Is This Bottoming Out? Post Surgery Assymetry 9 Months out

Per Drs comments,I was symmetrical pre-surgery (as much as a human body *can* be) so the asymmetry is a post-surgical issue mostly.Measure 9.5cm from left areola to fold, 6.5cm from right areola to fold.I want a result that is visually between the left & right.Left seems very low & the scar is an inch from my fold & an inch lower than my right breast from the front view.Is this bottoming out?I have my appt 9-13 with my board cert Dr & am getting prepared beforehand.Surgery 1-27 submusc 450c gel

Doctor Answers (9)

Bottoming out?

+2

I wouldn't say that your left breast has bottomed out but it is certainly lower than your right. It totally depends on which side you like better. Both are actually attractive and are desired by different women. In my opinion the left side look very natural but some women like the more fullness that you have on your right (higher) side. the implant on your right simply didn't drop as much as on the left. I would figure out which one you like better and then just try to fix the other side to match. It will be more successful to get them to maych if you just adjust one side. Good luck.


Baltimore Plastic Surgeon
4.5 out of 5 stars 22 reviews

Revision breast surgery

+2

I agree in that you have some asymmetry between the appearance of your breasts after surgery. While I don't think you exhibit the typical "bottoming out", it does appear like you have some implant malposition or overdissection of the left breast. This is difficult to fully estimate without your preoperative photographs. I agree with my colleague in that the left breast appears not only lower, but slightly more lateral than the contralateral right breast. This can be corrected through revision breast surgery. During the corrective surgery, internal sutures (capsulorraphy) is used to "tighten" the pocket in the desired direction. Recovery after such a procedure is much quicker compared your original procedure. Best of luck.

Jeffrey D. Hoefflin, MD
Los Angeles Plastic Surgeon
4.5 out of 5 stars 9 reviews

Breast implant bottoming out?

+2

In my opinion, from your frontal view, this is NOT "bottoming out."  The oblique view is best to determine.

Your implants have descended slightly so the inframammary crease is just below the scar through which the implants were placed.  This is common, and much preferred to the scar being below the inframammary crease where it may be much more visible on your chest.

Bottoming out is when the transverse meridian of the implant descends below nipple level.  The result is excessive fullness of the lower portion of the breast, and diminished fullness of the upper part of the breast.

Surgery is the only way to really fix this situation, by raising the implants back to their proper positon.  Again, from the frontal view, you appear to have a great result  I do not see bottoming out.

 

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 38 reviews

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Bottoming out correction

+2

From your photos, it looks to me that you have  "bottoming out" on the left side as well as probable lateral displacement (implant moving into the armpit when you lie down?).  These implant mal-position issues cause the areola to look off centered on the breast mound and the breasrs to appear quite asymmetric.  Correction would involve internal sutures (capsulorrhaphy) on the side and inferiorly.

Regarding size, it is very important to communicate your goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the press implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.

Best wishes.
 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 681 reviews

Bottoming out: correct the forces of submuscular augmentation with subfascial placement

+1

The problem is indeed that your left implant has dropped to low.  in the picture, your left shoulder is elevated as is your arm.  Both of these actions have the effect of raising your left breast and it is still several centimeters too low.  This is a progressive deformity resulting from the combination of two factors :  submuscular(or dual plane) placement and violation of the tight attachments at your native inframammary fold.  Placing breast implants under the muscle creates a few aesthetic problems. If you look at your picture, your breasts are too far apart at midline to have a natural appearance.  any time your arm moves this appearance will widen and worsen.  This is the reult of releasing the inferior portion of the pectoralis major muscle.  The more superior origins will not allow the implant to sit in a natural place and the continual forces of the muscle constantly push the implant down and out.  When this is combined with excessive undermining of the inframammary fold, the deformity that you are seeing results and continues to progress.  This is a very common finding with submuscular placement.  To understand these forces better, stand in front of a mirror topless, put your hands on your hips and push down onto your hip bones firmly.  You will see both breasts move down and out.  these forces over time always cause lowering, lateral displacement, thinning of the breast tissue and stretching of the skin.  This is the reason that I use a unique technique in my practice called 'cold-subfascial augmentation.' THis technique leaves the muscle alone and out of the equation but should not be confused with 'above the muscle' which I would also not recommend.  The cold-subfascial augmentation harnesses the strong structural power of the pectoral fascia to create a truly natural breast shape and act as a living structurally sound brassiere inside the breast protecting the breast from the pressure of the implant and forces of gravity. 

 

I have seen many patients with identical problems to the one you present and in my opinion there is only one good solution- changing placement to a new cold-subfascial plane.  All of the native inferior support of your breast is now violated and conventional techniques like capsulorrhaphy and neosubpectoral placement rely on structurally unsound scar that will surely stretch and recur.  There are several mesh and biological products people use to restore support but these in my opinion do not offer lasting support or add new risks or unnatural feeling/appearance.  In my experience, revising breasts such as yours with a subfascial plane can create a more beautiful and lasting augmentation then your original before the problems started.  I hope this helps! 

All the best,

Rian Maercks M.D.

Rian A. Maercks, MD
Miami Plastic Surgeon
5.0 out of 5 stars 31 reviews

Asymmetric breasts after breast augmentation

+1

You say you were symmetric before surgery but not when you first noticed the current problem. If the problem was present right after surgery the left side was slightly overdissected and the the fold disrupted. If it occurred later it could be due to anything from trauma to an inherently weak fold. The only solution would be another surgery to raise the fold by suturing the capsule and/or placing a dermal matrix to reinforce the bottom of the breast pocket.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Breast asymmetry

+1

It does not look specifically that it has bottomed out, because the breasts were most likely a bit different before surgery, An exam would be helpful.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Breast Asymmetry following Breast Augmentatiom

+1

There's no question about your having an unexplained asymmetry following your breast augmentation. There are several possible explanations, but your wish to end up with an appearance somewhere between the way each side now looks is perfectly reasonable. It's my impression that your right implant is sitting a little high. The likely causes are either a failure of the surgeon to sufficiently dissect the lower limit of the implant space or, more likely, an early capsule formation preventing complete settling of the implant into into the lowest portion of an adequately dissected implant pocket. On your left side, your implant has settled, perhaps, a little too low. This breast is tending toward bottoming out, and I wonder if your pectoral muscle may be causing some mechanical displacement of your left implant. This is a situation not likely to be self-correcting. Surgery may be required for both breasts, on the right to lower the implant (and deal with a capsule, if present) and on the left to raise the implant and close off the lower space into which the implant has migrated. If you were one of my patients, I might even consider exchanging your implants to a subglandular position. On your right, this would get your implant out from a possible submuscular capsule problem, and on your left it would move your implant away from the possible displacing influence an overlying pectoral muscle. I hope these thoughts help!

Charles Gruenwald, MD
Baton Rouge Plastic Surgeon
5.0 out of 5 stars 10 reviews

Bottoming out?

+1

It certainly appears that your left breast implant is at a slightly lower level than the right.  It's hard to tell you what the reason is for this.  There are cases where, for whatever reason, one implant is placed lower- inadvertently or on purpose.  There are cases where the implants are placed at a symmetric level yet the tissues of the lower pole of the breast stretch more on one side than the other- allowing the implant to migrate slightly lower.  With implants under the muscle, the muscle itself squeezes the implant, which may occur more on one side than the other simply because patients have a dominant side and, therefore, a stronger muscle on one side.

If this is really bothersome, the only way to truly correct the issue is to raise the implant and to surgically close the bottom of the pocket and reinforce the fold under your breast giving it more strength.  I hope this helps.  Scott Newman, MD FACS

Scott E. Newman, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 25 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.