Is this normal for 17 days post op? (Photo)

Question

I am 17 days post op and my implants are super high... i keep on massaging and wearing a band but it has not dropped. My plastic surgeon said i need to massage more aggressively but i have been. What to do? what helps? does vitamin E or anything help? is this still swelling? they are still somewhat hard not too much. I have no pain. I am hoping this is not my end result. Ii had Saline implants 450 ccs on right and 470 ccs on left under the muscle with crease incision.

Farah Naz Khan, MD · Answer

At only a little over 2 weeks post op, you are still early in your healing process. Your breasts are swollen and your implants are sitting high. I advise my patients to wait a good 4-6 months to allow the swelling to resolve and to let the implants drop and settle some. Time is your friend here! Best of luck for great results!

Gary Lawton, MD, FACS · Answer

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,Thank you for your question. Your implant volume does appear to be displaced high and your pectoral muscles are likely swollen which contributes to the squared, upper fullness. You can expect your breast implants to settle, drop and fluff between 2-6 months post op so you are still quite early at this point.I recommend that you follow your Plastic Surgeon's advice and try to wait until 6 months before evaluating your results. You will likely see a lot of change before then. All the best

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

Right now, you are very early on in the
post op recovery period. It will take 3-6 months for you to feel comfortable
having implants in your body and for them to settle. This time allows for you
to physically and psychologically adapt to your new body image. There are many
variables that contribute to a breast augmentation's final result. Preop size
and shape, IMF location, location of the implants and type of implant. Patients
heal at different rates and each breast will sometimes heal at a different
rate. Rest, relax, recover and heal. Please Express your concerns to your surgeon so
he/she can examine you. Then reassess final result at 6 months.

The best way to assess and give true
advice would be an in-person exam.

Please see a board-certified plastic
surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!Dr. Schwartz

Charles Galanis, MD · Answer

Thanks for your post and the accompanying photo.  Don't despair!  You are still extremely early in the process.  As I'm sure you've been told, implants take 3-6 months to fully settle into their final position.  Although massaging and band therapy may help, there really is no substitute for time and gravity so try to be patient (as frustrating as that advice may be).  Continue to follow the guidance of your surgeon but you should absolutely anticipate improvement over time.  Good luck in your recovery!

Curtis Wong, MD · Answer

but will you achieve completely natural?  Only time and the specifics of your procedure will determine that.  But as your surgeon said, you have to be very aggressive in your massage and should be employing a band as well.  If things do not settle to your satisfaction, revisions should be able to help you achieve your goals so find out what the revision policy is of your surgeon and be ready to employ it.  If your surgeon is actually charging a fee, I think you can negotiate that.

Vincent P. Marin, MD, FACS · Answer

From the photos, it does appear that your implants are very high. However, you cannot tell much from a single photo in time. It needs to be compared with your pre-op photos and should be in the context of what procedure your surgeon performed. Continue to follow up with your surgeon to ensure that you progress as planned. 
Best of luck,
Vincent Marin, MDSan Diego Plastic Surgeon

Lynn D. Derby, MD (retired) · Answer

A single photo is not a substitute for an examination, but the super-high, flat, tight appearance looks normal for this early after surgery.  The tight pectoralis muscles compress the implants, and the path of least resistance for the excess volume is up, along the underside of the muscles toward the shoulder.  For implants in your size range, it takes several months for the muscles to stretch enough for them to look natural.  Wearing a band and massaging can help the process along, but what it needs most is time.

Is this normal for 17 days post op? (Photo)

Answers (8)

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