One breast not dropping after almost 2 months. Asymmetry? Tight muscles? Capsular Contracture? (photos)
Doctor Answers 16
Implant massage technique is very specific, perhaps you are doing it wrong
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.
Breast implant dropping normally
Implant Not Dropping
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
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Should I be worried?
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.
2 month post op
Need to before you can judge asymmetry of breast augmentation
Breast Asymmetry Concerns
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!
Breast Augmentation Recovery
One breast not dropping after almost 2 months. Asymmetry? Tight muscles? Capsular Contracture?
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!
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.