Worried Skin is Too Tight, Breast Are Set Too Wide, Worried Will Develop Necrosis Due to Tightness and Previous Smoking? (photo)

had my anchor lift and aug 8/30/13 Saline implants, high profile. mild smkr pre surgery. Quit smking 7 wks pre op. otherwise healthy. Not smoked after surgery. 5 days and am still really swollen. My tape is dark with blood and my skin feels really tight, under a lot of pressure. I can see some new stretch marks developing near my nipples. I've heard that too much tightness on the incisions will cause necrosis. I'm also worried that I'm too wide. I hope the implants move in and down. Thoughts?

Doctor Answers 10

Consensus one week post op augmentation mastopexy

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Your photos do not show anything concerning or abnormal.  Things will soften and settle.  Swelling will go down.  If you had an active role in choosing your size, you will be close to what you expect.  Its really best to let your surgeon know your concerns as your surgeon is best able to help address them.  You chose your surgeon and now you need to stick with your surgeon through the end.  Your surgeon really does want the best result for you too.

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Tightness after Breast Augmentation and Lift

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-Thus far your results look very nice. I see no evidence of necrosis.

-The tightness you feel after undergoing a lift and augmentation together is completely normal, and with time, your skin and muscle will relax, and the tightness will resolve. Additionally, the implants will likely move down as well...

-5 days in "surgery time" is still really early, and you won't see your final results for weeks to months to come

-Congratulations on quitting smoking! Don't start smoking again!  Thanks for sharing your photos.

Implants wound healing

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To be honest it all looks great.

Necrosis occurs as a result of poor blood supply and it would have occurred in the first week.

Regarding smoking and blood supply, and therefore wound healing. The best scientific evidence suggests that 4 weeks is enough. So you are all good from that point.

Pouria Moradi, MBBS, FRACS
Sydney Plastic Surgeon

No evidence of vascular compromise after a breast lift / augmentation

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Congratulations on stopping smoking.  Your breasts look fine and there is no evidence of necrosis or any visible signs of lack of blood supply.   Your skin and nipple area appear pink.  You can test for capillary refill but it looks like it will be fine.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Breast lift postop worries

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Your results at this point are perfectly normal.  If you were to develop necrosis, the area would be black.  This is not the case with you.  Continue to refrain from smoking for several weeks since smoking can make the healing take longer.  As times goes on, the implants will come down a little and your breasts will project a little more.

Breasts and smoking

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Based solely on the photo, you look ok.  I would avoid smoking. SOme swelling and bruising is normal. Best to see  your doctor if you have concerns.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Worried Skin is Too Tight, Breast Are Set Too Wide, Worried Will Develop Necrosis Due to Tightness and Previous Smoking

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Your breasts look fine at this point. The nipple is viable and the lift is properly done. Don't smoke for the next two weeks and you will heal much better. The implants will settle down over the next 2-6 months and look more natural.

Worried Skin is Too Tight, Breast Are Set Too Wide

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I would worry about neither of these. Nothing in the photo suggests inadequate blood supply. The implants seem centered right behind the nipples and areolas, which is where they should be. The implants are (I presume) under the muscle, and they really cannot (and should not) be closer than they are. As the pectoral muscles relax to accommodate the implants, the lower poles of the breasts will likely fill out, and upper poles will bulge less. The implants will seem lower, but not closer together.

So far, this looks like a nice result. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Swelling after surgery

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Since you are only 1 weeks from surgery, it is quite normal to have swelling and tightness.  You may use Mederma on your skin, but not tapes, to help minimize any stretch marks. Your physician will probably show you exercises and stretches to help the implants settle. Please continue to not smoke, nor be with anyone who smokes.  If you have any concerns, I suggest you ask your surgeon.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.8 out of 5 stars 18 reviews

After breast augmentation with lift

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Your maximum swelling will be at around 4 to 5 days so it is not unusual in your case that you are tight and swollen.  There is always a risk of some necrosis along the skin edges especially with a history of smoking.  Things will settle and change over time.  The breasts will relax and be able to move around more and create more cleavage, especially in a bra.  Just make sure to keep all follow-up appointments with your surgeon.

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.