Why Do Breast Implants Ride High Early After Surgery?

Q: Dr. Eppley, after breast augmentation why do women usually have high placement of their implants even when insertion of the implant is inframammary? Also, why do the implants drop? Why doesn’t the surgeon just place them where they belong? Is it due to the type of implant used? (e.g. size, textured vs smooth?) Maybe you can offer some clarity?

A: Your breast augmentation question is an excellent one and the phenomenon of ‘high riding’ breast implants early after surgery is common. In fact, the plastic surgeon does place the implant in the desired position during surgery. But it is important to remember that the implant places some degree of stretch on the overlying skin which is greatest in the new lower pole of the breast mound. (nipple down to lower breast fold) In getting larger breasts much of that effect (at least 50%) comes from increasing the size of the lower pole of the breast. Tissues in this area are much tighter than that above the nipple and often new skin is recruited form the abdomen to accomodate the effects of the immediate and often dramatic volume expansion. (lowering of the breast fold)

This lower pole expansion will create a rebound effect as it needs time to relax after surgery. Since the upper pole of the breast has much softer tissues, the breast implants will often naturally ride up for a while from this rebound effect. Thus the early high riding implant. Once the lower pole skin relaxes the implants can drop down into the original pocket for which it was created. (implant settling)

How significant this rebound effect is and how high and how long breast implants may be high riding is influenced by many factors. The quality and amount of breast skin, size of the implants, and whether they are smooth or textured all influence this postoperative healing process.

Dr. Barry Eppley

Indianapolis, Indiana