Is There Any Hope After Bottoming Out 3x's?

I'm 5' 4" 105 lbs, originally a 32 B (barely) implants are Mentor Gel 375CC. 2 bottoming out corrections later, permanent sutures, over correction, and good support bras 24/7 it's two months later and I've bottomed out again. What questions should I be asking my PS at my next visit? With my smaller frame would a smaller implant prevent bottoming out from happening again? Is there hope or should the implants be removed permanently?

Doctor Answers (8)

Bottoming Out

+2

Hello,

I am sorry you are experiencing this recurrent problem.  I agree with the other surgeons that ADMs like Alloderm or Strattice might improve a subsequent outcome.  However, I think that something so obvious as the need to reduce the size of your implants is just as important. It should be known that the ADMs are only as good as the sutures holding it to your tissues, the very stuff that keeps giving way in your previous surgeries.  I would ask you to seriously consider this prior to another surgery.

Best of luck.


Beverly Hills Plastic Surgeon
5.0 out of 5 stars 29 reviews

Why do breast implants bottom out?

+2

Breast implants bottom out because of inadequate soft tissue support.  Sometimes this soft tissue can be reinforced with sutures but if it has recurred despite two attempts to correct it then you usually need to reinforce the tissue with a biologic mesh or acellular dermal matrix.  This acts as a hammock to support the weight of the implant and helps to prevent the recurrence of bottoming out.

In my Salt Lake City, Utah plastic surgery office I perform a very high volume of revision breast surgery (mostly referred from other plastic surgeons).  Most importantly you need to make sure that your plastic surgeon is experienced in revision breast surgery.

Richard H. Fryer, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 84 reviews

Strattice for correction of bottoming out breast implants

+2

If surgery to correct bottoming out implants has failed twice, it is a matter of inadequate tissue support not type of sutures. The best way to correct this is reinforcement with an acellular dermal matrix graft such as Strattice. This becomes like a living internal bra and has been very successful.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 25 reviews

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Bottoming Out

+2

Thank you for your question.

Yes, there is hope for correction of the bottoming out.

Please make sure that your surgeon has extensive experience with this type of surgery and can demonstrate it to you.

The use of permanent sutures +/- the use of Acelluar Dermis is usually successful for most patients.  

I ask patients to wait as close to 1 year post op surgery before undergoing this type of revision surgery because the permanent sutures will be placed in the capsule and the capsule needs to be strong enough to hold the suture.  I ask patients to limit their activity and no heavy lifting for many months to ensure that the repair holds.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 750 reviews

Is there any hope after bottoming-out 3x's?

+1
Hello! Thank you for your question!  Given your history of failed attempts at revision to correct symmetry and shape issues, consideration for either an acellular dermal matrix or mesh-type substitute is reasonable.  A capsulorrhaphy would be needed for revision of your breast pocket. If you do need such, the use of a dermal matrix or mesh may be considered if your tissue now has significant laxity that is failing in support or a significant deformity in which recreation of the breast pocket is required along with adding additional support and coverage of the implant.  Certainly, the larger the implant, the heavier the weight...thus, it may be useful to consider placement of a matrix or mesh. Otherwise, capsulorrhaphy for pocket revision using your native tissue should suffice.  It has been used safely and effectively to correct synmastia, restore the inframammary fold, mask implant issues (e.g., rippling, wrinkling, etc.), and improve aesthetic results in revisionary breast implant and reconstructive procedures.  However, only by physical examination would one be able to make recommendations on the benefits over the risk of using a matrix or mesh in your situation. 

Consult with a plastic surgeon well-versed in breast procedures and the use of dermal matrices and mesh in breast procedures who will assist you in determining which procedure(s) would be the best for you.

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Bottoming out x 2 of Breast Implants

+1

I agree with the previous answers. In my opinion if a surgery has not worked twice, time to try another technique. Using a acellular dermis to support/hold the implants will help relieve the stress on the breast tissue by the implants. There is a higher cost associated with this type of procedure, but well worth it for the results.

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.5 out of 5 stars 17 reviews

Botoming out

+1

If you have had three failure becuase of bottoming out, you may want to try smaller implants and use Strattice to provide support.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Pictures would be helpful

+1

It is impossible to give you good answer without reviewing your pictures. In general the solution for any problem is to reevaluate everything and start with a new treatment plan. I offer implant removal and fat grafting for the patients that have failed implants (multiple capsular contractures, infection and malposition). 

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.5 out of 5 stars 57 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.