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Posted April 14, 2019 in Uncategorized

Dr. Friedman gets asked this question several times a week. And the answer is always, “Yes, they are too high. But don’t worry; it’s normal.”

All breast implants placed under the chest muscle will start out too high and tight. It takes time for the muscle to stretch and adjust to the implants. Not only is this normal, it is also exactly what we want. All implants will descend after a first-time breast augmentation.

If your implants start out too high, they will probably end up in the correct position within six months to a year. If your implants start out in the ideal position, they will probably end up too low within six months to a year. The before-and-after photos below illustrate the normal descent of breast implants following surgery.

Saline Breast Implant Sequence:

Saline Breast Implant Settling Sequence

Silicone Gel Breast Implant Sequence:

Silicone Breast Implant Settling Sequence

Breast Augmentation with Lift Sequence:

Breast Augmentation with Lift Settling Sequence Front View

Breast Augmentation with Lift Settling Sequence Side View

What’s going on? In the image below, once implants are first placed, the skin and muscle are placed under tension by the implants (Figure 2). The skin will look tight and shiny, and the muscle will contract against the implants, displacing them upward. Within a month or two of surgery, the skin and muscle will stretch and relax, causing the implants to feel softer. The muscle will release its grip on the implants, allowing them to fall (Figure 3 below). Even a month after surgery, the implants will not reach their final softness or position; it will actually take about six months (Figure 4).

If you’re wondering why we can’t just “put them in the right place to begin with,” consider that if your implants look just right one day after surgery, they will probably look too low by six months after surgery. Ideally, we want your breast implants to start high and end up in just the right position.

Breast Implant Settling Sequence Front and Side

Most patients wonder whether the implants will continue to descend after a year, but typically they do not. Why not? Because the muscle has been stretched by the implants, and your body has formed a capsule of scar tissue that prevents them from descending any further.

But what if it has been over a year since your breast augmentation and your implants are still too high? Here are the possible causes and treatment options:

The Implants Really Are Too High

Most implants eventually end up in the right place, but some really do stay too high. This can involve one or both breasts. After a year, it is unlikely that the implants will descend much further without surgery. Revision surgery can be performed to remove the implants, release the lower part of the scar tissue capsule, and place new implants.

Before/One Year After Surgery/After Capsule Release

Before and After Breast Revision

In the image above, the patient’s left implant remained too high a year after her breast augmentation. Dr. Friedman released the lower part of her capsule and placed a new implant, which allowed it to fall to a more desirable position.

The Breasts Are Too Low

Sometimes the implants are in good position, but the breasts are too low. There are two possible reasons:

  • The breasts started out with some sagging, and you may have benefited from having a breast lift (mastopexy) at the time of your augmentation.
  • Your breasts may have fallen in the years following your breast augmentation, perhaps due to childbirth or weight changes. If your implants remain in good position but your breasts have descended, the implants will look high relative to the breasts.

Regardless of the cause, the proper surgery is a breast lift. It would be unwise to release the capsule under the implants, causing them to drop to the level of the already low breasts. Instead, it would be better to raise the breasts to the level of the implants.

Before / After (1 month)

Before and After Breast Lift Side View

This woman had breast augmentation performed by a different surgeon. Dr. Friedman performed a breast lift resulting in significant improvement in both the contour and symmetry of her breasts.

You Have Capsular Contracture

It is normal and desirable for your body to form scar tissue around your implants. This “walls-off” the implants from the surrounding tissues and helps support the weight of the implants on a long-term basis. However, if the capsule becomes too thick and tight, it will cause one or both implants to look too high, tight, and firm. This is known as capsular contracture The treatment of this involves releasing (capsulotomy) or removing (capsulectomy) the capsule of scar tissue and replacing the implants.

Before / After (2 weeks)

Before and After Implant Replacement Front View

Before / After (2 weeks)

Before and After Breast Implant Replacement Side View

The patient above complained of capsular contracture. In order to achieve a more natural appearance, Dr. Friedman released her capsules and replaced her breast implants.

Some women will complain of multiple issues and will require a combination of procedures to address their concerns.

Before / After (2 weeks)

Before and After Breast Revision and Lift Front View

Before / After (2 weeks)

Before and After Breast Revision and Lift Side View

The patient pictured above underwent prior breast augmentation by another plastic surgeon. She came to Dr. Friedman complaining of asymmetry, bottoming out, and capsular contracture in both breasts. Dr. Friedman removed the capsules of scar tissue, performed a breast lift, and placed her new implants under the muscle instead of over it.

Feel free to call our office at (469) 467-0100 or fill out our online form if you have any more questions about breast implants. (Sorry, we are not actually qualified to answer any real estate questions.)