Breast Implant Position and Breast Implants “Dropping” after Breast Augmentation

Sep 12, 2011 by

I read a lot of patient message boards and blogs, everyone should as this is a great resource for information. Like Widipedia, you should always double check the information, but many of the stories and before and after pictures contain valuable information.

The website www.realself.com usually has some good information. I found this question and answer (patient asks question, doctors answer): Do Implants Look High/Nipples Look Low? (photos) “I had a breast augmentation 4.5 months ago. Do my implants look high/nipples look low? If so, do you think they will continue to drop/fluff?”

Before I detail some of the answers, understand this: the fact that implants can “drop” or “settle” is not good. Why is the implant moving, dropping or settling? How can a doctor feel confident about the outcome of a breast implant surgery if the implants are going to move? Might some of this moving be what causes capsular contracture at some point in the future? And for how long will the implants be moving?

Someone should do a study on the following: the amount a breast implant drops or moves after it has been implemented and the rate of capsular contracture. Possibly the more the implant moves the higher the risk of capsular contracture?

Before I detail some of the Q & A, some information about Polyurethane foam implants and moving, dropping and settling- Polyurethane implants do not move. Doctors must be trained on how to implant them due to the higher friction of the Polyurethane implant- the implant forms what has been described as a “velcro like effect” immediately, the implant do not move, drop or settle. The patient does not massage the implant- in fact that patient is told NOT to massage the implant as it can cause bruising. The fact that Polyurethane foam implants do not move is a major advantage, the doctor does not have to make a “guess” as to the final position of the implant- the position implanted is the final position.

Still wondering if the lack of movement of Polyurethane foam implants is one of the reasons why they have a dramatically lower rate of capsular contracture….or maybe it is the combination of not needing massage (irritating the implant and capsule) and lack of movement.

Okay to a crazy part of the Q & A….here are some of the answers:

  • Yes I think they are just a bit too high. I would massage like crazy, pushing downward. Avoid wearing a support bra. I recommend to my patients to take Vitamin E which can help reduce the scar tissue around the implants which may be contributing to the fact they didn’t come down. They also make an elastic bandeau that can be placed across the top of your chest” Comment: massage like crazy? Again, somehow I have to think that “massage like crazy” is not ideal for the long term health and condition of the implant and capsule, couldn’t this irritate the tissue in the capsule and cause capsular contracture at some point in the future?
  • “At 4.5 months it is unlikely there is much more improvement in this look” Comment: so, the implants can keep moving even after 4 months? Does this mean that activities like exercise could lead to movement and malposition?
  • “If they did not drop or settle into a lower position by 5-6 months, the only way to correct it is with surgery” Comment- this sounds awful, implants move for 5-6 months and if they don’t move correctly you have another surgery.
  • “Based on these photos, the breast implant position seems high for 4 and a half months post surgery. They still may settle a little more over the next few months. Another reason could be early onset of capsular contracture which is scar tissue formation around the implants which may have prevented them from dropping. I recommend visiting your plastic surgeon for an evaluation and massaging your implants in the meantime.” Comment- Ugh. So this woman might have capsular contracture, the implants might move and she should keep massaging the implants. Ummm…okay…
  • “At this far our from surgery I would expect the implants to have dropped more than they have. I would recommend continuing aggressive massage and ask your PS about a a band that wraps around the top of your chest to help to push the implants down”. Comment- totally confused here- this doctor expects the implants to drop after surgery, sees pictures of implants that haven’t “dropped” and suggests the patient continue with aggressive massage? This really seems like you are forcing implants that don’t want to move- which should be a good thing.
  • “Generally, we wait about 6 months for final settling” Comment- oh great, so you get implants and then wait 6 months for them to reach their final position?
  • “With the exception for Dr. xxxxx (Note- I omitted this), I respectfully disaggree with the recommendations of the other 10 responders to your question. Both of your implants are sitting too high, especially the right implant, to be considered normal.  It is very difficult to make truly accurate assessments with only photographs and not conduct an actual examination, but it looks like there may be an element of capsular contracure to the right implant, and neither look like they are sitting against your natural inframammary fold, something we would expect after an augmentation.Regardless of why your implants are too high, I will give you assurance that vigorous massage, vitamin E, compressive bands, or pharmaceuticals like Singulair or Accolate will not be effective.” Comment- YEAH, someone saying to knock off all the massage and attempts at moving the implants! This seems like great advice- though the patient won’t like it due to the talk of capsular contracture and possibly the doctor that did the implant surgery placed the implants too high in hopes that they would settle.
My take on the picture- the doctor that performed the surgery placed the implants high on the chest and hoped they would settle- they did not and now the patient needs a second breast implant surgery.
Polyurethane foam implants have many advantages- an overlooked advantage is that they “stay where they are put” and don’t require the doctor to guess about how much the implant will settle.

 

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