American Society of Plastic Surgeons
For Medical Professionals
4 years ago

Making breast augmentation appear natural

I had my first breast augmentation in 2017, however, after 9months, they still haven't "settled" or looked natural, how I was told they were going to look, so I underwent another 30 min procedure at the time to try to "lower" the implants. It has been 6 months, and they still haven't settled and have an "arch" at the top of my this normal? Any exercises I should be doing?

Procedure: Breast Augmentation
Location: Hyde Park, NY

Replies 5

Shashidhar Kusuma
ASPS Surgeon

Hello Brittany,

It appears that this is a pocket problem and also sagging of the breasts over the implants and hanging lower than the implant. It is true that over time implants do settle provided that the pocket dissection is good.

In a case like yours it seems that you might need a revision of the pocket and or a lift of the breast tissue. This is ofcourse assuming that there is no hardening of the breast from the implants.

This is a very high level guess based on limited information. I recommend that you get a very thorough evaluation and discussion to determine the problem and have it corrected.

Ricardo Rodriguez
ASPS Surgeon
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You may have a capsular contracture.

If that is so you will need a capsule release with either fat injection or use of an acellular dermal matrix to provide extra space in the pocket.

Debra Johnson
ASPS Surgeon

Dear Brittany, There could be a few reasons why your breast implants haven't "settled". The implants could still be positioned too high on your chest. Even after your revision, if the bottom border of the implant is still above your inframammary fold, they might need to be dropped further. Another reason might be the type of implant. The higher profile implants, particularly those with more highly cohesive silicone, are stiffer and have sharper borders, leading to a more pronounced projection in the upper breast....that "arc" you mention. Or if you have saline implants, those with a higher profile and particularly if your implants are over-filled, can get that same pronounced edge. Implants which are too big for your anatomy can do this, too. If your surgeon is an ASPS member surgeon, I would return to his or her office and discuss your concerns. If not an ASPS surgeon, use the Find a Surgeon link to locate an ASPS member near you for a second opinion. Good luck!

J. Gerald Minniti
ASPS Surgeon

Hi, Without photos or a physical exam, nothing can be said to help you. Go visit a few revision breast specialists in your area. Best of luck!

Michael Law
ASPS Surgeon

It can be very frustrating for patients who do not achieve the ideal result. If your surgeon is a board -certified plastic surgeon, I would urge you to share your concerns with him or her. A common issue that leads to an unnatural appearance after breast augmentation, even with implants of an ideal size, is inadequate lower pole dissection and/or inadequate release of the pectoralis major origin just above the inframammary fold. As a result the implants sit too high and appear excessively full in the upper poles while the lower poles - which should be the fullest area of the breast - are underfilled. In many breast augmentation patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola. In a revision like this, Gala Form or Strattice may be used to help keep the implants from dropping or changing position after a revision.


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