Riding High after surgery but what about before?

I realize that many women get the dreaded frankenboob and ride high and tight after surgery. My question is, when the surgeon puts the implants in and sits you up in surgery, do they look normal at that point to them? Do they fall into the pockets created and look nice for a moment? Is it only after the patient wakes up and the muscles spasm/contract and swelling has occurred that they have that high and tight appearance? Could my Dr see the pockets and know they arent too shallow?

Doctor Answers 8

Implants "riding high"

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Thank you for your question.  I think the answer to this question can come down to time spent in the operating room.  There are some surgeons who are very quick and other surgeons who tend to be a bit more meticulous.  Attention to detail is very important, even for a simple procedure like a breast augmentation.  The pocket is precisely created to position the implant properly.  The action of the muscle and the immediate swelling can push the implant up a bit after surgery, but ideally the perfect position is created in the operating room. 

Salt Lake City Plastic Surgeon
5.0 out of 5 stars 37 reviews

Implant riding high

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Thank you for your question. Yes during surgery when the patient is placed in the sitting position both implants are to be in the same position sitting high. There reason for riding high is the lower pole breast skin is tight. It takes the skin about 3 months to stretch and relax for the implant to drop. For women who start off with a very small cup and wish for a D cup, it may take 6 months or more for the skin to stretch. Stretching may occur at different times due to uneven use of the arms or massage, therefore leading to uneven descent.

Johnny Shea-Yuan Chung, MD, FACS
Allentown Plastic Surgeon

Riding high implants

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Dear leela001When implants are placed in submuscular pocket the trauma to the muscle causes its tightening  (like in any muscle injury). This tightening can be immediate and the surgeon can see it on the surgical table with patient in sitting up position or can happen few hours or few days after surgery. An expert surgeon should be able to know if the implant sit too high because of muscular contracture or because the pocket is too tight.In the first case the implant will naturally settle in the right position once the muscle has healed and this can take up to few month after surgery.If the pocket is too tight should be ideally corrected during surgery but if not recognised might need revision of surgery at a later stage.Hope this helpsRegards,Mr Giorgio Netri

Giorgio Netri, MBBS
Manchester Plastic Surgeon
5.0 out of 5 stars 39 reviews

Swelling Post Op

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Thank you for your question. It is true that in the hours and days after surgery, the tissues swell and tighten, compressing and distorting the breast implants for a while. The pectoral muscles swell up after surgery. Your Plastic Surgeon likely saw a more true representation of their look during surgery and placement. I recommend that you talk to your surgeon about your concerns and expectations while you heal.
All the best

Normal looking in OR

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When you are sat up in surgery the breast most often look normal.  Then when you wake up and the muscle goes into spasm, you can see them rise up.


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Good question, during the surgery the pockets are created and the patient is sat upright to evaluate the pocket. At that time, the surgeon knows from experience what the breast implants are suppose to look like "on table". Depending on your surgeons dissection technique, the implants may sit in a closer to final position or they may sit high and have to settle over several weeks, technique dependent. With time, everything settles.

Riding High after surgery but what about before?

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Thank you for the thoughtful question. Yes, during surgery, as the patient's muscles are relaxed, breast implants sit  in the appropriate position (in the dissected pockets).  In our practice, it is customary to sit the patient upright several times to ensure good implant positioning, symmetry, and achievement of the desired outcome. The patient's goal photographs (and computer imaging  images) are used for comparison purposes during this process.

Generally speaking, breast implants will "drop" into the pocket that was created during surgery. 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 results.  

Many of my patients report that as the swelling around the breast implants (for example, in the sternal area) decreases, they feel that their breasts appear more projecting (and that they have better "cleavage"). Also, in my opinion, the "drop and fluff” phenomenon does hold some validity; as breast implants “settle”, many patients feel that their breasts actually look larger. Similarly, it takes a few months for the breasts to "soften" in most cases.  Most of my patients tell me that their breast implants feel "part of them" somewhere between 3 to 6 months after surgery was performed. 

 There is definitely a physiologic and "psychological" (body image)  adaptation process that occurs, at differing rates for every patient, for patients who undergo any type of aesthetic surgery, including breast  augmentation surgery.  Understandably, patients often experience significant emotional "ups and downs" around the time of surgery.

Best wishes for an outcome that you will be very pleased with.

Breast implant elevation

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What you described is what usually happens with a breast augmentation. OF course we surgeons sit the patient up and make sure the implant position looks good before the closure of the incision. With under the muscle implants the muscle spasm post op elevates the implants until the muscle relaxes and the implant falls back into the pocket the surgeon created. This can be immediate or take days or weeks. During this time the swelling is decreasing and the skin is stretching to the new normal volume. All this is what the surgeons call "drop and fluff". We get a lot of questions on this forum from nervous patients who are early post op and implants still up. We get far fewer questions that the implants stayed up more than 3 months. Thanks for the great question. Good luck.

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.