Double Board Certified
Plastic Surgeon

The "Drop and Fluff" of your Breast Implants

Before I was interviewed for Zwivel, I had not heard the term "drop and fluff" much in the breast implant world. Mainly just the pillow world.

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But "drop and fluff" refers to the dropping and settling out of the breast implant over time. 

You can check out my feature in the Zwivel article HERE. And for more of my thoughts on the "drop and fluff"...read on :)

DROP. We all talk about the implant “dropping” over time, as gravity takes over and the surrounding tissues (muscle, breast tissue, skin) stretch out. When this happens, the implant settles into the pocket that has been created and it takes on a more natural shape. This is the...

FLUFF. The lower part of the breast becomes more projecting and the breast takes on a more natural, “teardrop” shape, even if it is a round implant. Over time the breast looks bigger and rounder than it did originally, when at first it was tighter and flatter. breast-implants-pop

It's important for women considering breast augmentation to know about “drop and fluff” so that they understand how the implants will change over time, and what they should be watching for.

They initially start out high and tight on the chest wall. If the pocket is dissected out (created) correctly, the implants will fall into proper position. After a few days they really start to drop.

At six weeks they are usually almost there, and usually at three months they are where they are going to be, based on how the pocket is created. After that, the breasts can still stretch out and sag over time, depending on how elastic the patient’s tissue is.

When they are done “dropping” and the lower pole is done “fluffing,” you should be able to feel the edge of the implant at or just above the inframammary crease. That means it has fallen into the pocket.

Since breasts are almost never symmetric, the implant in the one with more space (a longer nipple to inframammary crease distance) will usually drop faster.

Sometimes we will give a patient a breast band to wear across the top-most part of the upper poles that can help push the implants down. Another thing that helps soften up the scar tissue is massage (imagine the implant is in a round room and you are pushing it to reach all the walls so you can feel it with your fingers), although this hasn’t really been proven.

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It is important that a patient keep an eye on the progress of the implant dropping; if it doesn’t seem to be dropping correctly, you could be developing a capsular contracture. I would start considering this if by one month the implant doesn’t show any change in position.

If after six weeks the implant doesn’t seem like it has dropped correctly, and the lower part of your breast feels “empty,” you should consult with your doctor. Either the muscle was not completely released to make the pocket or you may have developed a slight capsular contracture. Treatment for and to prevent this includes ultrasound treatment (there is a system specifically designed for breast implants called the “Aspen System”) and infrared treatment that most physical therapy places offer. Also, the medication Singulair has been shown to decrease the rate of capsular contracture when given prophylactically.

I personally try to have all of my patients do prophylactic ultrasound and infrared treatments and take three months of Singulair postoperatively.

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Here's what patients can expect during the following postoperative stages:

  FIRST WEEK:

 During the first week, there is usually significant soreness, usually inferiorly and medially and the chest feels very “tight,” especially when taking deep breaths and there can even be discomfort on the upper abdominal wall. (One thing that helps with this is using a long-acting local anesthetic, “Exparel” which lasts for three days. Another thing that can help with the tightness is injecting Botox into the Pectoralis Major muscle during the procedure to keep it from contracting.)

It is normal for there to be swelling on the chest wall around the implants, so that the implants look less “defined” and less round in the beginning. They can appear full on the top part only if the breasts were small and tight to begin with. It is also normal for there to be bruising and swelling of the upper abdomen.

FOLLOWING WEEKS (WEEKS 2-6ish):

By week two the bruising—if there is any—should be gone, and the swelling really starts going down by two weeks.

The incisions do not start getting red until about six weeks. Over the first six weeks the tissues soften up and by six weeks the implants are sitting almost where they will be.

FOLLOWING MONTHS:

At three months they are usually in the position that they will remain unless other factors interfere, like childbearing—which can cause increased size of the breasts, lactation, which can cause capsular contracture, loss of skin elasticity which can cause severe stretching out of the tissue and “bottoming out” of the implant.

THEREAFTER:

The incisions will lighten up after time, and by a few months usually blend in, whether they are inframammary or periareolar.

(This phenomenon of “drop and fluff” should not be any different for silicone or saline implants)

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If you've made it this far down, well done! I know the attention span isn't what it used to be ;) Thanks for reading. Hope this was helpful!

XO,

LQ