Four weeks after breast augmentation surgery marks a significant transition from acute recovery to moderate, ongoing tissue adaptation. Most initial severe discomfort and major limitations on movement have eased, allowing a noticeable return to daily routines. Although you may feel much better, the body is still healing internally, and the final aesthetic outcome is several months away. This stage is characterized by diminishing swelling and the beginning of the implant settling process.
How Breasts Look and Settle
At the four-week mark, a substantial amount of surgical swelling (edema) has resolved compared to the first two weeks of recovery. However, some residual swelling remains, which can subtly alter the appearance of the breasts and may persist for several more months. Implants begin the process known as “dropping and fluffing,” settling into a more natural, lower position within the breast pocket as the skin and muscle tissue relax around the new volume.
Initially, breasts often appear high on the chest and look firm or squarish due to the tightness of surrounding tissues. The “drop” refers to the implant moving downward, while the “fluff” describes the lower pole filling out to achieve a softer, more rounded contour. This settling process usually begins by week four but can take three to six months to complete fully. Temporary asymmetry is normal, as one breast often settles before the other.
Incision sites should be fully closed and clean. Scars will likely appear pink or red and slightly raised as the body produces new collagen to heal the tissue.
Resuming Daily Activities and Exercise
By four weeks, most patients are cleared to resume light daily activities, including driving, provided they are no longer taking prescription pain medication and have regained full range of motion. Sleeping on your side may be permitted if comfortable, but sleeping on the stomach is generally restricted for up to eight weeks to prevent undue pressure on the implants and incision lines. The resumption of physical activity must be gradual and should always be approved by the surgeon before beginning any new regimen.
Light, low-impact exercise, such as walking or using a stationary bike for lower-body cardio, is safe and encouraged to promote circulation. Activities that cause excessive bouncing or strain the chest muscles are still restricted to prevent complications like seroma formation or implant malposition. Avoid heavy lifting (over five to ten pounds) and strenuous upper body resistance training, such as push-ups or bench presses. These restrictions are important when implants are placed under the muscle, as chest muscle contraction can affect the implant pocket and prevent proper settling.
Navigating Numbness and Tightness
A sensation of tightness across the chest is common at four weeks, particularly with submuscular implant placement where the pectoral muscle was stretched to accommodate the implant. This feeling is a normal part of the internal healing process, involving the formation of a scar capsule around the implant. While pain has largely subsided, many patients experience altered sensation in the breasts, nipples, or surrounding skin.
This sensory change can manifest as numbness, tingling, or temporary hypersensitivity. These symptoms occur because the nerves in the breast tissue were stretched or temporarily disrupted during surgery. The presence of tingling or a “pins and needles” feeling is a positive sign, indicating that nerve regeneration is occurring. Although these sensations can be distracting, they are temporary and typically improve over the next few months as the nerves fully recover.
Warning Signs and Follow-Up Care
While four weeks post-operation is generally a smooth phase of recovery, it remains important to monitor for signs that may indicate a complication. Immediately contact your surgeon if you notice a sudden, significant increase in swelling or bruising in one breast, which could signal a hematoma or seroma. Other urgent warning signs include fever, worsening pain unresponsive to over-the-counter medication, or persistent discharge or separation along the incision line, which may indicate an infection.
The typical follow-up appointment with the surgeon is often scheduled between four and six weeks post-surgery to assess healing progress and monitor implant settling. During this visit, the surgeon may recommend specific post-operative care, such as beginning a gentle scar massage protocol. Scar massage helps soften and flatten the incision lines over time, but it should only be performed once incisions are completely healed and with the surgeon’s direct instruction.