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Bottomed out Even After Internal Sutures.. Am I Just Not a Candidate for a BA? (photo)

First BA (infra incision) in 2007 w/ submuscular silicone (250cc), bottomed out within 3 months on my right side. Explanted, and tried again (2011) w/ a revision specialist, & submuscular saline (275cc) mod profile & internal bra on both sides. Bottomed out again on same side. Dr. was surprised given the aggressive internal sutures. I’m explanted now, but want to try again. Dr. suggested Strattice, but can’t guarantee it won’t happen again. Am I not a candidate for a BA? Pics attached

Doctor Answers (11)

Easeally to correct by subfascial way/ muy facil de corregir por via SUBFASCIAL

+1

your problem is quite usual when submuscle way is done, now we  avoid bottiming out by subfascial way.

su problema es muy comun cuando se usa la via  submuscular  es facil de corregir y de evitar por via subfascial

Mexico Plastic Surgeon

Bottomed out Even After Internal Sutures.. Am I Just Not a Candidate for a BA?

+1

      A dermal matrix would be the next logical step to prevent recurring bottoming out.  Kenneth Hughes, MD Los Angeles, CA

Web reference: http://www.hughesplasticsurgery.com/breast-augmentation-revision-photo-galleries.php

Los Angeles Plastic Surgeon
5.0 out of 5 stars 147 reviews

Bottomed out Even After Internal Sutures.. Am I Just Not a Candidate for a BA?

+1

I have found that synthetic mesh works well inn recurrent cases such as yours.It appears that mesh  adheres  more rapidly than acellular matrices such as strattice

Web reference: http://www.beckermd.com/breast/revision-boca-raton-fl/

Boca Raton Plastic Surgeon
5.0 out of 5 stars 5 reviews

Bottoming out

+1

If you have bottomed out for a second time, you may want to go with smaller implants, and possibly strattice. I also like to have patients wear a thong bra.

Manhattan Plastic Surgeon
4.5 out of 5 stars 14 reviews

Breast augmentation following recurrent implant malposition ("bottoming out")

+1

Implant malposition ("bottoming out", lateral displacement, etc.) can be very difficult to correct surgically.  The ability of internal sutures to hold up over time is dependent upon the strength of the tissues being sutured.  While the success of using an acellular dermal matrix (eg. Strattice) cannot be guaranteed, it has been very useful for correcting difficult / recurrent cases of implant malposition.

Because silicone gel is more cohesive ("thicker") than saline, a gel implant may exert less force on the lower pole of the breast compared to the same size / shape saline implant, and may have a lower risk of bottoming out.

I would recommend consulting with several board-certified plastic surgeons experienced at performing breast augmentation revisions, who can review your history, perform a physical exam and recommend treatment options appropriate for you.

Good luck.

 

Houston Plastic Surgeon
5.0 out of 5 stars 14 reviews

Bottoming Out Again

+1

At this point in time you need an alternate approach. I use Strattice for just such an issue. Sutures will not work because they will just tear through as your tissues are most likely thinned out. Strattice will help control the pocket and act as an internal hammock to minimize the downward forces of the implant on your own tissues. From the photograph it appears that you already have an incision in your breast fold which is the incision that I prefer to use so you would not need any additional incisions.

Hope that helps,

Dr. Babak Dadvand

Los Angeles Plastic Surgeon
5.0 out of 5 stars 6 reviews

3rd Breast Revision

+1

Thank you for your photos.  The use of STRATTICE® is a good idea but there are no guarantees.  If the use of STRATTICE gets you closer but not perfect then I would recommend you stop there.

Dr. ES

Atlanta Plastic Surgeon
5.0 out of 5 stars 6 reviews

Recurrent bottoming out problem

+1

Time for plan B.  If plan A fails twice plan B is do not do plan A again.  You will get the same result.  Using a material like Strattice makes sense since you have thin skin and are having problems supporting the weight of the implant. 

Atlanta Plastic Surgeon
5.0 out of 5 stars 7 reviews

Bottoming out, I am not a Breast Aug candidate?

+1

I agree, if something has failed twice I would not do the same thing, I would recomend a product called strattice placed as an internal sling to support the implant and maintain your fold. I have had good success with this technique, good luck and do your research!!

Baton Rouge Plastic Surgeon
5.0 out of 5 stars 13 reviews

Transition from sub muscular to sub glandular can help "bottoming out".

+1

The vector of force generated on the implant by the pectoralis muscle can sometimes push it downward laterally. There is any implant to a sub glandular pocket will remove this force and often times fixes bottoming out.

Web reference: http://www.zubowicz.com/subpag,13-atlanta-breast-augmentation.htm

Atlanta Plastic Surgeon
4.5 out of 5 stars 6 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.

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