Breast Implant Height
and Settling-In Period

At the Toronto Cosmetic Surgery Institute we are meticulous in our every approach during Breast Augmentation to ensure that we leave you with a beautiful, sexy breast enhancement that will transform your body image and self-esteem. However, patience is required. The appearance of your breasts immediately after surgery will likely not be that of the final, optimal result. Before the final assessment of your augmentation, it is important to wait until all healing has taken place, all swelling has gone down, and for your implants to have had time to settle down into an optimal position.

Are My Breast Implants Too High?

Following your surgery, your implants may appear to be sitting slightly too high and to have too much fullness in the upper half. This is normal and is especially true when the implants are placed below the chest muscle (pectoralis major). It takes time for the overlying muscle fibres to stretch out and to allow the implants to settle in. Furthermore, the fullness of the breasts is exaggerated immediately after surgery due to swelling that is more pronounced on top.

Your implants will settle down over the first 3 months after surgery. All implants settle in; even Implants that sit perfectly the day after surgery will likely descend over time as they settle in. Gravity is a constant force pulling down on your breast implants, and initially after your surgery while your wounds are still healing and tissues are soft, gravity will pull down on the implants. Tissues around the breast implants will also stretch out. Implants that sit a little too high right after the surgery will also descend and when they do, they will come into just the right place.
In the period immediately after your breast augmentation, your implants may appear to be sitting too high. This is partly swelling (which is more prominent on top) and partly the implant which may have been pushed up but will settle down. Dr. Jugenburg recommends to his patients to massage their breasts to help implant settle down and pectoral muscles to relax.

Please do not massage your breasts without first checking with our office. Not all patients are allowed to massage. Patients with anatomic implants and those with textured implants should not massage their breasts.
Descent of Breast Implants
Breast Implasts initially sit high after surgery

Implants Above the Muscle (Sub-Glandular)

Implants placed above the chest muscle (sub-glandular or sub-mammary) are not held up by the muscle fibres and immediately after surgery, should be situated close to where they are supposed to sit. In this case, because there is no muscle to support the breast implants, the descent expected with a below the muscle placement is actually an unwanted event and leads to bottoming out (a drooping breast). When implants are placed above the muscle, Dr. Jugenburg secures the lower border of the implant pocket to prevent the implants from moving downward. Patients may notice that the swelling, which is more prominent on top, goes away, therefore creating the false impression of the implant descending.

Implants Below the Muscle (Sub-Muscular)

Implants placed below the chest muscle (sub-muscular or sub-pectoral) can sit either completely behind the muscle, or partially behind the muscle (a technique known as Dual Plane Breast Augmentation). When behind the muscle, muscle fibres act as a support holding the implants up. Initially, these muscle fibres are tight, which is their natural state and has the effect of pushing the breast implant upward. You will be instructed on breast implant massage that will push the implants in a downward direction, therefore stretching the muscle fibres. As the muscle stretches, it will allow the implants to descend.

The Importance of Breast Implant Massage

The appearance of implants positioned below the muscle sitting high might look odd at first. You must also keep in mind that the implants will not reflect an accurate size; once the swelling has gone down your breasts may look smaller than the final result because the muscle has not fully stretched out. This is only temporary. It is important that you perform breast implant massage as often as possible to stretch out the breast pocket and lengthen the muscle, therefore allowing the descent of your implants into a more natural position much more quickly. So, please be patient and continue massaging.

Breast Height and Capsular Contracture

The breast implant on one side will likely settle faster than the other, due to normal muscle dynamics. For right-handed people the right side often takes a little longer to descend. You will need to be more aggressive with your implant massage if one side begins to lag behind. There is, however, a chance (1 – 5%) that the implants may never settle despite continued regular and aggressive massaging. This is typically due to scar tissue formation that is forming faster than the implant is able to settle, a condition known as Capsular Contracture. The body generates scar tissue as a natural response to the presence of an implant or foreign body, no matter what that might be. Some patients develop scar tissue faster than others. When you do have a Capsular Contracture, Dr. Jugenburg may need to perform an Open Capsulotomy to ease the contraction of scar tissue and allow the implant to drop.

Bra Support and Bra Management

While push-up bras are designed to do the opposite, by pushing the implants back up. Bras with underwires can also press against tender incisions, which may lead to unwanted problems if worn too soon after surgery.
If my breasts are sitting too high, can this be corrected?
You must first wait until at least 3 – 6 months after surgery before the final appearance of your Breast Augmentation can be assessed. Depending on all the factors of your augmentation, such as original breast and chest size, surgical technique and implant placement, Dr. Jugenburg may advise you to wait even longer. This is particularly important if your implants were placed below the muscle, when regular implant massage is required to assist their descent into a proper position. Thereafter, if you find your implants are sitting too high for your liking, a procedure known as an Inferior Capsulotomy may be performed. During this procedure, your breast pocket or fold will be lowered to enable the implant to be positioned in a lower, more normal position. This will give your breasts a sloped, more natural look, with good projection and perkiness, and with nice fullness and roundness in the lower breast. Sometimes, a small Breast Lift may also be required for best results.
I’ve changed my mind, my implants are too high?
Most women are very happy after their breast enhancement. They finally have the breasts they have always desired in terms of size, shape and look. Thorough preparation for your Breast Augmentation consultation with Dr. Jugenburg should ensure the correct decisions for your enhancement are made and that, without the influence of other factors, such as pregnancy or aging, no future revisions will be required.
Initially after the breast augmentation with smooth implants, the implants may appear to be sitting high. Some refer to this as ‘Frankenboobs’. Although it looks really strange, as you can see from the previous image, over time these ‘Frankenboobs’ do settle into their intended position and shape.

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