Breast implants create their effect by causing an instantaneous expansion of the overlying breast mound. This relatively simple and obvious concept causes a variety of postoperative effects on the shape of the breast that are often incompletely understood by patients…although understandably so.
Some of their well known effects is that implants just make the breasts that a woman has already bigger. Therefore any pre-existing breast asymmetry, no matter how slight, will become magnified when the breast mounds become bigger. This has lead to the well worn phrase used by plastic surgeons of…‘breasts are sisters and not twins’…in preoperative expectation of what some women will see afterwards.
One of the most known after surgery effects of breast augmentation surgery is that the ‘implants will settle’. This indicates that the implant may initially look high. (too much upper pole fullness and/or an inframammary crease that is also too high) But with time and healing the implant will drop or settle into a more natural or desired position.
There is little question that the breast implant settling phenomenon is real and will affect all breast augmentation patients. But why this occurs may not be exactly clear. A not infrequent question, and an understandable one, is why the surgeon does not just put the implants in the desired position so they do not have to settle. In reality, the surgeon does place the implants where he/she wants them and on the operative table they do and are properly positioned.
But it is important to remember the tissue recoil effect. When breast implants are placed they create an immediate and dramatic stretch on the overlying skin and their elastic fibers. Like a rubber band that gets stretched out its natural elasticity will ‘fight back’. When you add in the immediate postoperative swelling that occurs, this combination will drive the implant upward where there is more tissue space. This is why early after surgery breasts look too round, too high and the skin even looks shiny.
It is much easier for a breast implant to move upward after surgery where there is much more skin that is not as stretched. The bottom pole of the breast is where the skin and underlying tissues are stretched the most and they are often naturally vertically short. (this is why the inframammary incision is almost always placed lower than the native inframammary fold) Thus it takes time for the bottom half of the breast tissues and skin to relax and allow the implant to come back down.
The breast implant settling process is one of months duration. Looking at a breast augmentation result can show some significant changes between the first month after surgery and six months later.
Dr. Barry Eppley
Indianapolis, Indiana