Is this normal for 4 weeks post op? Should I be worried about cc, seroma, hematoma? (photos)

4 weeks po 350cc under the muscle. Both breast were doing fine until the last few days the right breast is soft, not painful. Left is very tender it feels swollen or heavy but there doesn't appear to be a difference, only cm. Left most sore on the medial side (inner side) and under side. Previous bruising to left is healing and almost gone. appointment next week.No fevers, redness, or drainage noted incision healing well. Anything I can do to help with this swelling or whatever is going on?

Doctor Answers 11

Implant massage

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.

1 month post op, some advices:

Thanks for the question. In my practice, after performing a BA I recommend to my patients to limit the movement of the arms for two weeks. After that, you can move your arms taking care and always with common sense. 
In this regard, it's not advisable to carry heavy weights to prevent the implant out of position, and allow the formation of the physiological capsule around the implant, also to avoid pain and breast swelling. Kind regards

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 147 reviews

Summary of Post-Op Healing Process

HEALING OF SENSORY NERVES: Tingling, burning or shooting pains, which will disappear with time and should not alarm you, indicate regeneration of the sensory nerves. If these sensations cause pain, repeated, local self-massage helps. ASSYMETRY: 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. SHAPE AND CONTOUR: The final shape of your breasts will start to look its best approximately three (3) months after surgery. It takes time for the skin and muscle to stretch and relax around the new implant. The breast will often look higher, firmer, and “less natural” in the first three (3) months. It can take up to a year to see your final result.Be sure to keep up with your follow-up appointments and listen to your doctor in response to any concerns or worries that you may have about healing. If anything comes up that bothers you at all it is a good idea to see your surgeon right away. Best of luck!

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

Issues 4 weeks post BA

From your photos I agree it looks like you are doing well 4 weeks after surgery.  If you have concerns about your recovery, you should return to see your surgeon for an in-person examination to make sure he/she is happy with everything. You are very thin and it looks like you have had realtively large implants placed so swelling will be more at this early stage especially after placing them under the muscle

Breast augmentation recovery

From your photos, you appear to be doing well 4 weeks after surgery.  If you have concerns about your recovery, you should return to see your surgeon for an in-person examination to make sure he/she is happy with everything.

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 10 reviews

Is this normal for 4 weeks post op? Should I be worried about cc, seroma, hematoma? (photos)

It does not appear that you have an emergent situation, based on your photos. If you have returned to any activities that might be too strenuous, this discomfort may be the result of that. I do not see that there are any issues (by your photos, without physical exam) at 4 weeks post op. If you are extremely uncomfortable and need some reassurance, I recommend moving your appointment up to see your surgeon sooner. With a physical exam, he/she will determine if there is anything to worry about.Good luck!

Reza Rod, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 5 reviews

Is this normal for 4 weeks post op?

It is ALWAYS best to return to your operating surgeon for any concerns your having for an in-person exam to rule out capsular contracture, hematoma (though you do not have significant bruising in your photos), and/or a seroma. From the photos your breast appear fine based on having surgery 4 weeks ago and you also provided no pre surgical photos of your breast. Hope this helps.


I appreciate your question.

Since there has been a change in your post op course, please contact your surgeon so he/she can examine you and recommend the most appropriate treatment plan at this time.

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 plastic surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon


Breast issue

The two breasts look fine in the photos, some of what you are experiencing may be related to increased activity.  If concerned, you might want to speak to your surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Asymmetric Swelling/Discomfort

If you are noting new or sudden changes I recommend that you ask your Plastic Surgeon to examine you in person. The breasts appear fine based on photos but fluid collection would cause one breast to feel firmer/more swollen and sore.
All the best

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.