Two Years Post Breast Augmentation: Still Haven't Settled

I had my breast augmentation two years ago. 5'4" 140 lbs, was a small A, had 450 or 470cc saline smooth round high profile unders. My breasts don't seem to have settled all the way, the nipple looks too low and they seem too far apart. I probably didn't wear the strap as long as I was supposed to? Is it possible to have this corrected so they're in the right position? I'm thinking of having silicone 600cc high profiles put in.

Doctor Answers 16

Breast implants that haven't settled.

You have correctly diagnosed your problem which is to say that your breast implants have not settled.  And, this can happen especially with saline implants that are under the muscle.  The problem is this: saline implants are always going to stretch out, or expand the lower pole of you breast, and will thus settle.  How much this will happen is always a judgment call that depends upon the thickness of your muscle, the nature of how your body's tissues will relax, and the size and composition (saline vs. silicone) of your implants.  Massage after the surgery, and a strap (also known as a bandeau) will help.

Unfortunately, two years after surgery, yours have not settled, and will not settle on their own at this point. This makes you look too full up top, and makes your nipples look low.  You will need a revision to help correct this, and I would suggest that you proceed with it now.  I should also add that any surgeon who has done a lot of breast augmentations, has occasionally dealt with this problem

There are two things that I would point out.  First, it's a lot easier to lower and implant that is too high, than raise one that is too low, or has bottomed out. So you have this going in your favor.  You should be very diligent about massage after the surgery, and if a bandeau is recommended, I would divinely wear it.

Secondly, I would advise against, and strongly advise against, going any bigger. With and increase in size, you will need more stretching and expanding of the muscles and the lower pole of your breasts for the implants to settle.  And since you haven't settle yet, and haven't had enough relaxation of your tissues to accommodate your existing implants, going up on the size has the potential to make this worst.  This is a case where bigger is definitely not better!

Best of luck to you.  I would go back to the surgeon who performed your operations initially, or to another Board-certified plastic surgeon if he/she is not available.

Knoxville Plastic Surgeon
4.9 out of 5 stars 107 reviews

Breast revision

There are some patients that before surgery don't have very much tissue in the lower breast or very tight skin in the lower breast. In these patients there may be only  1-2 centimeters from the bottom of the areola to the inframammary fold. Even with lowering the crease the nipples may still look low in these types of patients and the implants high. So relative to your nipples the implants do look high but if your nipples were higher we might not be saying that. With your revision you would want to try to lower the implants further so the nipples could rotate up and if there is some element of capsular contracture you would want to address that.

David E. Kim, MD
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 97 reviews

Two Years Post Breast Augmentation: Still Haven't Settled

They will not settle- the implants are too high; maybe because of capsular contracture, maybe because of initial pocket formation.  You need a revision.  Be sure to choose a surgeon who can go over your options and who listens to what you want.  I personally dont see a reason why you cannot go to 600cc, you just have to be sure that the dimensions of the implant fit the dimensions of your breasts.  This must be done with the performing surgeon measuring your breast diameter, going over what implants you have now, and choosing the correct style and profile for your body, and determining if you have a capsular contracture.  Dont get hung up with "high profile"- it all depends on your body and the cc's of the implants that you will get!

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 106 reviews

My breast implants are not settling

I would agree with the other physicians in that you are correct that your implants are far too high.  I would also agree that you need to have this corrected by adjusting the capsule (scar) around your implants and possibly lowering your fold so that the bulk of the implant volume is better situated beneath the volume of your breast.

I would discourage you from going too much bigger because this may simply make it more difficult to now accomodate this extra volume since the original volume is already too high.

I hope this helps and wish you the best of luck with your revision!

Gregory A. Buford, MD, FACS
Denver Plastic Surgeon
4.9 out of 5 stars 42 reviews

Breast augmentation -getting it right the first time

For optimal results of breast augmentation for the average woman between 5 and 6 feet tall the desired proportions are that the nipples form an equilateral triangle with the upper notch of the breast bone and each side of the triangle is about 20cm in length and the breast and implant tissue are centered under the nipple. In your case the implant is centered above that. There could be a variety of reasons for this including a form of tuberours breasts with high breast fold present before the surgery, failure to divide the lower pectoralis major chest muscles near the breast bone etc. From the photos I would guess you had the implants placed through the armpits or belly button. The limited exposure of these techniques can make muscle release difficult causing the implants to shift and be held higher on the chest as well as further from the midline when placed under the muscle. The answer to the problem is to divide those muscle fibers to let the implant slide down and towards the midline a little bit. However after 2 years the capsule around the implants will be fixed in position so muscle release alone will not suffice. You will now have to remove the implants and capsules create better positioned pockets and then place new implants. There is nothing wrong with your current size and if you get much bigger, like 600cc, you are setting yourself up for more problems in the future requiring additional surgery. Some of those problems may not be completely correctable. If you continue down the path you started you will constantly need surgery to correct the previous surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

You will revision

Your implants were too big for your breast tissue and the lower pole of your breast could stretch to accommodate big implant. You will revision to lower the implants and bigger implants will make the results worse.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 122 reviews

Breast implants siting too high

At this point the result you see is fixed in place.  It would be better to do a revision and drop them down a bit.  You will get into more troubles perhaps going larger.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Breast too high - options

Thank you for your question and for sharing your photos. A revision procedure to release the lower aspect of your breast pocket/capsule should help to allow the breasts to descend. I would recommend an inframammary fold approach and also consider a dual plane approach if this was not done with your first procedure.

Young R. Cho, MD, PhD
Houston Plastic Surgeon
4.8 out of 5 stars 36 reviews

See your surgeon for revision

At this point, I would suggest you see your surgeon to discuss your results as your breasts will probably never settle. You'll probably need revision surgery. Best of luck!

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Breast Implants - "Settling" at Two Years Post-Op

Hi ehjayach,

Unfortunately, you cannot reasonably expect your implants to "settle" at two years post-op.  It can, in fact, take a few weeks to months for them to settle in general, but you're past that point.

The good news is that a procedure to lower implants is exponentially less complicated than a procedure that attempts to raise, reposition, or provide additional tissue coverage (such as when your skin is too thin, the implants are too big, etc).  In general, the existing incision can be opened and the intended pocket can be recreated, after which the implants can be pulled down (or pushed down, depending on where the incision is) into place.  Since it's two years later, you have the advantage of having given your skin time to stretch out.  That may have been part of the problem from the start; ie, that your skin and tissues were a little too tight for the size implants you received.  Now, though, things may fit better.

That's not to advise that you go larger.  Although I cannot tell without being able to see you in person, my sense is that the best approach at this point is the simplest:  lower your existing implants, and be comfortable with the way you'll appear after that.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 125 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.