Am I bottoming out? 4 years post op with lingering discomfort (photos)

Your limited photos show no evidence of bottoming out, but without a better view of the incisions and the bottom of the breasts, this can't be completely confirmed. If you are having pain, a visit to your surgeon for evaluation would be appropriate. You should also consider a visit to your primary care physician or gynecologist. There are multiple potential causes of breast pain, many of which may not be related to the implant.

Thank you for the photos. You are not bottoming out. Your breasts may have undergone changes over the past 4 years, and you are eligible for a lift. If you're having pain, please see your surgeon.

You are not bottoming out. That is when the implant migrates inferior to the breast tissue, typically below the natural inframammary fold, leading to 'double bubble' as well. What is happening to you is the opposite: your breast implants are in good position with an intact inframammary fold, but your breast tissue is 'falling off' the implant like water over a cliff, hence 'waterfall'. To correct your issue a breast lift would need to be performed.

Dear llexplore,
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

Breast pain after breast surgery can be due to many reasons including implant rupture, implant capsule changes, stretching of the capsule/pocket, and stretch. I believe that your breasts are showing signs of recurrent ptosis (saggy breast).

Thank you for your question. Pain behind the scar four years following breast implant surgery can be a sign of capsular contracture: hardening of the scar tissue surrending the impalnt. To find the cause of this pain and obtain the right treatment, you must speak with a board-certified plastic surgeon. They could recommend treatments.

It doesn't appear to me you are bottoming out, rather your breasts are falling off of your implant. In other words there is a disconnection between your implants and your breasts. We want the implant to be centered under your nipple but it appears your breasts nipples are lower than the center of the implant and a lift would be needed to return your breasts to the correct position. A lift would reposition your nipple to the correct spot and a lift would also reshape your breast to give you a rounder look.

You are sagging but are not bottoming out from looking at your photos. I would suggest going back to your surgeon and being checked.

I don't see bottoming out. Skin can stretch over time. Skin is elastic due to large implants. If you are having pain... an ultrasound or MRI can help detect any issues. Best to ask your board certified plastic surgeon for advice.

Good luck,

Andrew Cohen

Based on your nicely posted photos appears you have some capsule formation with mild descent. Recommend ultrasound of breast or mammogram. And determination by in person or virtual consultation if exchange capsulotomy capsulectomy is needed with full breast lift or L-shaped breast lift. Fees range from $5000-$15,000. Again best to virtual consult with.