Breasts sitting too high after my recent surgery.

Breasts sitting too high after my recent surgery, submitted image.

I had silicone breast implants put in about 2 weeks ago and they don’t look like I was expecting them to. They are sitting too high on my chest, and frankly they look unnatural. I know they are supposed to drop over time, but I’m nervous that my breasts are going to stay like this.

justjoy

F, 31, Delaware

It is unclear from your question whether the placement of your implants was subglandular or subpectoral. If the implants were subglandular (inserted beneath the breast tissue but on top of the chest muscle), you should not expect to see too much descent of the implant. However, if the placement of your implants was subpectoral, the breasts will descend, and you shouldn't be overly concerned about the position and size of your breasts three weeks postoperatively.

The majority of patients who have subpectoral implants tend to notice that their breasts have a higher profile than they would like, or in some cases, an ultra-high profile, immediately following surgery. When saline implants or silicone implants are placed beneath the chest muscle, tightness in the muscle and breast tissue hold the augmented breasts in a higher position than where they would sit naturally. The pectoralis major muscle takes some time to relax and accommodate the implant. Implant size also matters: if you have had larger implants inserted and have a smaller frame, it will take time for the chest muscle to stretch.

Over time, tissue expansion, muscle stretching, and gravity take effect and allow the implants to fall into a slightly lower place on the chest. Among many patients, this process tends to happen faster in one breast than the other, based on which side of your body you tend to favor and use most. In addition to descending, the breasts will also take on a more natural contour and, as postoperative swelling resolves, become softer and rounder in appearance.

You should begin to see some descent of the implant and fullness in the lower pole of the breast about five to six weeks after surgery. Your breasts should have a more moderate profile after three months, but final results may take up to a year to appear. If you have very taut skin, this may take a little longer. Plastic surgeons often recommend their patients gently massage their new breasts to encourage the tissue and muscle to stretch, so there is greater looseness and softness in the breast pocket.

Be mindful, however, that although the breasts should descend to a more natural position, the ultimate projection of your breasts will depend in part on the profile of the implants you chose. If you opted for high profile breast implants, these will have greater projection and less fullness in the lower pole of the breast due to the narrow base diameter of the implant. If you selected low profile implants, you can expect less projection and greater fullness in the lower pole due to the larger base width of the implant.

If you still feel concerned about the position of your breasts in a few weeks or have not noticed any significant descent or change in breast shape size, contact your plastic surgeon.

Dr. Jonathan Heistein has 17 Breast Augmentation before & afters:

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It is entirely normal for your breasts to feel unnaturally high on your chest three weeks after breast augmentation surgery. This is particularly true if you have had implants placed underneath the chest muscle which, in this case, acts as a support by upholding the breasts. It takes time for the muscle fibers in the chest and breast tissue to stretch out, allowing the implants to descend to a more natural position. The fullness in the upper pole of the breast is due to postoperative swelling in the period immediately after surgery and will subside over time.

On average, it takes approximately three months for the implants to settle after surgery. It is entirely understandable that you feel concerned about the high profile of your breasts at the moment, but I can reassure you that all implants descend over time as they settle in and give in to the force of gravity. Surgeons deliberately place implants a little too high beneath the chest muscle because they know that when they descend they will assume a lower profile and sit in the right place.

Your surgeon should have given you guidelines on post-surgical breast implant massage to push the implants in a downward direction, helping to stretch out some of the tightness in the chest muscle fibers. As these muscles loosen, the implants will descend. Regular breast massage is an effective way to stretch the breast pocket and lengthen the muscle, encouraging your implants to descend into a more natural position more quickly. In addition, avoid wearing push-up bras for at least six weeks after surgery. Push-up bras hinder the breast from settling and descending. Bras with underwire may also cause problems and irritate incisions that are still healing.

Allow your breasts another few months to settle into a more natural position on your chest. Do not hesitate, however, to voice your concerns to your plastic surgeon: he or she will be able to explain the changes you can expect to see in your breast implant profile as you move through the different stages of the recovery period.

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Repositioning the nipple areolar complex after breast surgery is possible.  If it has been a year and you still feel they sit too high it is worth reconsulting with your surgeon.  There are a couple of different ways to approach this, depending on your anatomy.  Sometimes the actual areola will be repositioned or sometimes the tissue at the bottom of the breast can be adjusted to pull the nipple lower.  Most likely it will require surgical revision but is worth it to have breasts you are happy with.

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An experienced board certified Plastic Surgeon can certainly help you assess whether your breasts are tubular, and how to correct them.  Remember that a consultation is just gathering information from an expert so I would not hesitate to do that.  It will be much more valuable in person.  You are under no obligation to schedule surgery.   Tubular breasts tend to have the breast tissue all under the areola rather than distributed throughout the breast.  

Dr. Susan Buenaventura has 4 Breast augmentation before & afters:

Breast augmentation before image performed by Dr. Susan BuenaventuraBreast augmentation after image performed by Dr. Susan BuenaventuraBreast augmentation before image performed by Dr. Susan BuenaventuraBreast augmentation after image performed by Dr. Susan BuenaventuraBreast augmentation before image performed by Dr. Susan BuenaventuraBreast augmentation after image performed by Dr. Susan BuenaventuraBreast augmentation before image performed by Dr. Susan BuenaventuraBreast augmentation after image performed by Dr. Susan Buenaventura

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Hello Joy,

    At 2 weeks out, I would certainly address your concerns with your surgeon.   They should look reasonable even at the beginning, but sometimes if a patient has very tight muscle or large implants (for your frame) the implant can get pushed upward.  I would ask your surgeon how long you should expect to wait to see a more natural result.  Sometimes muscle relaxants and or a breast band to put some gentle pressure on the upper pole is helpful too.  I would not do anything without speaking to your surgeon and ask to be seen sooner if you are concerned and don't have an appointment.   The good news is that if position does end up too high, it can be corrected by lowering the implant if needed.  It is still early.  Good luck to you.

Dr. Susan Buenaventura has 4 Breast augmentation before & afters:

Breast augmentation before image performed by Dr. Susan BuenaventuraBreast augmentation after image performed by Dr. Susan BuenaventuraBreast augmentation before image performed by Dr. Susan BuenaventuraBreast augmentation after image performed by Dr. Susan BuenaventuraBreast augmentation before image performed by Dr. Susan BuenaventuraBreast augmentation after image performed by Dr. Susan BuenaventuraBreast augmentation before image performed by Dr. Susan BuenaventuraBreast augmentation after image performed by Dr. Susan Buenaventura

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I can imagine how hard it is to accept that the implants are going to settle. But they are going to settle! It takes longer in some women than others but based on this limited image I'd bet you are on the path to an amazing result!

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