Is 800 ccs too big? Will they ever drop enough?

Question

I started as an A cup barely and I put in 800 ccs of high profile, saline, and through the transaxillary approach on each breast. It's been 3 weeks and they're so high. I know it's early and it takes 6 months to drop but now I'm wondering if I went too big. I want more lower pole fullness. Do I have enough tissue to ensure it will drop properly? Do I have to do another surgery? What do I have to do to achieve the look I want in my wish photos? If I wait, will I achieve the look I want?

Mark E. Mason, MD · Answer

800cc seems like a very large implant based on your pre-op photos. However, you are DEFINITELY still swollen and high and they will still drop. Have you been back for a follow-up with your surgeon? It is common for implants to stay high on leaner patients, and sometimes we will give them a strap that applies pressure to the upper pole to help the implants drop down. I would ask your surgeon about this. I would definitely encourage waiting at least 3 months before considering a revision, because you want to be sure they have had time to settle before adjusting your inframammary crease. Best of luck!

John L. Burns Jr., MD · Answer

Your skin envelope was very tight preoperatively and you jumped to the largest sized implant available.  To make room for the implant, the upper pole expanded and there is limited room in the lower pole for the implant to drop.  I'd definitely give it some time but it you continue to be unhappy with the appearance then I'd suggest downsizing to an implant with a base diameter equal to your native breast.

Michael E. Decherd, MD, FACS · Answer

It is hard to know exactly how it is going to play out, but I doubt they are going to end up like your wish photos.  Preop you are relatively tight in the lower pole...If your fold was lowered I think you would be seeing it now.  They will settle some, but I would talk to your surgeon first.Good Luck!

Ashley Gordon, MD, FACS · Answer

Hello and thank you for providing the photos. Your lower
pole was tight prior to surgery, so it will take several months for the skin to
stretch to accommodate the implants. I would definitely suggest seeing your
surgeon to express your concerns. They might have suggestions (such as wearing
a strap) that could potentially speed up the process. Best wishes!

Jonathan Weiler, MD · Answer

Great quesiton, hard to tell without a exam , would allow your body to heal and tissues to stretch for at least 6 months before anything is done, and discuss your concerns with your surgeon, good luck in your healing process...

Moneer Jaibaji, MD · Answer

Hello azngrl91, thank your for the questions and the myriad of photos, have you been back for a follow-up with your surgeon? It really is too early to discuss the results,  it is always helpful if you discuss your concerns with your surgeon and keep a close contact with him/her, at 3 weeks it is too early to judge the final outcomes and it may take up to 6 months to see the final results. Communicating your concerns with your surgeon will be helpful to you and him/he is the best person to address your questions and concerns since they know what procedure was done. Best of luck.

Andrew T. Cohen, MD, FACS · Answer

This is exactly why I don't like the tranaxillary approach. I have had the same problem recently with the implants ending up to high and not enough lower pole fullness.  Yours may drop I can't predict but I would tell you you may need a revision through an incision in your nipple or inframamary breast to lower your pocket.  The implant needs to be lowered to fill the bottom of your breast .  I would wait at least 3 -6 months post op and then see how they look.

Tom J. Pousti, MD · Answer

Thank you for your question. Your plastic surgeon will always be your best resource when it comes to an accurate assessment of your situation, advice, predictions, and/or meaningful reassurance.
Generally speaking, breast implants will "drop" into the pocket that was created during surgery and massaging the implants downward may assist in the dropping of the implants after surgery (for those patients who want to help with the settling of the implants). The rate of breast implant "settling" may depend on factors such as size of breast implant pocket dissected, tightness of the overlying skin/muscle layers, and size of breast implant utilized. Normally, it takes about 3-6 months (for some patients longer) to see the final result. It is very common for one side to settle faster than the other.
Sometimes, one or both breasts implants do not settle as planned and revisionary breast surgery becomes necessary to improve the outcome. On other occasions, if the long-term breast asymmetry is mild ( understanding that absolute symmetry is very rarely achieved), patients will need to decide whether proceeding with revisionary breast surgery is worth the potential downsides associated with additional surgery.
Again, best to follow your plastic surgeon for more specifics. Best wishes for an outcome that you will be pleased with long-term.

Marc J. Salzman, MD, FACS (retired) · Answer

Generally speaking, especially early in the post-operative
phase of healing, it is not uncommon to have one or both implants appear to be
high up by the clavicle. Although the “pocket” may be made correctly, the
implant may not have access to the bottom for several reasons. If the overlying
muscle or skin is tight, this will move the implant to the path of least
resistance which is up and towards the underarm where there is little or no
pressure. As the pressure relaxes, the implant will drop down to the bottom.
Smooth implants, because their surface is slippery, may move faster downward
than a textured implant with its rough surface. Because these variables
mentioned above can be different for each side, it's not uncommon that one side
will drop faster to the bottom of the pocket than the other. Similarly,
sometimes one breast will swell more than the other or be more painful than the
other early in the postoperative phase. After the first month or two, usually
things will even out. It wouldn't be, in my practice, until four months or so
has passed that I would entertain going back to the operating room to “touch
up” the location of the breast implant in the pocket. Sometimes specialized
bras or straps as well as massage and stretching protocols may be helpful in
allowing this process to happen more quickly. Each plastic surgeon will have
different thoughts on what the best protocol is for the patient. Your operating
plastic surgeon will be your best resource to have this information passed on
to you. I recommend that you faithfully follow up and follow the instructions
of your chosen plastic surgeon. Congratulations on your surgery, and good luck
on an uneventful recovery.

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