I saw a breast augmentation patient in the office today who is seven days out from her operation. She had round moderate profile silicone gel implants placed under the muscle. She was concerned about how high and full her breast implants were. She is actually doing very well, and the appearance of her implants at this time is very normal.

Submuscular breast implants commonly start off “high and tight”, and drop into a more normal  position and shape over the course of several months. The early post-operative shape, and how fast the implants drop, depends upon the patient’s anatomy and tissue characteristics, as well as the size and volume of the breast implant. For any individual woman’s frame, as the implant volume increases the upper pole fullness seen post-op will also increase.

For several weeks following surgery, implants underneath the muscle tend to exhibit prominent upper pole fullness. This is related to the tightness of the newly dissected submuscular pocket, the contraction of the pectoralis muscle, and post-operative swelling. This shape is typically not visible in the operating room when the patient is asleep and relaxed. Once the patient awakens from surgery, the pectoralis muscles contract and push on the implants. This flattens the implant against the chest wall and forces the fill material (saline or silicone gel) upward, producing fullness in the upper breast. This upper pole fullness will be more exaggerated with larger sized implants, or as saline implants are (over-)filled with greater volumes. This upper breast fullness is normal, but sometimes can be quite significant and give the breast a rather unnatural appearance.

With normal post-operative progression, the breast shape will improve over several months. As post-operative swelling decreases, and the breast tissues relax and stretch, the implants will drop into place. This really is not so much a “dropping” into place, as it is a “volume redistribution” behind the breast. With less pressure on the implant, gravity begins to pull the filler material downward, and the volume will redistribute from the upper part of the implant to the lower part of the implant. With this volume redistribution, the upper portion of the implant collapses somewhat while the lower portion of the implant becomes more filled. The upper pole of the breast will become more sloped, and the lower pole of the breast will become fuller.

Some surgeons will recommend an elastic band worn around the upper chest and breast to place pressure on the upper part of the implant and help the implants settle more quickly.   Implant displacement exercises may also help implants drop; the implant is moved around within the pocket to help the breast soften more quickly.

The comments above primarily address the post-operative recovery that is commonly seen with smooth round breast implants. Anatomic shaped implants may demonstrate a different appearance, and may be managed differently because of their textured surfaces. Implant displacement exercises are not used with textured implants because the implant shell is designed to become adherent to the capsule surrounding it. Highly cohesive anatomic silicone gel breast implants are used with a greater focus on breast shape, as opposed to breast (large) volume. Therefore, in the early post-operative period, these implants tend to show less upper pole fullness when compared to round implants.

Your surgeon should be able to guide you through your postoperative course and make appropriate recommendations to enhance your recovery.