One breast not dropping after almost 2 months. Asymmetry? Tight muscles? Capsular Contracture? (photos)

I will be 2 months postop in a couple of days and my right breast is getting way too behind on dropping and fluffing. I've doing pushing down massages on the right breast as I was told to do so by my surgeon's office (along with vit E 1000 iu/day) and contacted the nurse again, but they think it's just my muscles still being tight on my right side. The right side is tighter than the other as well... I'm afraid I might have capsular contracture or might need a revision. What am I doing wrong?

Doctor Answers 16

Implant massage technique is very specific, perhaps you are doing it wrong

The photographs show an excellent result.  You are also quite early.  Eventually the symmetry should be better.  Implant massage is the key. 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.


San Antonio Plastic Surgeon
4.9 out of 5 stars 136 reviews

Breast implant dropping normally

Thank you for your question and for sharing your photos. During the post-operative period the breast are swollen, and the breast implants appear in a much higher position. Over time they descend and fills out the lower half of the breast. It may take several months for this to happen and can be encouraged with breast massage and compression. It may appear that the breast enlarges as the lower aspect of the breast fills out (at the expense of the upper portion of the breast).

Young R. Cho, MD, PhD
Houston Plastic Surgeon
4.8 out of 5 stars 38 reviews

Implant Not Dropping

Dear shutterbug.p.v

I always tell patients that when we do a bilateral operation, one side is always going to hurt more, bruise more, swell more and drop at different rates. Be patient with that. As an aside, you should realize that muscles are not tight and delay descent. The pectoralis major muscle which is lifted up only covers the up 35 or 40% of the implant. The muscle does not completely surround the implant and hold it up.

I hope this has been helpful.

Robert D. Wilcox, MD

Robert D. Wilcox, MD
Dallas Plastic Surgeon
4.1 out of 5 stars 22 reviews

Should I be worried?

Hello Shutterbug. Sorry to hear this is happening to you. I do see the right implant being higher, but I don't see strong evidence of contracture. However, the only way to diagnose CC is through performing a physical examination. Your photos and history is more suggestive of a tight muscles and skin. Preop photos and an idea of your breast implant size would be helpful.

Here's the Baker classification on contractures to see if you have any other symptoms:

  • Grade I — the breast is normally soft and appears natural in size and shape.
  • Grade II — the breast is a little firm, but appears normal.
  • Grade III — the breast is firm and appears abnormal.
  • Grade IV — the breast is hard, painful to the touch, and appears abnormal.
At 2 months, I think it's too early to diagnose a CC. You should, however, continue to follow your surgeons instructions and perhaps there are other modalities they may suggest to continue to soften the breasts. CC is an inherent risk of having an expensive piece of plastic placed under your breast muscle and most likely neither you or your surgeon have done anything wrong. 

Best wishes,

Dr. ALDO

Aldo Guerra, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 202 reviews

2 month post op

It takes at least 3 months for the implants to drop and soften up.  They tend to do it at different rates, so one side usually drops and softens up a little earlier than the other.  Try and be patient as it will likely improve in the next few weeks.  Keep in contact with your plastic surgeon and follow their advise.  I hope this helps and best wishes. 

Luis H. Macias, MD, FACS
Los Angeles Plastic Surgeon
4.9 out of 5 stars 60 reviews

Need to before you can judge asymmetry of breast augmentation

You are very early in the recovery process.  The breast will change over the next several months.  Time, weight and gravity are on your side.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Breast Asymmetry Concerns

Hello,

Although I do see what you are talking about, it appears very minor in photos, and overall you seem to have a nice result. As for why one has not dropped as much as the other can not be determined in this format.

What I can tell you, and for the benefit of women reading your post is that despite what you've been told by your surgeon's office, there is no scientific data that shows that post operative implant massage is either effective at prevention or treatment of capsular contracture, or necessary for normal healing. The same can be said for high dose vitamin E.  In fact, there is evidence in the literature that long term use of vitamin E above 200 i.u. per day increases your risk for cardiovascular disease, something that you don't necessarily need to worry about right now.  Likewise for implant massage, a recent study published last year showed a correlation between implant massage and higher rates of capsular contracture in a group of surgeons being followed.  Although there is no cause and effect relationship established, it should get us (plastic surgeons) thinking that this may not be some harmless recommendation we give our patients.

Many surgeons like myself gave up on recommending implant massage many years ago, and I can speak for many of us that capsular contracture and implant malposition rates are below the average. 

Bottom line is you can't blame yourself if things didn't come out perfect.  There is really nothing you can do to affect the outcome.  The good news is that you look great and things will probably get better with time, as it is still early in your recovery. 

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 90 reviews

Breast issues

Your breasts look nice, and they may descend some more with time. Be patient, but remember no two breasts are exactly the same.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Augmentation Recovery

I know it's frustrating to not have your ideal results immediately, but it doesn't look to me as if you need to worry about capsular contracture or revision surgery at this point. It can take anywhere from 3-6 months for your breasts to fully heal and settle/drop into their new position. It is also extremely common for one side to heal/drop at a faster rate than the other. For now, keep following your surgeon's advise. If in a month, you are still concerned, then schedule an appointment to see he or she to discuss. 

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

One breast not dropping after almost 2 months. Asymmetry? Tight muscles? Capsular Contracture?

I appreciate your question.

From your photos, you appear to be recovering well and have a very good outcome so far.  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. Rest, relax, recover and heal. If you are concerned about capsular contracture, please contact your surgeon so he/she can examine you at this time. That diagnosis can only be confirmed by physical exam.

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

Jaime S. Schwartz, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 93 reviews

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.