My surgeon has suggested 610cc smooth HP under the muscle. I'm concerned that being smooth they might bottom out?

I think that you are realistic to be concerned about bottoming out. It can happen. Although I think that implant size if more of a factor than implant type. I would definitely recommend that you discuss your concerns with your surgeon. Best, Dr. Nazarian

I appreciate your question.

The size of implant best for you is dictated by your
chest wall measurements. Once we determine that we can choose the profile
based on what you want or need to achieve.  If you are seeking a natural look,
then the diameter of the implant should be equal to or, more ideally, smaller
than the width of your breast. The breast width is a measurement of how wide
your breast is at the base, which should be measured at the level of the
nipple. Choosing an implant that is smaller in diameter than your breast width
will avoid the "side breast" fullness that is often associated with a
more artificial appearance. Other than that, you should choose the
implant based on volume, not on the dimensions of the implant. You should
choose a board certified plastic surgeon that you trust to help guide you in
this decision.

Silicone will give you a fullness at the
top (upper pole fullness).

Silicone implants come pre-filled with a
silicone gel and are the softest implant available. They feel more natural,
which makes them a good option for women with less natural breast tissue; but
they require a larger incision. It may be more difficult to realize if this
type of implant has ruptured, so it is important to monitor them with annual
follow-up visits. Additionally, because this implant contains a more liquid silicone
(less cross-linked), if this implant should rupture, it will leak only into the
scar capsule formed around the implant but may cause some discomfort or implant
distortion.

Anatomic gummy bear implants might be a
good choice to give you volume.

These highly-sought-after, anatomic
implants offer a look that more closely resembles the natural silhouette of a
breast, and, therefore, are a very attractive option for individuals seeking a
natural-looking, aesthetic primary breast augmentation. Additionally, these
implants are an especially excellent option for patients undergoing restorative
or corrective breast surgery because they provide more stability, shape, and
reduced incidence of capsular contracture. Compared to other types of silicone
gel implants, the silicone in the cohesive gel implant is more cross-linked;
therefore, should the implant shell “rupture,” it maintains its shape and
silicone does not leak.

During your breast augmentation
consultation, you should feel the different types of implants available, and
try on various implant sizers in front of a mirror to help you to get an idea
of how you will look following the surgery. You should also bring pictures of
the look you would like to achieve, as well as a favorite top to wear when
trying on implant sizers.



The best way to assess and give true
advice would be an in-person exam.

Please see a board-certified plastic
surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!



Dr. Schwartz

Hello,I recommend that you share your concern with your Plastic Surgeon and discuss your options again before proceeding. While smooth implants may be more commonly used and tend to show rippling less, thee are situations where textured implants are more effective. Your Plastic Surgeon will need to ensure multiple measures to keep large, heavy implants in place for the long term. All the best

 The biggest risk factor for your implants bottoming out is the size and weight of the implant. A 610 mL implant is a very large implant and as such is very heavy. The tendency for an implant to bottom out is not dependent on the surface of the implant, but rather the weight of the implant and the ability of your tissues to hold it in place.  I would share your concerns with your plastic surgeon prior to surgery to better define this risk.  Good luck!

 600 cc implants sounds rather large for your small height and weight. Large implants are going to have more of a stretching and gravitational effect over time than smaller implants.Shaped,  anatomic implants, which are textured and have more cohesive gel will, in theory, adhere to the walls of the pocket and put less pressure on the bottom of the pocket. This will theoretically lead to less bottoming out over time. 

Bottoming out occurs when the fold is weakened and the tissues stretch out.  This may happen due to surgical technique or even with the use of large implants (both smooth and textured). Best to choose your plastic surgeon based upon his or her experience with breast augmentation. Good luck!

The 610 rather than the smooth surface will influence bottoming out of the breast implantHave  a chat to your plastic surgeon about your concerns

While not very common, I think any time breast implants are being put in, there should be a concern about bottoming out.  Not because we expect it or see it frequently, but because it CAN happen, and we should take as many measures as possible to prevent it.  I'm in agreement with my many colleagues who have already stated that the size of the implants is a factor - larger implants have a greater risk of bottoming out as they impart more force on the tissues.  However, that doesn't mean that we shouldn't use large implants, again, we just need to take proper precautions when we do.  I respectfully disagree with those who have stated that texturing has no effect on the movement of implants.  While it may not be the most important factor, I think texturing of implants creates a certain degree of "friction" against the tissues, and this can help to keep the implants in place, whether we are talking about rotations about the x, y, or z axes, or lateral or up and down movements.  It is pretty well recognized that texturing helps minimize implant mobility, in addition to decreasing the risk of capsule contracture.  There are many different types of texturing processes depending upon your implant manufacturer, and I'm sure you have different options "Down Under" than we do in the States, so I would defer to your surgeon regarding the specifics of those options.  I personally believe that the most important factor involved with bottoming out is a combination of the patients's anatomy and how the surgeon deals with that technically.  Most of the time when implants bottom, there has been some manipulation of the inframammary fold below the breast.  Especially in cases like yours in which large implants are being inserted and the fold must be lowered to maintain proper proportions and perspective on the breast mound.  The fat layer below the skin and above the muscle is divided into two separate compartments - one deep and one more superficial, and there is a layer of fibrous tissue called "superficial fascia' separating these two compartments of the fat.  The superficial layer is usually tougher and resists downward forces, but the deeper layer is more filmy and flimsy, and in some people it is weaker than others.  Those would be the people most prone to bottoming out.  If this deep layer of fat is opened and not managed properly, and a large object like a breast implant is placed above that opening, it may not have enough strength to resist gravity and other downward forces, and the implant can "slide down behind" that deep layer of the fat.  That is what we recognize as "bottoming out."  I have confirmed this anatomically on multiple occasions by simply sliding my finger down into this flimsy deep layer of fat without much difficulty.  Thus, when the fold is to be lowered, and especially when using a large implant, and especially a large smooth implant, the surgeon must take measures to control that opening in the deep layer of fat, or there will be a risk of bottoming out.  He or she must close that layer in some manner reliably enough to prevent the bottoming out.  Detailed technical descriptions of how that is done I think are beyond the scope of this forum or this answer, just know that your instincts are correct in your question, and this is an issue to be discussed further with your surgeon.  If he or she would like to discuss this with me, for what that may be worth, surgeon to surgeon, I would be most happy to share what I know and have learned about this issue from my mentors before me as well as my own experience (bad and good!), and you are welcome to put him or her in touch with me.  Otherwise, I wish you the best of luck with your upcoming procedure!

Thanks for sharing your question. I can
appreciate your concern.



In general the bottoming out of implants is related to the
weight of them. Although texture implants help prevent implant rotation, at the
end the weight is the one that favors the desired tear drop look to your final
shape.



Finally, make sure that you have a
consultation with a board certified plastic surgeon that specializes in after
weight loss surgery.



Wishing you the best in your journey

Hi, there.Bottoming out of implant has to do with your breast tissue, surgical technique, and implant size.Implant being smooth does not affect the bottoming out rate.Please discuss your concern with your plastic surgeon.