Breast Implant Revision: Q&A

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Bottomed out with 375 Salines Would Going 100cc's Larger Make a Diiference And More Revisions if Im Diagnosed with Thin Skin?

Small B Placed 375/380cc Mod+ Salines & couple months was diagnosed with Bottoming out of both implants, was told to come for a revision along with switching to a 450/475 Silicone implants in mind. im currently 100lbs 5'3 with about 27in ribcage id say im like mary kate&ashleys frame but less tall. will goin up 100ccs be a good idea to place when i fix the bottom out? On small frame w/ thin skin would size be a big difference or problems? This is stressful but im happy to get as much help :)

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22 Doctor Answers | Asked by DollyMonroe in Paramus, NJ

Doctor Answers (22)
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Going to larger implants can it fix bottoming out?

Absolutely not! It will make your condition worse. You have to ask why did this happen in the first place? As you state, you are too thin and your tissue cannot support the large implants you currently have. Going larger will further aggravete this problem. The other reason might be that your surgeon lowered your breast crease too much during surgery. My personal approach to your problem would be to puncture your implants, let them deflate and help rebound and shrink your breast tissues.... more

Don't go bigger when bottomed out

It makes absolutely no sense to go bigger (and thus heavier) when trying to fix bottomed out breasts. The repair of the excess pocket will have a bigger chance of re-bottoming out if you go larger. If anything go smaller if you want to increase your chances of success.

Bottomed out Breasts will NOT benefit from going larger

Hi there- The fundamental problem, which is a poorly dissected implant pocket, will remain, but will now be further complicated by a larger and heavier implant. This may look better initially, but is doomed to fail over the longer term. Your best bet is to correct the fundamental problem- the implant pocket itself.

The bigger they are...

DollyMonroe, You know how the saying goes. Putting in larger (i.e. heavier) implants will only worsen your bottoming out and tissue thinning. The "revision" might help the bottoming out, depending on what the plan of the "revision" is, but larger implants are likely to compromise that as well. Be sure that you are in the hands of a plastic surgeon certified by the American Board of Plastic Surgery before proceeding. Good luck! more

Saline implants bottomed out

As a rule saline implants are heavier and have more of a tendency to bottom out than gel implants. Having said that I would not advise changing to even larger gel implants. This will only aggrevate the situation. An inferior capsulorraphy may be helpful. If, at the same time, you would like to change to gel implants consider going to a smaller volume than you currently have. This better increases your chance of having a long term satisfactory result.

Breast Implant Revision - Bottomed out with 375 Salines Would Going 100cc's Larger Make a Difference?

It's difficult to say without photos or an in-person examination but I would be concerned that going 100 cc larger would make the situation WORSE. You first have to try figure out why you have bottoming out - it may be a question of how the pocket was made, what you looked like before, what your tissue is like, or any combination of those and other factors. Repairing the anatomy may not be that simple but may include the addition of an Acellular Dermal Matrix (ADM) to help... more

Exchange of implant for bottoming out

If you have bottomed out with 375 cc implants, switching to a larger implant will worsen the situation. SIgnificantly, you haven't mentioned whether the implants were above or below the muscle.

Will Larger Implants Fix Bottoming Out?

Your "bottoming out' is quite likely due to thinning of your tissues by the weight of your implant. A larger implant is likely to trigger a cascade of implant problems. Get a second opinion from an experienced surgeon certified by the American Board of Plastic Surgery. There must be a better solution for you.

Correction of bottoming out

At this point, I would worry much less about changing the size of the implants and be concerned more about the loss of support to the current implants. There are several ways to correct this, but this usually involves more than simply tightening the capsule around the implant. Therefore I would be suspicious of any surgeon recommending a simply change in the size of the implant or a minor revision of the capsule.

Breast Implant Revision?

Thank you for the question. It is not possible to give you precise advice without direct examination. Based on your description of body type and the size of the implants are contemplating you are at risk for further complications. Correction of the “bottoming out” will likely require permanent suture repair (capsulorraphy) and/or the use of allograft. Use of a larger implant will stress this repair. I would suggest consultation with well experienced... more

Bottoming out

Bottoming out many times means that your tissue could not handle the size of your implants. Going larger may make it worse.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Thin skin & tissue stretch

Think of a ball inside a sock. A lighter ball isn't going to stretch out the sock as much as a heavier ball would. If your skin is thin and stretchy, you want to avoid things that would make it more prone to fail. Don't go to a larger size - if anything, you may want to downsize to a smaller & lighter implant. Consider repairing the pocket with sutures or reinforcing the skin with Strattice. Expensive, but it works. All the best, more

Go smaller

I agree with the surgeons here that going larger makes little sense. If anything, go smaller and change to gels. Products like Strattice can help, but are expensive. Depending on the degree to which your tissues have stretched already, it may not be too late to simply tighten your pocket internally, go to a smaller gel implant, and even consider onlay fat grafting to thicken the tissues and provide more padding over the implant.

Strattice to fix bottoming out breast implants

While the advice to avoid going larger in the case of thin skin is valid, it doesn't help with the underlying issue of thin tissues not adequately supporting the implants that you have. Whether or not you decide to go larger, it may be worth considering an acellular dermal matrix graft to make a living internal bra. Strattice is specifically designed for this purpose.

Breast Augmentation and Bottoming Out

Hello Dollymonroe, As the feedback from the other surgeons suggests, you have the wrong idea. However, I am here to tell you that your problems have just begun. You are tiny and with minimal body tissue. Your current implants will continue to fall and your tissue will become paper thin, showing every ripple of the implants. Worse than that, changing to silicone gel in that situation will likely not make much of a difference either. Contrary to your... more

Bottoming Out of Breast Implants

Without seeing you in person or having before and after pictures to examine, it is impossible to give you specific advice. However, larger implants may not be your answer. The implants need to be chosen based on your anatomy and tissue quality. The procedure needs to be customized to your particular body type.

Bottoming out

I would agree with all the other surgeons. The implant type is less relevant, but larger implants will definitely not improve your problem and will likely be worse ultimately. You need more support in the lower pole, which you could achieve with an acellular dermal matrix, as well as ideally smaller implants pocket revision. It is probably worthwhile to get a second opinion from another board certified surgeon. Good luck.

Bigger implants are not the solution and will make the problem worse

The reason for the bottoming out are many and one of the is too big a implant in relation to the breast soft tissue. I would guess that your surgeon suggested going with the silicone to help with rippling and bigger to fill your upper breast. You will bottom out more with bigger implants...

Kamran Khoobehi, MD

28 reviews

New Orleans Plastic Surgeon

Bottoming out after breast implants

The bigger the implants, the faster they bottom out. Newton's law of gravity wins all the time. The bigger the breasts the saggier they get. Good luck.

Bottoming out after breast implants

This problem can occur despite meticulous technique. The problem stems from thinning of the deep fascia, named Scarpa's facia. This support needs to be reconstructed in some way, either by suture techniques or with acellular dermal matrix (a much more expensive method). Putting in a larger implant will probably worsen the dropout, in my opinion.

Thin skin and bottoming out

Bottoming out occurs when there is not enough support to hold the implants in place. This can happen for different reasons, and thin skin or thin tissue is one of them. Larger implants will strech the skin further especially if nothing is done to add support to the bottom of the breast. The best way to correct bottoming out is to add support to the lower breast by suturing the pocket. Adding tissue with acellular dermis is an alternative way, but it is very... more

Bottoming out

It would depend on your exact situation. As a general rule the heavyier the implant the increased chance for late movement or as you described bottuming out. It also depends to a great deal on the tissue of the patient.Patietns with thin and weak tissue bottum out more easily but even in patients with great tissue and a perfect operation you can see position changes with time.