Thank you for your question. It sounds as though you have been compliant with conservative massage which is great. The asymmetry that you have and the hardness you are experiencing is most consistent with an encapsulation process. This accounts for the high riding position and the firmness. There is little else you can do conservatively. I would make an appointment with your surgeon to discuss current options. Don't despair a nice result is very possible. Best of luck!
Implant has not dropped post 5 months
Thank you for your question.
You have reached the minimum time it takes to achieve final
results. However, you may benefit from waiting 1 more month (6 months total)
for the final results as per your surgeon.
I humbly request you to not be discouraged. For some of my
own patients, the implants had not settled until 5-12 months.
Implants initially sit high up because the chest muscles and
surrounding breast tissues have not become accustomed to the implant resulting
in tightness. You have to allow gravity to take effect, and overtime, natural
tissue expansion will allow the implants to fall into place causing your
breasts to appear more natural, softer, and rounder. Once that happens, the
implant will sit directly behind the breast tissue in a natural 45:55 breast
ratio, and the nipples will move up higher. Currently, there may be excessive
upper pole fullness (> 55:45) in the left side, so in time, this will
Please note that it is not uncommon for breasts to heal and
adapt to implants at different rates. In fact, the process I described above
can occur quicker in one breast over another.
Please give time for the “drop and fluff.”
With persistent inward and downward breast massaging, along
with pole wraps, the breasts drop.
Patience is key!
If any implant does not drop with time, then it may be the
case that the muscle attachments or the inframammary fold attachments are
really strong and they may be preventing the implant from dropping completely.
You may require an IMF release in the future to symmetrize the breasts if it
does not get better for time.
Please continue to have regular follow-ups with your surgeon
to make sure your breasts are healing beautifully. Their recovery instructions
should take precedence over all else you read here as they are better informed
about your surgical details.
Hope this helps.
Regarding the firmness and the asymmetry there is little you can do to help it settle since this is a part of the healing process, you can only do something to ease the pain that you will experience during the recovery period.
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.
I'm sorry to hear about your difficulty. Pre op photos would be useful for comparison. If you note a significant difference in how the breasts look and feel this long after surgery, you may need surgical intervention to correct it. I recommend that you contact your Plastic Surgeon to discuss next steps.
All the best
Implant NOT DROPPED IN 5 MONTHS
from your photo, I believe you are correct in worrying about your result. Without pre-op photos to compare, it appears that your right breast was lower and larger than your left, and it still is. Your options will be to raise the right breast, or lower the left (whichever you like better), and change the implant in the left breast. Waiting one more month will not make any difference. You will need a surgical correction. Sorry for your problem.