Breast Augmentation Recovery and Asymmetry

Breast augmentation is one of the most popular cosmetic surgical procedures performed in the U.S., consistently ranking in the top three.

One of the most frequent concerns patients have is an asymmetry that appears right after the procedure. It is, therefore, important to understand the usual recovery pattern for breast augmentation.

First and foremost, like any cosmetic procedure, it is important to have realistic expectations. Perfect symmetry in a procedure is never possible, just as it is not possible in nature; humans naturally have minor body asymmetries, and surgical results are limited by the patient’s anatomy. (In the age of social media, online bodies that have been Photoshopped have affected our expectations. I wish my patients could see these people in real life!)

Different areas of our bodies never heal at the same rate. Whether it be the breast or ears or eyes, one side usually heals faster than the other. Some theories about it have to do with hand preference (a right-handed person will have stronger, more developed muscles on the right side) versus sleep preference (patients like to roll on one side more than the other which may impact healing).

Of course, we make every effort to create a natural, reasonably symmetrical look. During breast augmentation, once the implants have been placed, the patient is flexed at the hips, so the upper body will come up at almost 90 degrees. With arms stretched out on a surgical arm board, I carefully examine the breasts for symmetry and I also ask the opinion of colleagues. It is important to note, however, that one cannot make the breasts symmetrical in all areas. Commonly, patients have breast asymmetry at the bottom. For example, the bottom of one breast may be rounder than the other side. Since a patient will usually display the upper part of the breast, the goal is to make the upper part of the breast as symmetrical as possible. This sometimes requires using different size implants.

Once the surgery is completed, the incision and the area around it will enter an inflammatory stage. Surgery, even if done under ideal conditions, is still a significant trauma to the body. Often, one side of the area may swell up more than the other. I often receive frantic calls from patients one or two days after surgery (sometimes even the day of the surgery!) as to why one side seems bigger than the other. If one side is significantly larger and harder to touch soon after surgery, a hematoma needs to be ruled out by an examination. Otherwise, patience is the best treatment. It will take at least three months for significant swelling to resolve. In some cases, patients must wait six months for the implants to completely settle. It is important not to wear a push-up or underwire bra for the first three months, and to avoid any strenuous upper body activity for the first month.

Nipple sensation may also be affected. Some patients may experience no change, while others may become less or more sensitive to touch. This is usually temporary and will improve with time.

Hot, cold, or an electrical feeling (like hitting your “funny bone”) may also occur and will improve with time or additional medication. I have had patients who, even several years after surgery, developed pain in one breast. Often, careful questioning reveals a sudden movement or activity may be related. The pain usually subsides with over-the-counter anti-inflammatory medication. If the pain persists, an additional workup may be required. Sometimes, shortly after a procedure, air becomes trapped in the implant pocket, and patients may feel or even hear gas bubbles moving inside their breasts. This typically resolves in the first two or three weeks.

In summary, the first week after breast augmentation is typically the toughest. The first few days, the patient will experience the most discomfort. Some patients also feel some pressure,­ which is due to the implant pressing on the chest wall. The breast shape is often described by patients as ­“weird,” with the implant being too high and the bottom portion of the breast empty. This, surprisingly, will make the breast shape look smaller than if the implant had settled in its intended position. Some patients have raised concerns about the size of the implant soon after surgery and later were pleased with the size after the implants had migrated into place.

I have always placed my implants in a sub-pectoral (behind the chest muscle) position, to minimize the risk of missed breast cancer diagnoses during mammography. I have patients start implant massage around two weeks after surgery. The idea behind implant massage is to keep the surgically created pocket from closing and distorting the implant. The massage is continued for three months. Also, I have patients wear a front opening sports bra without padding or underwire. Again, the goal during the first three months is to allow the implant to properly settle into the surgically created pocket.

Over the next three months, the implants will start to migrate into place (albeit at different rates in most cases). There will be minor swelling, but the result is typically acceptable. If there is still visible asymmetry, and the implants are soft to touch and in a good position, I may recommend additional three months of follow-up to allow maximal healing time.

It is important to understand breast augmentation is never a one-time surgery. A patient’s body and the implants will change with time, and additional procedures are almost always required.

Michael A. Jazayeri, M.D. is a board-certified plastic surgeon with over twenty years of experience. His offices are located in Orange County, California. If you would like to schedule a consolation, please call (714) 834-0101 or visit the contact page.