Breast Augmentation and Operating Room of Dreams: If You Make Them, They Will Drop.

Breast augmentation remains one of the most enjoyable surgeries.  Perhaps one of the reasons it is so fun is that the results are immediate, well sort of…   I saw a very pleasant woman today in the office who is one day after her breast augmentation with saline implants under the muscle (submuscular).   She was a B cup, and we chose to make her a big C small D cup.  This patient reminded me that many patients don’t understand that going from A or B cups to C or D cups is a process.   While the results invariably look spectacular on the operating room table, within hours after anesthesia the patient’s body puts of obstacles for the implants to settle.  The muscle and soft tissues swell and the muscles tighten.  The implants going up 2 cup sizes are often larger in radius than the nipple to fold distance.  What does this matter?  Well, the center of the implant should sit behind the nipple.  However, when the implant radius is larger than the distance from nipple to fold, the ONLY way the implant will sit behind the nipple is for the surgeon to lower the fold surgically.  However, that patient has lived with that fold for maybe 20 or 30 years.  It WANTS to be there.  It has ‘memory’.   So, the fold is lowered, and on the table the implant is exactly where you want it.  But then, the patient wakes up, the muscles tighten, the muscles swell, the implant rides up, and that fold you lowered tries to go back to its native position.  This is where I believe wrapping and aggressive massaging can help.  Some surgeons don’t believe that wrapping the upper pole of the breasts help push the implant down, others do.  However, most agree that massaging the breasts aggressively and EARLY help the implant fall and prevent that fold from healing in its old position (too high).  I encourage massaging after a couple of days if tolerable, with the patient squeezing the top of the implant to push it down.  And in a month or two, they’ll start to settle.  However, it is not unusual for the implants to stay ‘high’ for months!  Patience!  And beautiful breasts will come…