in size to begin with).  It may take several months for this to happen and can be encouraged with breast massage and compression.  It may appear that the breast enlarges as the lower aspect of the breast fills out (at the expense of the upper portion of the breast).  At four months, a good deal of settling will have happened (although more may continue).  I would also assess your pre-op photos as it is common for one breast to be higher than the other.   Also revisit with your plastic surgeon who can better evaluate and assess your post-op healing.

Lewis Albert Andres, MD · Answer

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 as the lower pole skin/breast stretches to accommodate the implants. 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. If still displaced after this time, a surgical procedure may be necessary to further open the pocket and bring the implant(s) down. Hope that this helps! Best wishes!

Richard J. Bruneteau, MD · Answer

It’s not unusual for patients to have asymmetry and
implant malposition following breast augmentation. This malposition can occur
for a variety of reasons. In some cases, asymmetry may be present prior to
surgery. This may involve the actual breast tissue or the underlying chest
wall. In other cases, asymmetry may be created during the surgical procedure.
An example might include the creation of asymmetric inframammary folds.
Finally, asymmetry may develop in the post-operative period. An example would
be the development of a unilateral capsular contracture. This phenomena results
in a progressive deformity which becomes more noticeable with the passage of
time.

Without preoperative pictures and a physical examination
it’s difficult to know the cause of your breast asymmetry. Despite this, it’s
important to realize that wound healing is a dynamic process that takes months
to occur. Muscle spasm, swelling, and skin tightness take time to resolve
before secondary surgery is a consideration.

Although there’s definitely reason for concern when
asymmetry is still present four months following surgery there’s still the
potential for improvement. For this reason implant displacement exercises may
result in the right implant dropping into a more normal position. If these
maneuvers fail, then revisional surgery may be necessary but shouldn’t be
undertaken for at least six months after surgery.

It’s important that you maintain close contact with your
surgeon. Your surgeon will be able to formulate a
treatment plan that’s appropriate for your problem.

Michael Constantin Gartner, DO · Answer

You can wait it out to see if they settle, or you can ask your surgeon about a revision so that the implant can drop lower.

Jerome Edelstein, MD · Answer

Although it generally takes about 4 months for drop and fluff to occur, it can take longer and be at different rates for each breast. Please wait for a bit longer since you've just passed the four month mark. Best of luck.

Christopher V. Pelletiere, MD · Answer

After a breast augmentation, most of the changes really should be done by three months. If after 4 months you still have one breast that appears not to have settled into position, or is remaining higher then the other side, chances are this is how it is going to stay at this point. The first thing to do is to look at your preoperative pictures. Alot of women do not ralize they have some degree of asymmetry before having surgery. Once the implants are in, they magnify asymmetries, and make them more apparent. This is something that you should discuss with your surgeon.

Jeffrey Claiborne, MD · Answer

In my experience with my technique, I do not expect any significant changes in breast shape or volume beyond 4 months (sometimes some subtle changes between 4-6 months). Your surgeon will have a better idea of his own experience with his specific technique.  I would discuss with him your concerns and ask him for a time frame to help you develop clear expectations.

Can Breasts Still Even out and Drop 4 Months After Augmentation?

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