Breast augmentation is one of the most common types of plastic surgery.  Submuscular implant placement – below the pectoralis major muscle – is generally recommended for thin patients and for those with insufficient breast tissue in the upper pole to provide adequate implant coverage for subglandular placement.  Breast implants placed below the pectoralis muscle often appear high on the chest wall for the first few months.  How the breasts implants ultimately settle into final position is commonly referred to as “dropping and fluffing”.  So, what does the phrase dropping and fluffing refer to following breast augmentation?

This answer is best explained by reviewing what causes submuscular breast implants to appear high in the first place.  Following implant placement below the pectoralis major, the muscle goes into spasm.  This holds the implants high on the chest wall following submuscular placement.  The skin and breast tissue of the lower pole is also tight following implant placement and takes time to stretch to accommodate the implant size.

Dropping refers to lowering of the implant on the chest wall as muscle relaxation occurs.  The effects of gravity also contribute to implant dropping over the first few months.  Fluffing refers to skin and tissue expansion of the lower pole to allow adequate space for the implant to settle into position.

Dropping and fluffing are the two effects that occur to allow submuscular breast implants to achieve the best aesthetic outcome as they settle into final position.  It does not happen to the same degree following subglandular placement – under breast tissue, above muscle – since the pectoralis muscle does not affect implant position.  Implant placement will be discussed in detail during consultation for breast augmentation and is determined by clinical presentation and other patient factors.

Patients often ask whether it may be possible to speed up the process of dropping and fluffing.  Time is the most important factor as this process takes place.  Following the initial 6 week period, it may be recommended to wear a less supportive bra as the implants continue to drop.   Implant massage is recommended, focussing on maintaining the pocket dimensions.  Appropriate technique will be demonstrated during routine follow up.  Some plastic surgeons recommend bandeau wear, which is a tight band secured above the implants intended to lower their position more quickly.  There is no evidence to support bandeau wear and I generally do not recommended their use in my practice.

Patience is required as submuscular implants settle into final position.  This process is generally complete by 3-4 months post-operatively.  The photograph example in this blog shows results on post-operative day one vs. 4 months post-op.  Final appearance and scar maturation may take up to one year based on wound healing studies.

Please contact us if considering breast augmentation in the Toronto area to schedule a consultation with female plastic surgeon, Dr. Stephanie Power.

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