Have my Breast Implants Bottomed Out? (photo)

Hi, I had a breast augmentation and lollipop lift 3 1/2 yrs ago. About 2 months post op I started suspecting I might be bottoming out. I have very little upper pole fullness especially on my left. My nipples are too high on the breast mound to the point that I can't raise my arms in a bikini or my areolas will be exposed. Is it possible to increase size with a revision for bottoming out?

Doctor Answers (12)

Bottoming out after implants and lift

+2

Thank you for your question and photographs.  I'm sorry that you are having  a problem with your implants.  It does appear that you have some bottoming out, worse on the left side.  Fortunately, this is a correctable problem.  The procedure may require excision of skin in the lower aspect of the breast.  Additionally, the scar capsule around the implant likely needs to be tightened and possibly reinforced with an acellular dermal product such as Alloderm or Strattice to try and prevent a recurrence of the implant malposition.  Be sure to ask your board certified plastic surgeon about how best to correct your situation.  Good luck!       


Fort Worth Plastic Surgeon
5.0 out of 5 stars 37 reviews

Bottoming out after a vertical lift

+2

One of the drawbacks of the vertical lift technique is that is can not correct the situation where the distance from the nipple down to the crease beneath the breast (the IMF) is too long.

I suspect that is what has happened with you.

If you measure from the nipple down to the crease, it shouldn't be more than about 10 cm, even for a D cup breast.  If it is, you might consider having a horizontal ellipse of skin taken out, especially on the left.  This will do 2 things:  lower the nipple, and tighten up the breast, giving you more upper pole fullness on that side.

 

All the best!

Thomas Fiala, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 27 reviews

How Long Will It Take to for my Belly Button to Look Normal After a Tummy Tuck?

+2

The posted photos demonstrate some bottoming out, poorly positioned N/a complexes in a lift (that was most likely not needed), asymmetry of N/A complexes. Only detailed revision can help. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

Bottoming out of breast implants

+2

It would appear that your breasts have bottomed out to some degree.  This can be corrected with internal capsulloraphy sutures( tightening of the capsular scar tissue with stitches) to elevate the folds.  Other considerations may involve using smaller implants, although on occasion larger implants may still be considered, and conversion of the implants into a new pocket to stabilize the implant position.  Your local Plastic Surgeon should be able to help you with this decision.  I have done all of these maneuvers on occasion, and they all work for different reasons.

 

Good luck to you.

 

Frank Rieger M.D.  Tampa Plastic Surgeon

Francis (Frank) William Rieger, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 45 reviews

Bottoming out?

+2

Yes, you do have some bottoming out with your vertical lift. A simple solution may be to have a small excision of skin and tissue along the lower pole that will  probably correct the deformity. Of course an exam in person is essential.

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

Poor implant position after augmentation/lift

+2

Thanks for your question and pictures.  It does appear that your implants are in a poor position as they are not centered on the nipple-areola complex.  You would benefit from a revision where the pocket for the implant is raised.  You may be able to go to a larger implant, but if the implant is in a better position you may be happy with your current size.  Finally, the use of acellular dermis (such as Alloderm) to help reinforce your revision may be a good idea depending on the quality of your tissues.  Good luck!

Naveen Setty, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 23 reviews

Breast Implants Bottomed Out?

+2

Spice09, thanks for your question.

Yes, the breast implants have bottomed out, your left more than right. Surgical improvement will require internal and/or external work.

  • Internal: Closing the inside, bottom part of the implant pocket with sutures.
  • External: Removing a horizontal wedge of skin above the breast fold.

Placing larger implants at the time of revision could result in more bottoming out within 6-12 months.

There is not an absolutely right or wrong answer, so I suggest you get several opinions before revision surgery.

Best of luck!

Stephen M. Lazarus, MD
Knoxville Plastic Surgeon
4.5 out of 5 stars 3 reviews

Yes, you have bottoming out of your breast implants

+2

Hello,

Thank you for the question and photos.  Yes, your photos do show what is often called bottoming out of the breast implants. Correction will involve repairing the breast implant pocket to keep the implant position higher allowing your nipple to be more centered and to have more upper pole fullness.  You can have bigger implants placed at the same time.  Depending on your tissue strength as well as the size of your final implants you may also choose to have acellular dermis placed for additional strength.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 92 reviews

Mastopexy Augmentation Is A Complicated Procedure

+2

The combination of mastopexy with a breast augmentation is a much more complicated procedure than meets the eye.  The interactions between the implant, breast tissue, and skin envelope are quite complex and not always completely predictable.  Nationally, there is a higher revision rate for this procedure when combined, that if done seperately.  For that reason, some surgeons recommend doing them seperately in cases where there is very significant breast ptosis.  Without your preop photos it is difficult to comment on your result.  The photos suggest that you have a small amount of bottoming out, but you also have some recurrent skin laxity.  The nipple position may appear to be higher than ideal when the implant bottoms out.  I would suggest revision of the implant malposition and perhaps revision of the mastopexy.  I would caution against a larger implant in a situation where you are already experiencing implant malposition.  Best of luck!

Robert F. Centeno, MD, FACS
Fairfax Plastic Surgeon
5.0 out of 5 stars 33 reviews

Bottoming out after a breast lift can be corrected

+2

Your scars have healed very nicely.  It does look like you may have bottomed out and the good news is that this can be corrected by a revision to repair the breast fold.

Martin Jugenburg, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 143 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.