Will my implants fill out/drop more into my lower pole? (photos)

Though there still is
a chance the implants can further drop filling out the lower pole with the use
of the strap and some good breast massage, significant changes may be unlikely
at this point as the fibrous capsules forming around your breast are pretty
stable at this point. However, it is unpredictable. You should return to see
your plastic surgeon for a physical examination and go over your concerns.

Best of luck

It is possible that the implants will continue to drop with the aid of a strap. However if they do not over the course of the next two months, I would consider  possible breast lift to get the  breast tissue centered over the implant. The Vectra system is a simulation and not a guarantee of an outcome,  nevertheless improvement may still be seen six months postop.

Thank you for your pictures. At five months your breast augmentation is pretty stable. It is unlikely that the implants will drop and fill out the lower pole. This is why I  am an advocate for placing the implants exactly where you want them at the time of surgery.

Thank you for your question.I would not suspect that the appearance of the breast will change much over the next couple months.  You stated in your comments that the nipple position was low prior to surgery and they are remaining low.  From the appearance of the photos you provided, the nipple/areola and maximal projection of the breast is not centered over the maximal projection of the breast implant.  To correct this discrepancy, you would need to have a breast lift to re-position the breast tissue and nipple/areola to be directly over the maximal projection of the breast implant.With that said, this determination could not be accurately made without a physical examination to evaluate each of the breast and implant characteristics that I described above.  I would recommend you discuss this with you plastic surgeon.  He or she would be your best resource.I hope this helps.  Best wishes!William J. Vinyard, MDBoard Certified Plastic SurgeonPalm Beach, Florida

This is a great question. Breast implants can continue to settle for at least 6 months, and sometimes they settle for up to 9-12 months. If I were you, I would give them some more time to settle and continue to see your plastic surgeon. If necessary, a relatively minor procedure (capsulotomy) can be performed to help them settle and make them move even, and this is a much simpler procedure than a breast augmentation with much quicker recovery for you.It's very important for you to keep your appointments with your plastic surgeon and discuss your concerns with him/her.I hope this helps and wish you all the best!Dr Knoetgen

At five months postop the implant position is not likely to change significantly. The fibrous capsules that naturally form around any implanted medical device are now well-established, so while I am sure it is not what you prefer to hear, it almost certainly will require a revisional surgery to improve your breast shape and to achieve a more aesthetically ideal positioning of the nipple-areola complexes (NACs). To provide a complete and accurate assessment of your current situation, one would need to review your preoperative photographs as well as some additional information (implant position relative to the pec major muscles, type of dual-plane dissection if performed, implant size and profile, etc), and of course perform a physical examination. You stated that you had ‘low nipples to begin with’, so clearly there was some element of preoperative ptosis (the medical term for droopiness, the ‘p’ is silent). From the photos it appears that implants which are too projecting - and perhaps too large - were placed in too high a position. In profile this creates an unnaturally full upper pole (excessive roundness / projection in the cleavage area), and in the lower pole the appearance of a breast hanging off of the lower end of the implant. If the implants are subpectoral, an incomplete release of the inferior origin of the pectoralis major muscles may hold the implants in too high a position and contribute to this appearance. Patients with mild to moderate breast ptosis who seek breast augmentation with implants generally fall into three categories, which vary with the degree of breast ptosis and the degree of skin elasticity: 1.Will have a fairly ideal appearance with an augmentation alone, as implant pocket dissection and implant placement can be performed in a manner the rotates the NACs into a higher position on the breast mound (usually requires a conservative implant volume or the upper poles will appear too large/full).2.Will have an acceptable appearance overall with augmentation alone but the NACs will be relatively low on the breast mound; many moms of 2 or 3 are fine with this, as are patients who are absolutely opposed to breast lift scars (again implant volume should be conservative).3.Will have the appearance of breasts hanging off of implants and therefore absolutely require a mastopexy at the time of augmentation.Without reviewing your preop photos (and, more importantly, without actual physical examination), it is difficult to say with certainty what set of circumstances led to your current postop appearance. But from your photos and your description I think it is most likely that preoperatively you fell into category 1 or 2 above, and that your postoperative appearance at five months results from overly projecting, overly large breast implants being placed in too high a position. It sounds as though preoperative Vectra imaging led you (and perhaps your surgeon) to believe that the ultimate NAC position would be more aesthetically ideal. That is a problem inherent in computer imaging: it shows you a potential or possible result, but not necessarily the result that you will actually end up with. What you get depends on what happens in the operating room. Breast augmentation of the mild to moderately ptotic breast, without simultaneous mastopexy, is a surgical procedure that requires careful preoperative planning, thoughtful and usually conservative implant volume and profile selection, and meticulous attention to detail in the OR. It is also incumbent upon the surgeon to provide each patient with a clear understanding of the outcome they are likely to have. Rather than showing patients a computer-modified image of what they might look like postoperatively, I find it much more useful to show patients ‘before and after’ images of actual surgical results where the preoperative appearance was similar to their own. This gives prospective patients a more meaningful impression of the kind of result they can expect depending on their own starting point. Your surgeon wants you to continue to wear a breast band for postop months 6 and 7 then return to the office for re-evaluation. If you have confidence in your surgeon based on your experience thus far, then wait it out and return at 7 months postop. If the appearance has not improved, then ask your surgeon what their plan would be for surgical revision. If you have lost some confidence, or if it would just provide you with some peace of mind to hear what someone else has to say, then it is probably worth seeking an opinion from another surgeon who is experienced in breast augmentation and breast augmentation revision surgery, and who has a large number of ‘before and after’ images for these procedures which show results that are appealing to you.

While there still can be some drop and stretching of the lower pole skin adapting to the implant, big changes are unlikely at this point. Your right breast looks like it is certainly higher and tighter than the other. Are they softening up or is there some tightness still? If it was earlier you could have went without a bra or a specialized bra in hopes it would promote the correct shape, but your capsules should be pretty mature at this point. There are also some prescriptions that may help, though earlier would have been better. I would return to your surgeon and go over your concerns and what the plan will be including possible reoperation to help even out your results.

Round implants have a tendency to do this even more than form-stable shaped implants.
Typically, this motion of the implant lowering into the breast occurs over
three to six months postoperatively.

Thank you for your question photos.  At 5 months it is unlikely that your implants will drop further.  I agree that a breast lift may be necessary to center the nipple areola over the implants.  Please see your plastic surgeon.