500cc implants to 700cc - can this be done if I previously had bottom out and double bubble issues? (photos)

Question

I’m mtf trans . I had breast implants 500 cc now it’s 2yrs for them and in 3 months I seen it’s double bubble and bottom out Now I need go for 700 cc but can I know if I go for revision can go 700 cc or it definitely has to be less than 500c. ? Also need know What precautions methods doctors use / take when doing revision breast augmentation which had bottom out n double bubble issue before ?

Daniel Barrett, MD · Answer

Dear Terrific677088,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

Your double bubble is from the original inframammary fold. Your breasts are bottoming out and are very asymmetrical as well. Adding more weight/volume will make your situation worse. You need the original inframammary fold released and a donut mastopexy to reposition the nipple-areola complexes. I would recommend fat transfer, not large implants.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Mustafa Aydinol, MD · Answer

If I was going to operate on you, I wouldn't change your implants with bigger ones. This is alone a difficult condition to correct and you need a proper healing phase to achieve an optimal result. Because the implants are big, I suppose they have dropped causing double-bubble condition, meaning that the lower space must be fixed and secured. So instead going bigger should keep the same size or even reduce them. If you want big volume, you can combine the breast augmentation with fat grafting as well.

Connie Hiers, MD, FACS · Answer

Please do not go larger. You bottomed out with 500 and will bottom out again with 700. You need to go smaller and probably need mesh.

Mark Eberbach, MD · Answer

Your pictures suggest a real problem. 
In my opinion given your breast’s native anatomy, you need much smaller implants.

I fact to have the greatest chance of long term normal looking breasts, you will need two stages. First removal with capsulorraphy to restore the crease and base. Second augmentation with a smaller implants some months later.  Fat grafting may help a bit also.

Not all women have large breasts and there are limits. That is you.

Mats Hagstrom, MD (license on probation) · Answer

The ability to restore at quality outcome is highly dependent on how the first procedure was done.
Based on your pictures, I seriously question how your first procedure was done, including the size of the implants.
If you want, need for multiple future revisions with eventually implant failure then you need to find a really talented breast surgeon.
That is the most important variable and everything that you should be looking for.
Finding the right plastic surgeon is much more difficult than most people realize.
Basically, it means having multiple consultations and knowing how to vet providers.
Look for plastic surgeons, who can clearly explain what’s wrong with your augmentation currently and what the treatment is going to be.
Before we even begin to make an assessment we need quality information and this is going to Need to include your previous report and all before and after pictures.
Your previous operative report is absolutely critical in order for the surgeon who’s going to take care of you to understand how the first procedure was done which will explain why the outcome looks the way it does.
Your outcome can be corrected, but the chance of having repeat failures is higher if it’s not done correctly.
I don’t know how to tell you how to find the right provider other than it usually requires consulting with a number of plastic surgeons.
Look for plastic surgeons, whose career is focused almost exclusively on breast surgery, and preferably those who include breast reconstruction in their practice.
Ask providers to open up their portfolio and show you their entire collection of before, and after pictures of previous cases that were similar.
Don’t look for discounts look for the most experienced and talented provider for your condition.
Best,
Mats Hagstrom MD

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