“Dr. Friedman, aren’t my breast implants too high?”
I am asked this question at least a couple times a week. And the answer is “Yes, they are too high. But don’t worry; it’s normal.”
All breast implants placed under the pectoralis major muscle will start out too high and tight. It takes time for the muscle to expand in response to the stretch of the underlying implants. Not only is this normal, it is also exactly what we want. All implants will fall after a first-time breast enlargement surgery.
If your implants start out too high, they will probably end up in good position within six months to a year.
If your implants start out in good position, they will probably end up too low within six months to a year.
The before-and-after breast augmentation photos below illustrate the normal descent of submuscular saline and silicone gel breast implants following breast augmentation.
Saline Breast Implant Sequence:
Silicone Gel Breast Implant Sequence:
Breast Augmentation with Lift Sequence:
If you’re wondering whether the implants keep falling after a year, the usual answer is “no.” Why not? The muscle has been maximally stretched by the implants, and your body has formed a capsule of scar tissue around the implants that prevents further descent.
But what if it has been over a year since your breast augmentation and your implants are still too high?
“Dr. Friedman, aren’t my breast implants still too high?”
You already know that breast implants placed below the pec major muscle tend to look too high for up to six months to a year after surgery. This is normal and generally resolves with stretching of the muscle. But what if you had breast augmentation performed over a year ago and your implants still look too high? Here are the possible causes and treatment options:
1. 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. The surgery involves removal of the implants, release of the lower part of the capsule of scar tissue below the implants (inferior capsulotomy), and placement of new implants.
This patient’s left implant position remained too high at a year after her breast augmentation. Dr. Friedman released the lower part of her capsule and placed a new implant which allowed the implant to fall to a more desirable position.
2. The breasts are too low.
Sometimes the implants are in good position, but the breasts are too low. There are two possible reasons:
a. The breasts started out with some sagging, and you may have benefited from having a breast lift or mastopexy at the time of your augmentation.
b. 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 (a or b), 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 breasts. Instead, it would be better to raise the breasts to the level of the implants.
This woman had breast augmentation performed elsewhere (before). Dr. Friedman performed a breast lift resulting in significant improvement in the contour and symmetry of her breasts (after).
3. You have capsular contractures.
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 (capsular contracture), it will cause one or both implants to look too high, tight, and firm. The treatment of capsular contracture involves releasing (capsulotomy) or removing (capsulectomy) the capsule and placing new breast implants.
In order to achieve a more natural appearance of the breast, Dr. Friedman released her capsules and replaced her breast implants.
Some women will present with one or more of these problems (implants too high, breasts too low, capsules too tight) and will require a combination of procedures to address their concerns.
This patient underwent prior breast augmentation by another plastic surgeon with 270-cc subglandular saline implants complicated asymmetry, bottoming out, and bilateral capsular contractures. Dr. Friedman performed capsulectomies and conversion to 390-cc total submuscular saline implants and mastopexy.