Am I Bottoming Out? - Breast Augmentation (photo)

I got a breast aug 4 months ago and feel that my left breast is bottoming out slightly. It appears fuller on the lower half, my nipple is therefor higher, my incision has moved up, when I lay down the implant feels like it falls to the side, I feel uncomfortable like I have nothing holding up the implant, and my right side feels secure and normal. I have always felt that the left breast felt lower but thought things would even out by now. Is a revision recommended? How common is bottoming out?

Doctor Answers (12)

Bottoming Out After Breast Augmentation

+1

Dear Jane,

 

Thank you for sharing your photos.

It seems the your left pocket is a little larger than the right one causing the left implant to bottom out relatively.

The cause of a pocket lateral enlargement could be surgical or simply induced by the implant.

A correction could be considered only after you achieve full recovery from your primary surgery.

Please note that the revision is of a delicate nature and only a board certified surgeon of extensive experience will be your best bet.

I encourage you to wait a little to achieve the final results on which you will base your final personal assessment.

Thank you for your question and the best of wishes to you.

Dr. Sajjadian


Orange County Plastic Surgeon
5.0 out of 5 stars 117 reviews

Implants bottoming out

+1

Hello and thanks for the question.

 

Bottoming out entails disruption of the infra-mammary fold of the breast with the implant descending caudally past the native fold position. This creates the typical bottoming out stigmata ( asymmetric breast positions with associated changes in perceived nipple-areolar positions.  This can come about by a number of means -  Fold disruption from over-zealous dissection of the implant pocket during surgery may lead to this condition.  Fold disruption may also occur by virtue of poor nascent tissue quality - introduction of an implant may subsequently uncover underlying tissue weakness that wouldn't otherwise present itself under normal circumstances. 

 

In your specific case and in evaluation of you photos, it appears that you may have some native breast IMF asymmetry ( your left pre-operative IMF appears slightly lower than the right).  The introduction of an implant into mildly asymmetric breasts can augment this asymmetry. This may be what you're seeing.  In any event, I think you need to give the breasts ample time to heal - no less than a year -  before considering any sort of surgical correction, if necessary at all.  I recommend following up with your plastic surgeon on a regular basis to follow the progression of your healing.

 

Best of luck,

 

Glenn Vallecillos, M.D., F.A.C.S.  

Glenn Vallecillos, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 20 reviews

Am I Bottoming Out? - Breast Augmentation (photo) ANSWER:

+1

Yes you have bottomed out, but just a bit...It's really not too bad and the correction may not be easy...It's hard to get an implant to go uphill and stay there but yours do not seem that big so that may make it a bit better....But if you were my patient I would try and reassure you that you really do look good and probably not worth the trouble to fix it...

John J. Corey, MD
Phoenix Plastic Surgeon
4.5 out of 5 stars 16 reviews

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Am I Bottoming Out? - Breast Augmentation

+1

Based upon your posted photos you are NOT bottoming out. You have other issues at work. The inframammary folds are uneven and can only be corrected by revisional surgery. But is the differences worth the additional operation? i=s the real question. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

Bottoming Out

+1

Hello,

Yes, you have inferior malposition (bottoming out) of your left implant, which is revealed by the lifting of the inframammary scar off of your chest, the longer distance from your nipple to the new inframammary fold, and a loss of upper pole volume. 

All forms of implant malposition usually represent about 10-20% of the reasons for revision surgery. Bottoming out is usually associated with inappropriately large implants for the patient's anatomy, which is not the case for you.

Because your malposition is minor, and your implants are small, a revision surgery will fix this problem very well.  I am very sorry that you are having this problem.

Best of luck.

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 28 reviews

Bottoming out after breast augmentation

+1

From the photos you provided, the left breast implant does appear to be more displaced inferiorly. This may have resulted from over dissection of the pocket on the left side. It can be fixed with internal suturing of the capsule. But, I think you should give it few more months before you make that decision.

Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 3 reviews

Change of Breast Shape (Bottoming Out)

+1

It seems like you had a breast augmentation with round, smooth breast implants.  Based on your pre-op photos, you have a reasonable result.  It appears to me that the inframmamary fold- the area where your breast is joining your chest wall- has been divided during the surgery and the implant is gliding down due to lack of strong support at the lower pole of your breast which causes the surgical scar to glide superiorly and be more visible.  If your breasts are not supported, this may become more pronounced.  The solution is a revision surgery with reconstruction of the fold, with the possible use of a textured implant.  Consult your surgeon.  

David Evdokimow, MD
Morristown Plastic Surgeon
5.0 out of 5 stars 10 reviews

Bottoming out

+1

Thank you for your question and the photos.  I believe you have had a nice result from your surgery especially given the starting point which can see in the before photo.

Everyone has some degree of difference from one side to the other.  If you look closely at the after photo the implants seem well positioned relative to the nipple areola. There is a bit more volume below the nipple than above but I wait to see if this progresses before having more surgery.

I would continue to follow up closely with you plastic surgeon. Good luck.

Ralph R. Garramone, MD
Fort Myers Plastic Surgeon
4.5 out of 5 stars 23 reviews

Bottoming Out of Breast Implant?

+1

Thank you for the question and pictures.

Yes, based on your pictures and description of implant movement, it may very well be that you are experiencing inferior and lateral ( off to the side)  displacement of the left breast implant.

Some form of breast implant displacement/malposition  is not infrequently seen after breast augmentation surgery.Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. This is corrected by “raising” the inframammary fold using internal sutures.  This procedure is called capsulorrhaphy.

Some post operative breast augmentation patients present with lateral (outwardly) displacement of the breast implants. This can also be corrected using an internal suture technique decreasing the size of the pockets and moving the implants toward the midline.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 715 reviews

Implant issues

+1

There is definitely asymmetry according to the photos, but that may be your natural difference that looks similar in your pre-op photos.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.