5 weeks post op of Breast Augmentation, why is my nipple still pointed downward? (photos)

Question

I am 5 weeks post op, 600cc high profile, smooth round mentor silicone under the pectoral muscles , donut lift , Have my breast completely drop and settle yet? Why my nipples still pointed downward to the floor and I can feel there are hard rings under the both areola incision and full of air? Is it normal for the implants move side to the bed when laying down?

Robert M. Wald, Jr., MD · Answer

From your photographs, the breasts appear to be healing well. There is continued swelling for up to 6 months following surgery and the implants take several months to settle and drop. Breasts move normally from side to side and an implant will continue to allow the breasts to move normally.  Incisions feel hard for up to a year until the scar tissue in the area of the incision resolves. Please be patient, healing takes time.

Vaishali B. Doolabh, MD, FACS · Answer

Hi.  It would be easier to comment with a preop picture, but in general, there are limits to how high a donut lift can move the nipple areolar complex.  The rings are expected scar tissue, with maturation this will soften & flatten. The puffiness ("full of air") look will also improve. It takes months before the implant pocket is fully mature, so while it is hard to do so, try and hang in there.  You appear to be healing well otherwise.  Be sure to keep your postop appts with your surgeon and follow their directions on implant massage if needed and scar care.  Best wishes, Dr. Doolabh

Kurtis Martin, MD · Answer

As your breasts heal and the implants drop the nipple will continue to be pushed up. So wait at least 6 months before considering another procedure. And it is normal for large breasts to fall towards the axilla when laying down.

Gregory T. Lynam, MD · Answer

If only 5 weeks you are looking fine. The periareola lift often has some swelling that takes 3-4 months to flatten out. Keep following you docs instructions and update us on your progress please. Good Luck!

Richard J. Bruneteau, MD · Answer

The period of time immediately following combination breast lift/augmentation surgery is characterized by rapid change. During this dynamic period of time, swelling, muscle spasm, inflammation and the healing process itself all contribute to changes in the appearance of a woman's breast. In some cases, swelling and muscle spasm can displace the breast implants in a superior direction when implants are placed beneath the muscle. This can result in an artificial upper breast fullness and inferior malposition of the nipple areola complexes. Based on your pictures, I believe this is a distinct possibility.In some cases, superior implant displacement may be due to inadequate dissection of muscle insertions of the inferior portion of the breast pocket. There is no evidence that this has occurred in your case. With time, assuming adequate pocket dissection, these implants might return to a more normal position. Sometimes, the use of a bandeau superiorly and massage can facilitate this process.It may take 3 to 6 months for these implants to drop into a normal position. If no progress has occurred by then, revisional surgery may be necessary. This would involve recreating the lower portions of the breast pocket.It's important to have good communication with your plastic surgeon. Make sure he's aware of your concerns. He is familiar with the specifics of your surgery and will be able to give you appropriate direction.

Jerome Edelstein, MD · Answer

It appears that your breasts haven't dropped and settled, yet. This usually takes three to four months, so please wait a little longer before assessing results.

Vincent N. Zubowicz, MD · Answer

From the photographs it's apparent there is still a substantial amount of swelling in the nipple and areolar complex. This has to subside before a judgment can be made about abnormal nipple projection.

William T. Stoeckel, MD · Answer

It appears as if you have a rather nice result so far despite having oversized implants and undergoing a periareolar lift. Your nipples appear to be very well positioned and are not pointed downward in my opinion. The implants will continue to settle and soften, the puffiness of the areolae will lessen, and the rings around the areolae will soften over the next 3 months or so. Be patient and follow your surgeon's instructions.

Ziyad Hammoudeh, MD · Answer

At only 5 weeks postop following a breast augmentation with circumareolar (donut) lift, you are still very early in your recovery.  You implants will continue to drop and settle into position, which will likely produce some elevation of your nipples as the lower pole skin stretches out from the weight of the implants.  You appear to have satisfactory healing for this point in your recovery.  The hard ring you feel under the areola incisions is the suture used to perform the donut lift and is normal.  The best advice I can offer you at this point is to be patient.  I would recommend following up with our plastic surgeon to discuss your concerns to allow him/her to provide you with reassurance.  Good communication between patient and surgeon is very improtant both before and after surgery. Best of luck in your recovery!
Ziyad Hammoudeh, MD

Angela Champion, MD · Answer

At 5 weeks post-op, it is too soon to worry about final results.  Everyone is different but it can take 3-6 months for your swelling to go down and implants to settle.  Try to be patient and give it some time.  Continue to follow post-op instructions and re-evaluate at that time because as your implants settle and swelling to goes down, your nipples will most likely move to a more central location on your breast mound and nipples rotate up.  Be patient.  ac

5 weeks post op of Breast Augmentation, why is my nipple still pointed downward? (photos)

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