Implanted breasts undergo an evolution
of sorts following surgery. The body adjusts to hosting the implant and this adjustment can change over the years that follow. There are also events of which the patient may have control that have predictable changes in an implanted breast. When I tell patients this prior to surgery, many of them look at me with surprise, so it seems like a good topic for discussion. Realistic expectations are important to establish again BEFORE
AN OPERATION.
Here are a few more breast images some collected from the Internet and one featuring one of my patients (as indicated). They are again assembled as an educational exercise for the potential patient.
Breast implants themselves do not change much after placement. That which does change early on is the individual's surrounding tissue. Consider that the breast implant is a new mass placed under the skin, breast and (most often - if I have anything to do with it) pectoral muscle. It naturally follows that the body will adjust to this item. How the body adjusts however is (like most issues in surgery) variable. There are some generalizations which are pertinent here.
The Natural History Of The Implanted Breast
For young patients without much breast tissue or skin (young and haven't had children and breast fed), the breast appears full just following surgery. The chest skin and pectoralis muscle are stretched by the new implant. The patient below is one day from the operation at which time moderate sized implants were placed beneath her pectoral muscles. Notice the full area above the nipples and the general appearance of "tightness." The breast almost looks upside down at first.
This appearance changes over time (or no one would want breast implants). The implant will "settle" to a degree and the fullness in the upper breast region will descend towards the lower portion. The degree to which this will occur depends upon the elasticity of the skin and muscle of the chest wall as well as the size of the implant placed.
Some patients with ptosis ("droopy breasts") may have chosen the placement of a larger implant as opposed to a formal mastopexy ("breast lift"). Worse yet, this implant may have been placed just beneath the breast gland ("Subglandular placement") and not under the pectoral muscle ("Submuscular placement"). Submuscular implants get some support from the overlying muscle and seem not to descend as much. Patients who opted for no lift and a subglandular implant can descend quite a bit. These same patients usually will have a good deal of breast and chest wall skin. This tissue can of course stretch further leading to droop once again. The degree to which this may happen is difficult to predict. Furthermore, it may not happen to the same extent on both sides. Some patients are not bothered by this outcome. Others will desire a breast lift operation later on down the line (If one was not performed with the implant placement originally). Below is an image of a young lady with a moderate degree of "sag" (especially on her left). Her implants appear to have been placed in a subglandular position ("over the muscle").
Other patients will have very little breast tissue and elastic skin. In patients here that may wish to have large breasts, this descent may not be as great. The skin will stretch but may not stretch much. Many have seen individuals with implants that appear very tense upon the chest; almost like they are straining to come out through the skin. Fortunately, this scary event is extremely rare, but the breast will tend to appear very foreign not natural in these kinds of cases.
In the worst case of a large implant in a small patient, stretch marks (yes, like those of pregnancy can form). These stretch marks can form in any patient and those present from previous pregnancy can certainly be made more prominent following augmentation. The bottom line here is that there is a practical limitation to implant size to minimize the potential of these "not-so-wonderful-looking" outcomes.
Back to the time line. The breast following implantation is swollen (further contributing to the "perky" appearance). This swelling normally resolves over the first two to three weeks. Many patients don't like this decrease in swelling ("makes the breasts look like they are shrinking!"). The resolution of the operative swelling is associated with a softening of the breast as well. The implanted breast (especially with saline implants) will appear to decrease in size (10-20% over the first year). As the body notes early that the breast implant is foreign, it begins the process of isolating it from the rest of the body. A capsule is formed. This capsule is composed of collagen and can be soft or hard. Some of these are so thin you can see through them and others that look like leather hand bags. These may not form to the same extent on both sides. In fact, if a severe capsule (or contracture) is to form it is usually more severe on one side than the other. I encourage breast massage in the freshly implanted patient when smooth-walled implants are used. I must admit that the scientific evidence that this reduces the possibility of forming firm capsules is not solid, but I have been fortunate to see very few firm capsules in my augmentation patients.
The body forms this envelope around the implant that exerts a force upon it which can make it (in the worst case) take on the appearance of a sphere. The image below shows an implant patient with pretty severe contracture. This is accentuated as she has her arms above her head. In some patients, only this maneuver will display the contracture well. This patient also appears to have subglandular implants. Patients with subglandular implants seem to have more contracture problems.
The Big Picture:
Post-Implantation changes
(1) Swelling resolves over first few weeks (for moderate sized implants) resulting in softening and slight decrease in size.
(2) Implants "settle" over first 3-6 months descending (usually) to a more natural position. They can descend further in upcoming pregnancy (rare - I have seen one case) or over the long term. This (like everything else) is individual. Examples of patients with settled implants several months from surgery can be found from the Breast Index Page. Larger implants may settle more (more gravity). Implants in breasts with more lax skin (large weight loss or older patients) may settle more.
(3) The implant's presence will cause the body to produce a capsule around it. This begins to form soon after implantation. Most of these (thankfully) are soft, but infrequently (2%) they may become firm and uncomfortable. Most firm capsules seem to form in reconstructive patients (after mastectomy), when silicone implants are used or in cases involving hematoma or infection). The degree to which a capsule forms has alot to do with the genetics of the patient and the geometry of the chest and implant.
Sounds scary....doesn't it? The good news here is that most patients are quite happy with their implants. Only in few cases in which some of these variable issues manifest prominently, does appearance or comfort become an issue.
A study printed in a 1994 issue of Aesthetic Plastic Surgery (a medical journal) addressed patient satisfaction with breast augmentation. The author found that 95% of patients felt that the operation met their expectations. 86% reported that they were completely or mostly satisfied with the results. Finally, 81% of the patients stated that they would have the operation again. Below is an example of one of my patients before and 6 months after her breast augmentation procedure.
Please note that this information (as well as that on all my pages) is offered freely to individuals considering cosmetic surgery. No rights are granted and it is not to be reprinted or copied without the author's prior written consent.
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