My left implant bottomed-out due to over dissection and/or thin skin & minimal fat tissue. My plastic surgeon attempted to correct this with a series of stitches to create a new fold, both times failing to hold. 2 years later, I'm planning on a 3rd attempt; but this time I plan to undergo a fat graft to reshape due to an additional defect whereas the structure of my chest cavity causes my breasts to be unusually far apart and fall further to my sides when laying down on my back. Any advice?
Implant Bottom-out. Correction Attempt, But Failed. Contemplating a Fat Graft, Suggestions?
Doctor Answers (6)
Breast implants and bottoming out
You may want to consider smaller implants and/or strattice to support the lower fold. This should help.
My breast implants keep dropping!
Implant malposition may result from a variety of factors, among them implant type, implant positioning, capsular contracture, patient activity level and habits, and of course, surgical technique. My belief is that textured surface implants remain at their intraoperative location better than smooth surface implants. Subglandular rather than submuscular positioning eliminates the dynamic lateralizing and depressing force (but not gravity) of your strong pectoralis major muscle. Capsular contracture is likely related to presence of ductal microflora at your implant tissue interface, and a variety of strategies are emerging to prevent or eliminate this problem. Patients who are physically active without adequate support, patient with large implants and poor skin elasticity, and patients who aggressively massage their implants may enlarge their capsular dimensions and/or stretch breast skin enough to displace their implants.
A comprehensive approach should be developed to prevent further malposition in your case.
Solutions to Breast Implant Malposition Problems?
Thank you for the question.
Assuming your plastic surgeon is a well experienced board-certified plastic surgeon who can demonstrate significant experience with capsulorraphy and/or fat grafting, then he/she is in the best position to advise you. Online consultation cannot do justice to your complicated situation.
Based on your description however, it sounds like you will benefit from capsulorraphy on the sides of the breasts to prevent implants from falling to the sides when you lie down. The use of acellular dermal matrix may be helpful.
I personally have not used fat grafting for the purpose you describe and have found capsulorraphy to be the best technique for implant malposition issues.
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Sounds Right on
Bottoming out can be due to over Dissection. But it can also hsppen over time...
just as pockets can contract excessively, so can they relax
excessively causing bottoming out and lateral drift. Often these
patients have insufficient soft tissue coverage over their implants.
Your surgeon is spot on to treat you by repositioning your pocket followed
by soft tissue coverage.
If all else fails consider "SIEF" - simultaneous implant
exchange with fat.
Fat graft may work well
I like to use fat grafts for both primary breast augmentation as well as reconstructive procedures, so generally it is a good idea.
However, bottoming out can be a sturdy and unpleasant problem, so whatever is done may fail.
Fat grafting is not a very aggressive procedure and absorption is the worst realistic case scenario, so I think much is to be said for a try.
However, if not succesful, I would consider removal of the implants, a waiting period and then reconstruction, possibley with a mesh.
The repair of this type of malpositon may involve a number of techniques. Suturing the capsular tissues can be successful, but in your case apparently did not hold up. There may be a number of reasons why. Were multiple layers of sutures placed, including permanent ones? Are the implants too large ? What was your level of activity, and how were your breasts supported post-op? In spite of a surgeons best efforts, this sometimes can occur if the tissues are just that weak. Another option is to place a dermal graft along the lower lateral pocket to create a supportive sling for the implant. This tissue is attached to the edge of the pectoral muscle, as well as inferior and lateral chest wall tissues. This type of graft material can be quite costly, but may be a good option to be considered in your situation .