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5 Year Old Implants Bottoming Out. What Do You Think? Thank You.

asked 1 year ago by M198 in Massachusetts
Latest answer by Tom J. Pousti, MD
Question viewed 879 times
Tags: 5 years post-op, drop, normal, revision

I'm 5'4'', 110 lbs w 300cc submuscular saline implants. Post op, my PS said my nerves were anatomically unusual, & anticipated damage as he created the pocket. I lost feeling & got an infection. 5 years later I'm bottoming out & returned to my PS. He says I'm in the 10% that doesn't scar (to keep the implant in place), but that bottoming out would not progress further. He advised capsulotomy w or w/o lift & implant replacement, or let it be. What do you think of this & what would you advise?

13 answers to 5 Year Old Implants Bottoming Out. What Do You Think? Thank You.

How to correct bottoming out after breast augmentation.

Your photographs show marked bottoming out and breast asymmetry. It does not seem like you have breast ptosis, your nipple and areola seem to be at the right location. Because you have very little subcutaneous tissue to support the implant, I would recommend bilateral breast revision with a dermal matrix mesh (Stratice) to support the implants. If you are happy with your implant size, it does not need to be replaced, although a silicone implant might feel more natural.

Frank Agullo, MD
El Paso Plastic Surgeon

www.elpasoplasticsurgery.com

Treatment of Bottoming Out of Breast Implants?

Thank you for the question and pictures. It is clear that your implants are positioned too low on the chest wall. One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Breast implants bottoming out

Bottoming out is a known complication of breast implant surgery, and can be the result of thin tissue, heavy implants, surgical disruption of the normal inframammary folds, or just unpredictable healing. The standard approach has been to place sutures in the pockets to close off the inferior portions, but some risk of recurrence exists. A more recent approach is disssecting new pockets, called "neosubpectoral" pockets, closing off the old ones, and placing the same... more

Robert M. Grenley, MD
Seattle Plastic Surgeon

Breast Implants and Bottoming Out

I agree with you and the other posts: It appears that you do have bottoming out, with the right breast more affected than the left. If your appearance is bothersome to you, you may consider a revision or secondary surgery. This did not occur because of anything you did wrong, nor could you have prevented it. Bottoming out occurs for several reasons: 1. Over-dissection of the breast implant pocket 2. Placement of very large breast implants 3.... more

Jaime Perez MD
Tampa Plastic Surgeon

www.jaimeperezmd.com

Breast Implants - Bottomed Out - Sutures or ADM (Acellular Dermal Matrix)

Hi M198 in Massachusetts I agree that it looks like you've bottomed out. There are many different explanations for this but none of them really matter at this point - the main thing is figuring out what can be done to improve the appearance of your breasts. The first issue is, of course, to raise your implants. But the main issue is how to maintain them in that elevated position. Traditionally, that has been done by inserting a series of permanent or... more

Alan Engler, MD
New York Plastic Surgeon

Breast implant revision

Yes it appears that you have bottomed out. The traditional treatment for this has been to do internal capsular suture to shorten the lower portion of your breasts. For complex patients or those that have failed other therapies I usually suggest reinforcing the lower breast with Strattice which dramatically has decreased the recurrence rates of bottoming out in my practice.

Delio Ortegon, MD
San Antonio Plastic Surgeon

www.sacs-sa.com

Bottoming Out of Implants

I agree from your photos that your implants are bottoming out. I d not think that this has any relation to your nerves being "anatomically unusual". I agree that you should seek a second opinion. You may need to have AlloDerm or some other ACD placed to correct your problem, but you should discuss this with your original and a second opinion surgeon.

John Whitt, MD
Louisville Plastic Surgeon

Get a second opinion

Looking at your pictures and reading your story, i agree w the other postings here. I would add that i would suggest seeing another plastic surgeon (board certified plastic surgeon). Sincerely, Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon

www.torontosurgery.ca

Revision breast augmentation is usually successful.

Hi. I don't believe in blaming the patient. The bottoms of your implant pockets are too low. They can be raised to an attractive level with a revision, and this usually works. The repair is done with rows of internal stitches. Most patients do not need dermal matrix for this. see video

George J. Beraka, MD
Manhattan Plastic Surgeon

Breast implant bottoming out can be corrected

When breast implants drop so that they are no longer centered behing the nipple, it is called bottoming out and can be caused by several factors such as the size (weight) of the implants and the patient's tissue strength. Usually it is repairable by an internal repair of the scar capsule around the implant (called capsulorrhaphy) but if the tissues are stretched thin the repair may be better if reinforced with Strattice.

Richard Baxter, MD
Seattle Plastic Surgeon

Breast implants too low, bottomed out

The low implants or bottoming out has more to do with the pocket placed at the time of breast augmentation rather that a fault with your tissues. The type of implant, saline or silicone has no bearing on the bottoming out, and low implants do not occur in 10% of patients. Your nipple position is quite normal and you do not need a breast lift. If you feel your saline implant is the right size and is soft and acceptable you do not need a new implant or a silicone gel implant. What you do need... more

Peter E. Johnson, MD
Chicago Plastic Surgeon

www.peterejohnsonmd.com

What to do for bottoming out

When bottoming out occurs it is usually with saline in my experience. Just judging from your photos, and by no means is this to be mistaken for a consultation, you definitely have bottoming out. It is more severe on the right and even the old post-op photo shows signs of s low set breast. It would be interesting to see your pre-op photos as well. In my patients I would recommend a bilateral revision by doing a capsulorraphy or capsule repair and supporting this with... more

Steven Schuster, MD
Boca Raton Plastic Surgeon

www.schusterplasticsurgery.com

Repair of bottomed out breast implants

I agree that you don't seem to need a lift, just a pocket repair to correct the bottomed out asymmetrical implants you have. If your tissues are as fragile as your doctor says, you might need to go to Strattice now to make a new stronger pocket in the lower pole.