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Downsizing and Subglandular Placement to Fix Bottomed out Breast Implants?

asked 2 years ago by pickles0127 in Pennsylvania
Latest answer by Armando Soto, MD
Question viewed 1,272 times
Tags: bottom out

I am 4 months post-op with 325cc hp placed subpectorally. I am 5'2, 115 lbs w/ a pidgeon chest and athletic. I have nursed 3 children. My problem is 2 fold. My left breast has bottomed out (within the first month). My right breast is far out laterally. Due to the spacing of my breasts, I am in pain on my right side. The right side is slightly bottomed out as well. I cannot find bras to fit. My surgeon wants me to go with a smaller implant (280cc or 300cc)& move them to a subglandular position. Is this appropriate?

17 answers to Downsizing and Subglandular Placement to Fix Bottomed out Breast Implants?

Correction of implant problems requires a very customized approach

Hi there- I'm sorry to hear you're having problems after your breast surgery. I agree with my colleagues that because you have a pectus deformity, and because you are athletic and active, you are predisposed to having your implants slide laterally. Correction of problems after breast augmentation requires a very customized approach and I personally am not comfortable making recommendations to you by email or in this forum... I would suggest that if you are interested in other opinions of what wo more

Armando Soto, MD
Orlando Plastic Surgeon

www.DrArmandoSoto.com

Revising a breast augmenation

Hello - Changing the pocket of the implant is one way to improve the position of the breast implants. You also may want to consider internal suspension sutures, smaller implants, or a lift if needed. It's hard to say without seeing photos and/or examining you. However, it's also important to make sure the swelling has resolved after your surgery to really get a good sense of where the implants are positioned, so you may want to wait several months before any revisions.

Jeffrey E. Schreiber, MD
Baltimore Plastic Surgeon

www.BaltimorePlasticSurgery.com

Displaced breast implants

Bottoming out post breast augmentation is not an uncommon problem. There are several different ways of correcting bottoming out. The method I favor is to use the same implants if they are gel and place them in a subglandular (subfascial) position. If you have saline implants and don't want to switch to gels, I would reposition the implants and close off the pocket inferiorly by recreating the breast fold. This requires more healing and downtime. Your exercise would be restricted for 4-5... more

Todd B. Koch, MD
Buffalo Plastic Surgeon

www.toddbkochmd.com

Implants bottoming out

To answer this properly I agree with one of the answers that pictures would help define whether there is bottoming (stretching out of the lower breast, lowering of the inframammary crease, lowered implant position, or a combination) or the problem is malposition of the implant or possibly an improperly sized implant (the width of the implant was too wide for the breast like a foot being too long or wide for a shoe). I disagree with another answer that subpectoral positioning of the implant... more

Scott L. Replogle, MD
Denver Plastic Surgeon

Chest shape and bottomed out implants: revision surgery.

Placing an implant under the muscle generally provides additional support to the implant. I worry that placing any implants above the muscle will further aggravate your bottomed out implants. Your chest shape further predisposes you to this tendency. If you undergo any revisionary procedures I would advise wearing a bra to bed at night to minimize this tendency.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Downsizing and subglandular placement

I appreciate the other expert posting. But I for one need to see photos (before and after). This will allow me to see the differences and more accurately see the problems. Regards Dr. B from MIAMI

Darryl J. Blinski, MD
Miami Plastic Surgeon

Implants moving downward and off to the sides

Patients with loose skin, widely spaced breasts, and those with a chest wall shape like yours will have a tendency to have the implants move "down and out." My approach to this (which works well in weight loss patients who have LOTS of loose skin) is to consider placing a smaller implant in the pocket after it has been stitched to close off the lower and lateral areas. Equally important is avoiding bouncing, shaking, etc. (i.e. jogging or high-impact workouts) and wearing very... more

John LoMonaco, MD
Houston Plastic Surgeon

www.DrLoMonaco.com

Fixing bottomed out breast implants

Your own chest wall anatomy has predisposed you to having the implants slide laterally, the slight bottoming out is another issue and can come from simple implant descent. In order to correct this, you would need to tighten the pocket laterally and inferiorly and go with the same or smaller implants so as to reduce the risk of recurrence. The problem with a pigeon chest and implants that are already widely spaced so that going smaller will also potentially widen the space between the... more

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Bottomed Out, Laterally Fallen Breast Implants

Although VIRTUALLY any implant could feasibly be placed into most women, it really does not mean that they should be. In your case, the side sloping of your chest ( IE Pigeon chest) means that EXTREME care needs to be taken when the breast implant pockets are NOT overly developed sideways. Instead, the side walls need to be left alone and undermined slowly and incrementally to prevent what you describe. However, sometimes this happens despite good pocket dissection. On the other hand,... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Correction of malpositioned breast implants

Every plastic surgeon who performs breast augmentation will occasionally have a patient who has malposition of the breast implants. Correction can sometimes be difficult. I do not think that there would be a significant advantage to making a relatively small change in the size of your implants or in placing the implants in a sub glandular position. Usually the implant position can be corrected by adjusting the existing pocket. This involves excising and repairing the excess capsular tissue... more

Michael D. Yates, MD
Huntsville Plastic Surgeon

Implant problems

It sounds like you have two issues. It is something that would best be evaluated in person so that a proper plan can be suggested.

Steven Wallach, MD
Manhattan Plastic Surgeon

Misplaced breast implants require expert revision.

Hi. Bottoming out of breast implants is really a technical problem (so is lateral displacement). I would wait several months and get a couple of different opinions. Changing implant size or implant pocket will not correct deformity.

George J. Beraka, MD
Manhattan Plastic Surgeon

Options for bottoming out implants

From your description the shape of your chest is predisposing to the implants sliding laterally, but bottoming out should not be part of that. Simply put, bottomed out breasts need support, and in my opinion switching to the subglandular plane doesn't add support. However, there is the possibility that the muscle action is pushing the implants downward, just as it pushes them apart. This may be what your surgeon is thinking. A better solution in that case might be to add support with... more

Richard Baxter, MD
Seattle Plastic Surgeon

Please send pictures

I would not recommend to change the position of the implant(front and lateral pictures will help). You should ask your doctor what is the reason and what is he trying to achive with the changing the poket. More suegery with a clear pln will make future revisions risky.I also disagree with the idea of going to smaller implant without clear reason for that. You neeed to get a second opinion from board certified plastic surgeon.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon

Poorly postioned breast implants can be corrected

Regardless of your chest shape, breast augmentation should center the implant under the nipple and fit the skin envelope of the breast such that they move and appear as one. It is not unusual to hear about implant malposition with an implant falling out from the side of the breast, remaining high in the breast, or falling slightly below. Ideally the pocket should be made to fit the implant well, though it sounds like your procedure has not gone as expected. If you are happy with the size of... more

Peter E. Johnson, MD
Chicago Plastic Surgeon

www.peterejohnsonmd.com

Fixing breast implant malposition

Breast implant malposition can occur under the best circumstances. Without a photo it is difficult to say, but I do not see how a slight reduction in implant size or changing to a subglandular position can help the situation you describe. I would suggest revision with a technique called neopectoral pockets to get a fresh start with sub-pectoral pockets. Also, the use of a material called Strattice, though expensive, could add support to your tissues to keep the implants in place. Good luck. more

Bruce Genter, MD
Abington Plastic Surgeon

Correcting implant malposition

Implant malposition can unfortunatelyoccur in a breast implant surgery. It is always best to not have it happen but if it does, the plan to correct it involves looking at the possible causes and trying to correct them in the revision surgery if it is required. Not having a photo it is difficult to give a lot of specific advice. I don't see that reducing the volume of the implant by 25 or 50cc will make that much difference and changing to above the muscle will thin the coverage of your... more