Unfortunately, you have not provided any photographs or told
us the size of your implants.Bottoming out
means the implants are too large, have extruded inferiorly and laterally or the
patient has lost the supporting tissue allowing the implant to herniate out of
the pocket.In any case, I recommend
smaller implants with plication of the capsule.The technique I use is Implant Exchange with Mini Ultimate Breast
Lift™.Using only a circumareola
incision it is possible to reshape your breast tissue creating upper pole
fullness, elevate them higher on the chest wall and more medial to increase
your cleavage.The pockets can be
plicated and smaller implants placed at the same time.Aligning the areola, breast tissue and
implant over the bony prominence of the chest wall maximizes anterior
projection with a minimal size implant.Small round textured silicone gel implants placed retro-pectoral look
and feel more natural, are more stable, less likely to ripple or have
complications needing revision.
Gary Horndeski, M.D.
A procedure called a capsulorrhaphy a revision of your breast implant pocket can be used to correct bottoming out. The capsular contracture will require a capsulectomy and replacement with textured breast implants wrapped with acellular dermal matrix.
However the pectoralis muscle contraction deformity is going to be extremely difficult to correct. Specifically discuss your surgeons plans for revision of the pectoralis muscle insertion. If the problem is bottoming out the capsulorrhaphy may help however if the problem is that the entire inferior portion of the pectoralis has been detached from your rib reinserting the muscle can be very difficult.
Photographs would be helpful but in general most aesthetically problematic breast augmentation outcomes can be fixed with one operation.
The issue with "bottoming out" is only partially secondary to displacement. This can also occur when the implant is too wide for your natural anatomy. Your surgeon should discuss the relationship between implant and nature breast size. The lift on the right should be able to be addressed at the same time However, the issue with distortion due to muscle flex is a normal side effect of sub-muscular placement and will probably need to be accepted. Implant surgery has numerous imperfections and the challenge is to decide which imperfections you can tolerate and which you can't.
Robin T.W. Yuan, M.D.
It does sound like you have had multiple problems with your breast surgery. You should be able to correct both problems with one operation. The left side will require a capsulopexy with the possible use of a mesh such as Seri or and ADM like Strattice to support the implant and repair. On the right side you will need a capsulectomy and replacement of the implant.
You are asking great questions and sorry to hear about your
surgeries are quite complex and you want to make sure you seek out a board
certified plastic surgeon who is comfortable and experienced with the
procedure.In addition, mesh and dermal
matrix products are used in your type of cases to stabilize the implant and
minimize long-term complications.As a
revision patient you have a higher chance of having another revision in the
future and therefore would follow your board certified plastic surgeon’s
instructions.All this can be addressed
with one surgery.The stabilizing
products that you want to invest in are called Strattice or Seri Scaffold.Good Luck.
I am sorry to hear about the complications you are experiencing. Based on your description, revisionary surgery will likely be helpful. It is likely, based on a description that you will benefit from capsulorraphy surgery; this operation will serve to help prevent the breast implants from moving too low or towards the sides when you lie down. Sometimes, the use of acellular dermal matrix as an additional layer of support, may also be helpful. Especially when the tissues involved are thin, this additional layer may help prevent recurrence of the breast implant malposition. This operation will also help to center the position of the nipple/areola complexes on the breast mounds. The use of acellular dermal matrix may also be helpful in prevention of encapsulation. You may find the attached link, dedicated to this type of revisionary breast surgery, helpful to you. Only after in-person consultation with well experienced board-certified plastic surgeons will you be able to have your question regarding the need for several operations answered precisely. Best wishes.
The picture would be very helpful to visualize your issues. It sounds like your problems can be fixed with one surgery. I would consult with several board-certified plastic surgeons for a detailed physical examination and subsequent treatment recommendations.
I would agree with Dr. Yuan about implant size being too big as a cause of bottoming out. There has been "conventional wisdom" out there that implants larger than 400 cc's are too big and heavy and will lead to stretching or bottoming out. I think the problem is implants that are too big (too wide, too large in diameter) for the base width of the breast, not how many cc's they have.
If the revision is to be done by the original surgeon and the implant was too wide to begin with they might have difficulty realizing it and addressing it.
The need for a lift on one side is also suspect. That should have been apparent before the original surgery.
Revisional surgery requires a very careful and objective assessment of what was the cause of the problem and how best to correct it using the simplest approach possible. Most plastic surgeons understand this in revisions from rhinoplasty but there remain a lot of misconceptions in cosmetic breast augmentation surgery as to what does what and how to correct things that didn't go the way intended.
It sounds like you may need another opinion.