Breast Implants: Q&A
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How Does a Plastic Surgeon Create a Pocket That Will Not Allow Bottoming Out?
How does a plastic surgeon ensure that a relatively large silicone implant (400-450cc) will not bottom-out if only minimally covered (top 1/3-1/2) by pec muscle? What prevents the inframammary fold from slipping down below the pre-surgical level?
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13 Doctor Answers |
Asked by
3bink72
in santa rosa ca
+2
Implants falling below the IMF are ALWAYS due to poor planning or execution.
Hi there-
This is honestly not a problem adequately trained and experienced plastic surgeons should experience.
The inframammary fold is an anatomic structure, that when appropriately respected, will NOT, somehow stretch or weaken spontaneously.
In some patients, reconstruction of the fold is necessary, and a good outcome in these circumstances would require this (experience and recognition of these patients is very important).
I guess I would say the take home...
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Breast Augmentation Technique to Prevent Breast Implant Bottoming-out
There are multiple factors that come into play when discussing the possibilty of implant descent and malposition. They include implant size, surgical technique and inherent quality of the patients skin and breast tissue. Too big of an implant and laxity in the tissues combined with an already long nipple to fold distance can lead to bottoming out. The attachments of the inframammary fold have varaible strength as well, just as the chest skin does which are the primary support for the...
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Bottoming out of breast implants
I was interested to read the other plastic surgeons opinions on this one. The definition of bottoming out is not well defined and can relate to double-bubble deformity but there are at least two types of bottoming out. There is also a long list of "causes" of bottoming out which even a cursory evaluation reveals that there is no consistency in patients or even from one side to the other.
The two types of true bottoming out are a stretch of the lower pole (half) of the...
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Breast implants properly placed should not bottom out
When a breast implant after breast augmentation sags below the nipple it is said to have bottomed out. This is not something that naturally occurs, even with a large breast implant. The breast pocket, in both under the muscle, and in over the muscle augmentation must center the implant under the nipple and exactly fit the implant hand in glove to keep it correctly positioned. If breast augmentation is well done, bottoming out is so infrequent that we don't find it an 'issue'...
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Bottoming out after breast implants prevented with good technique.
Hi.
1) Everybody gets an occasional complication in plastic surgery, including bottoming out.
2) But there is no magic. Bottoming out can be prevented by really studying the patient's anatomy, by having a good individual surgical plan, and by making the breast implant pockets meticulously.
3) Just before the end of surgery, when doing breast augmentation in Manhattan, we put the patient in the sitting position (of course, you are still asleep) and...
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Preventing Bottoming Out with Large implants
Is skin was a great building material we would NOT have stretch marks, jowls, facial sagging, droopy butts, pot bellies and sagging breasts. You get the idea. Skin gives and ages. So in principle you cannot count on skin to provide a permanent support for any significant weight. In other words, in the battle between gravity and skin - skin ALWAYS losses.
The keys to avoiding a bottoming out are:
- precise pocket dissection. Not undermining more than in needed inferiorly to relocate the...
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How Does a Plastic Surgeon Create a Pocket That Will Not Allow Bottoming Out?
Excellent question: sometimes it is unavoidable. Precise pocket dissection respecting the anatomic boundaries is probably the most important factor that the surgeon can control. Beyond this appropriate implant size is an issue. Textured surface implants may remain more fixed in their positions. Use of acellular dermis or crease fixation sutures in reconstuctive cases is another technique.
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Several factors contribute to bottoming out with breast implants
Surgical technique is part of the answer, but as you have pointed out the muscle covers the top of the implant and does not add support from below. A hyperactive pectoral muscle can actually push the implant down over time and cause bottoming out. One of the biggest contributing factors is implants that are too large, which will succumb to gravity over time regardless of how precisely the pocket is created. There are a few specific things that can be done, such as using the fascia...
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Preventing bottoming out after breast lift
preventing bottoming out begins with good surgical planning and technique. The implants should be placed under the muscle .A sling of acellular dermis(Strattice) in combination with breast parenchymal flaps should be considered as well.Good bra support is imperative. Naturally ,larger implants require more internal and external support than smaller implants.
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Bottoming Out with Implants
The goal with preventing bottoming out is to not violate the inframammary fold any more than necessary. The fold is a strong connection between the skin and the underlying tissues. If possible, the goal is to leave this intact. There are some women on whom you need to lower the fold to accomodate the implant, or correct some abnormal anatomy of the breast.
In these patients, you need to be careful with the dissection and not disrupt any more of the tissues than...
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A pocket that will not allow bottoming out
Experience, experience, experience is one way. The other way is to not dissect the pocket to inferiorly or use deep fixation sutures in the internal infra mammary fold. Just a few thoughts to answer your question.
From MIAMI Dr. B
+1
Bottoming out
There are a number of factors that go into bottoming out. This can include overdissection, implant choices, and gradual increase in soft tissue laxity to name a few.
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