4.5 weeks post op Breast Augmentation. What do I do?

Question

I had a breast augmentation 4.5 weeks ago and I am so very unhappy with my results. My breasts are very uneven and it is extremely noticable in any shirt that is remotely tight. I paid so much money to have a staged breast lift followed by implants and a tummy tuck. My confidence is even lower than before; I feel heartbroken and embarrassed of my breasts. What do I need to do to fix this? Will I have to pay for it?? I've already paid (cash) so much! :-((

Gary Lawton, MD, FACS · Answer

Implant massage will help.  Move the right side down.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.

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question! You are still early post-procedure. Your appearance looks typical at this stage and will continue to improve as the swelling subsides and the implants continue to settle into their desired position. This usually proceeds over the next several weeks to months as the lower pole skin/breast stretches to accommodate the implants. Follow-up closely with your surgeon for additional restrictions/instructions and the potential use of bras/garments or massage that may encourage the implant to settle appropriately.  It is not uncommon for the implants to settle at different times due to swelling, dissection, or muscle tightness.  If still displaced after this time, a surgical procedure may be necessary to further open the pocket and bring the implant(s) down or implant exchange/revision. Hope that this helps! Best wishes!

Paul J. Leahy, MD · Answer

I'm sorry to hear you are battling with this. It would interesting to know more details about your procedure, but it looks as though the left side is lower (and maybe larger) than the right, for reasons that are a little unclear. I would definitely keep up w/ your surgeon as he/she will understand your case the best. Often, if a revision is necessary, your surgeon will fight to help keep your costs to a minimum. Best wishes.

Arian Mowlavi, MD, FACS (license on probation) · Answer

It seems that your left breast is slightly larger than the right; It also seems that you have more of a lift on the right side which will result in more swelling on that side; I would give it at least one more month for symmetry to improve.

4.5 weeks post op Breast Augmentation. What do I do?

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