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Bottoming out of Breast Implants the Fault of Surgeon?

asked 2 years ago by Shepard OK in Iowa
Latest answer by Tom J. Pousti, MD
Question viewed 7,898 times
Tags: breasts, bottom out, uneven

I think my right breast implant has bottomed out. I noticed the difference within a month of the original surgery. When I lay on my back the right implant falls into the axillary area. Both breasts are very soft and the implants can easily be moved around. Was this the fault of the surgeon, and if so, what type of fee reduction should I ask for on his part for the revision? It has been 18 months since the original surgery, but he has been aware of the issue since 3 months post-op. Thanks!

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14 answers to Bottoming out of Breast Implants the Fault of Surgeon?

You need a surgical revision to fix the breast asymmetry

I certainly appreciate your concern. It is time for you to have a heart-to-heart discussion with your plastic surgeon regarding your post operative results. Unfortunately, you are in need of a surgical revision. There is obvious breast asymmetry do to mal-positioning of the breast implants. I would recommend that you return back to your original plastic surgeon and discuss your options at length. Of course, fees will be a topic that needs to be addressed. I’m sure that your plastic... more

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Lateral displacement (movement into armpit) of implants can be repaired

Movement of the implant into the axilla is not necessarily a sign of bottoming out. In my practice, I often see this in a few repeated scenarios: patients who have submuscular placement of the implants and then return to agressive pectoralis strengthening exercises which causes lateral displacement of the implant with muscle contraction patients with a pigeon chest deformity called pectus carinatum patients with lax tissues and subglandular placement. In many instances, I have repaired... more

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Bottoming out

Bottoming out actually refers to the implant falling below the fold. If the implant is going into the axilla, the pocket obviously has enlarged. It is often not the fault of the surgeon. Any reduced fee should be discussed with the surgeon but not to be definitely expected.

Steven Wallach, MD
Manhattan Plastic Surgeon

Usually a combination of factors

Bottoming out or stretching of the lower portion of the breast causes the implant to appear lower than desired. This can be simply a results of skin type which is prone to easy stretching and looseness. A non-surgical example would be pregnancy where some women have no residual loose skin after giving birth and some women need a tummy tuck due to the loose skin. Another factor would be the size of implant chosen. The bigger the implant, the more chance the skin will stretch. Every surgery... more

Bahram Ghaderi, MD
Chicago Plastic Surgeon

Is it bottoming out?

Bottoming out to most surgeons means that the implant settles or slides below the inframmamary fold and the nipple areolar complex looks too high. What you describe is a lateral pocket overdissection or tissue stretching that allows the implant to slide laterally. Unfortunately, it is pervasive thinking in our society, that if something is not "perfect" one must find someone to blame and ask for renumeration. It is most likely no one's fault. You do not state how thick your skin is... more

George Marosan, MD
Bellevue Plastic Surgeon

Bottoming out of Breast Implant?

Thank you for the question. Without pictures or examination it is not possible to give you specific advice. Based on your description however you may be experiencing inferior (bottoming out) and lateral (sideways) implant malposition. Although frustrating, the entire malpositions are not necessarily the fault of the surgeon. One of the most common complications after breast augmentation surgery is implant malposition. This occurs when the implant is in an... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Bottoming out of implants has a variety of etiologies

“bottoming out” is the term used to describe the condition which occurs when the breast tends to look as if it has descended on the chest wall after previous surgery, whether the surgery involved implants, a lift, or a reduction. In the case of “bottomed out” implants, sutures can often be placed in the lower pole of the breast to re-elevate the breast on the chest wall. This is called a capsullorraphy and can achieve excellent tresults... more

W. Tracy Hankins, MD
Las Vegas Plastic Surgeon

You Need a Revision

There are a couple of issues that need to be addressed. First, your choice of implants. Your preoperative breasts demonstrate grade 3 ptosis with significant loss of upper pole fullness. This is common after child birth and breast feeding as well as age. Obviously you wanted much more "perky" breast since you went with the high profile implants. Unfortunately these don't do anything for the loss of upper pole fullness. I would have gone with a moderate profile implant... more

Christopher L. Hess, MD
Fairfax Plastic Surgeon

The pocket was likely made too big

When a breast implant moves or falls into the axilla it is usually because the Serratus Anterior muscle was violated during surgery in the case of a submuscular implant. If a subglandular breast implant was done, then the pocket was made too large and extended too far laterally. This is especially true if the problem was noted in the first month or so after surgery. You need to review your photos and discuss this with your surgeon. Revisions are expensive and my own view is that expenses... more

Brooke R. Seckel, MD
Boston Plastic Surgeon

www.drseckel.com

Asymmetry or bottoming out after breast augmentation

Every surgical case has certain characteristics that make it unique. The only way to attempt to accurately answer a question such as yours is through a face to face consultation through the physical examination and review of preoperative photos. Bottoming out, or in your case movement of the implant laterally or into the axillary region can result from a combination of factors including the technical aspects of the surgery performed, implant selection, stretch of tissue postoperatively,... more

Sean A. Simon, MD
Miami Plastic Surgeon

Bottoming out or pocket asymmetry

Bottoming out infers a chronic condition of stretching out of the lower portion of the implant pocket causing the implant to move further and further down the chest. This causes a contour deformity of a double bulge. If the implant is moving too far towards the axilla, this infers a pocket or capsule asymmetry possibly due to surgical dissection. There is almost always some asymmetry of the pocket but when implants are correctly chosen to match the natural breast, these asymmetries are... more

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Most likley it is from stretch of your tissues

Although it is not possible to say with certainty without reviewing your record and early post operative photos, it sounds like the problem you describe may be one of those unfortunate circumstances where your native tissues have stretched out. On rare occasion if the pocket was over dissected at the time of surgery you would likely have noticed a considerable difference within a few days after surgery. Many problems like this fall into a group that some surgeons will refer to as... more

John E. Gross, MD
Los Angeles Plastic Surgeon

Bottoming out often predictable

I find that bottoming out can be totally predictable and in rare cases totally unpredictable. If you are placing an implant at the base is much larger than the base of the breast itself he will often need to release the adhesions which make up the inframammary fold. In some patients this works well and in some patients this leads to bottoming out. The good thing about bottoming out is that it is relatively easy to repair with a closure of the pocket with either permanent or long-term... more