Breast augmentation is one of the most dramatic of all the body contouring operations. In just an hour in most cases, the breast mound is enlarged and the entire shape of the chest wall changed through the insertion of a synthetic implant. While the operation is short and the change is immediate, the actual recovery from breast augmentation is much longer. The feel and shape of the breasts will go through a series of classic phases of recovery of which most patients are unaware or do not expect fully.
For whatever reason, many breast augmentation patients seem to expect that the final shape and look of the breasts are achieved in days to just weeks. Many of the questions in the first month after surgery are very typical and range from concerns about size, shape, feel and symmetry between the two breasts. While a breast implant causes an immediate size increase, it does so without the skin yet being adapted to the pressure of this volume increase. When this is combined with the swelling and bruising that occurs from the trauma of surgery, there is a predictable series of phases that one can expect in their breast augmentation recovery.
The first phase of breast augmentation recovery (week 1) is associated with the immediate stretch of the breast skin and the trauma of surgery. This is seen in the swelling and extreme tightness of the breast which does not peak for up to 48 hours after surgery. The swelling of the breasts for some women will make them feel like they are going to pop. This swelling is seen by how shiny the skin becomes. Even though the same procedure was done to both breasts, they never swell exactly the same and one may note some asymmetry of the two mounds. Bruising may occur but it usually isn’t seen for days and will often appear not on the breasts but on the sides of the rib cage to the sides or below the breasts. The breasts will appear very round and often will look too high with a lot of upper pole fullness. They will feel anything but natural and will be as hard as a rock. Some women may feel some fluid moving around (residual irrigation fluid from surgery) or even hear the breast implant make noises (squeak) as it slides over the ribs underneath.
The second phase of breast augmentation recovery is from the first to the third week after surgery. The very visible swelling of the breasts begins to subside and whatever bruising occurred is completely absorbed. The breasts do not feel quite as tight and they may not look as high. They will not feel quite as stiff although they are still not soft and natural feeling. There will be persistent numbness on the lower pole breast skin and the nipples may still feel hypersensitive with shooting sensations or easy irritability. They will likely be some persistent asymmetry of the breasts and this should not be a concern at this point.
The third phase of breast augmentation recovery is from three to six weeks after surgery. At this point all the significant swelling of the breasts is gone and they are beginning to feel more natural and soft. The once high position and fullness of the breasts has usually subsided. They will move freely and no longer feel stiff. Nipple sensation is usually back to normal. The skin on the bottom half of the breasts will still feel numb however. At six weeks after surgery, it is reasonable to assess breast size, implant position and symmetry. The skin has nearly fully adjusted (stretched and relxed) to size and weight of the implants.
The fourth and final phase of breast augmentation recovery is from six weeks to three months after surgery. It is during this time that all of the residual effects of the change are realized. The breasts are soft and fully relaxed, nipple sensation is normal and most of the numbness of the skin has resolved. This is the time to become critical about the final results of the surgery in terms of implant size and asymmetry.
These four phases of breast augmentation recovery show that the time to be concerned about how the results look is not until three months after surgery. Patients will have many understandable concerns along the way but most of these will be self-resolving with time and tissue adaptation.
Dr. Barry Eppley
Indianapolis, Indiana