Breast augmentation is one of the most popular cosmetic procedures, with over 300,000 breast implant surgeries performed in the U.S. each year. Many women choose to get breast implants to increase their breast size and achieve a more proportional figure. However, it’s common for breast implants to appear smaller and less projected in the early weeks after surgery before they fully “drop and fluff.” This is a temporary issue that typically resolves within 2-3 months as the implants settle into position. In this article, we’ll discuss why breast implants may initially look smaller, what causes breast implant drop and fluff, how long it takes for implants to drop, and when to be concerned if they don’t.
Why Do Breast Implants Look Smaller at First?
There are a few reasons why breast implants can appear smaller and less projected in the early post-operative period:
Swelling and Inflammation
It’s normal to experience significant swelling and inflammation after breast augmentation surgery. The breast tissue around the implants becomes aggravated during surgery, leading to fluid accumulation and swelling that makes the breasts look enlarged. This swelling starts to subside within a few weeks, causing the breasts to look smaller before they fully heal. It can take up to 6 months for all the post-surgical swelling to resolve.
Tight Chest Muscles
The pectoralis major chest muscles are disrupted during breast implant placement. After surgery, these muscles will be tight and constricted. As the muscles stretch back out over several weeks, they give the implants more space to settle into the pocket and project forward.
High Implant Placement
Sometimes implants may be initially placed too high on the chest wall. As the swelling resolves and the implants drop, they will move into a lower position with better cleavage and projection.
Tight Skin Envelope
If the patient has tight skin with minimal natural breast tissue, the skin envelope has to stretch to accommodate the implants. This causes the implants to be compressed until the skin has time to expand.
What Causes Breast Implants to “Drop and Fluff”?
Breast implants drop and fluff as they settle into position in the weeks following surgery. The main factors that allow implants to drop and achieve their final shape are:
Release of Pectoralis Tension
As mentioned earlier, the pectoralis muscles are stretched and aggravated during implant placement. As the muscle tension releases post-surgery, the implants have more space to drop downwards into the newly created pocket.
Expansion of the Surrounding Tissue
The tissues around the breast implant (skin, muscle, breast parenchyma) are expanded during surgery and become inflamed. As the swelling resolves, the tissues naturally stretch and expand to comfortably accommodate the implants. This allows the implants to settle into position.
Softening of Breast Tissue
Breast tissue stiffens after surgery due to inflammation and fluid accumulation. As this resolves, the natural breast tissue softens, creating more malleable pockets that allow implant movement. The implants “fluff” as they attain a natural shape in the softened breast tissue.
Gravity
The natural effects of gravity also come into play as swelling resolves. The weight of the implants causes them to descend into a lower position on the chest wall, increasing projection.
Patient Massage and Activity
Gentle massage starting a few weeks after surgery can help relax the breast tissues and encourage implant drop and fluff. Returning to normal activity also allows natural movement that settles the implants into position.
How Long Does it Take for Breast Implants to Drop?
Breast implant drop and fluff is a gradual process that takes place over the course of several weeks to months:
1-4 Weeks After Surgery
The most significant implant drop happens in the first month after surgery as swelling resolves and tissues expand. During this time, it’s common for the breasts to look quite small and upturned. Don’t be discouraged, as noticeable dropping and fluffing will occur.
1-3 Months After Surgery
From weeks 4 through 12, breast implants continue to settle as inflammation subsides and tissues stretch. The implants will drop further and develop a more natural, teardrop shape during this time. Most patients are happy with their results by 2-3 months post-op.
3-6 Months After Surgery
Between months 3-6, subtle further dropping and fluffing can occur as the implants fully settle. Residual swelling should resolve by around the 6-month point. After this, the implant results are maximized and final.
Here is a general timeline of breast implant drop:
| Timeframe | Changes |
|---|---|
| 1-4 weeks | Significant drop and appearance of small breast size as swelling peaks |
| 1-3 months | Continued gradual drop and fluffing as swelling resolves and tissues stretch |
| 3-6 months | Final subtle drop and fluffing; swelling completely resolved |
When to Be Concerned About Lack of Implant Drop
Most women will enjoy a nice implant drop between 1-3 months after breast augmentation. But in some cases, issues like capsular contracture, peri-implant fluid, or hypertrophic scarring can impede implant drop and fluff. Signs of a complication include:
Unnatural Upturned Implant Shape
If the bottom half of the implant fails to drop at 3 months, it is likely stuck in an overly tight pocket or by scar tissue. This creates an unnatural “snoopy nose” shape.
Visible Rippling or Wrinkling
Thick scar tissue or capsules prevent the implant from properly filling out the pocket. This allows wrinkling in some areas.
Asymmetry
If one breast implant drops nicely but the other does not, this points to an issue with the high breast pocket.
Excessive Hardness or Tenderness
Capsular contracture causes severe hardening and pain that prevents the implant from settling.
Signs of Peri-Implant Fluid
Fluid accumulation around the implant causes inflammation and swelling that fails to resolve.
If asymmetry, high riding implants, rippling, hardness, or pain persists beyond 3 months, schedule a follow up appointment. Additional procedures like capsule removal or pocket adjustment may be required.
Conclusion
It’s common for breast implants to appear smaller and less projected during the first few months after augmentation surgery. Factors like swelling, tight muscles, and skin cause the implants to look compressed until they are able to stretch out the tissues and settle into position. Between 1-3 months, most patients enjoy noticeable implant drop and fluffing as the breasts take shape and regain a natural hang and jiggle. Be patient through the first few months of healing to allow this process to fully occur. If you have any concerns about lack of implant drop or other issues, make sure to follow up with your plastic surgeon.