Is my right breast bottomed out? (photo)

Bottoming out involves the implant moving below the inframammary fold over time without causing two distinct folds.  Sometimes this is the result of weak patient tissues, too large an implant, or a combination of both.  The repair involves suturing the pocket with capsulorrhaphy sutures and possibly adding an acellular dermal matrix for reinforcement (Alloderm, Strattice).  The implant size may need to be reduced as well. 

Thank you for sharing your question and photographs. I agree that your right breast implant has fallen too low on your chest and will require surgery to attempt to correct it.  This can be done with tightening of the capsule of the implant to push it higher and inward towards the breast bone, or at times requires a soft tissue reinforcement.  Seek out a second opinion for the best treatment advice. 

Dear lucyinthesky90,
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, MD

Thank you for your question and for your photos. I'm sorry about your concern. Based on your photos provided, I do see the implants sitting a bit low. I would advise you to follow up with your original surgeon for an examination and to discuss what options you have for correction.

Judging by your photos, it does appear that you have inferior implant displacement or bottoming out.  The treatment would be to go in and repair the capsule to raise the crease +/- reinforcement with acellular dermal matrix vs Galaflex mesh.I would see a board certified plastic surgeon to see what your options are.Hope that helps.

Hello and thank you for your question and sharing your  photos. Yes, your right breast is bottomed out, causing the nipple on that side moving upward. There is inferior displacement of the implant, resulting from disruption of the infra-mammary fold. Fat grafting will not help. You will benefit from a revision surgery and repair of the fold. Best,
Pejman Aflaki, M.D.

Johns Hopkins-trained double board-certified plastic surgeon

Based on your photos unfortunately it does appear that your breast has bottomed out.  The proper corrective measure involves revision surgery.  This should bring the nipple placement into better symmetry.

as your photos suggest surgical options are available to tighten the lower pole, or elevate the implant is that is determined necessary.  Your left side is showing a little laxity at 6 o'clock as well.  Only way to know for sure what is needed is to have an exam and your surgeon has the benefit of that.  Wondering what he/she would fat graft to correct your problem?  You should ask him/her for the logic behind that recommendation.

It does appear from your photos that your right breast implant is bottomed out. It will require another surgery to correct this problem. 

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are appropriate; your right breast implant does seem to sit low on your chest wall, consistent with breast implant displacement ("bottoming out”).
It is possible that you are feeling the implant significantly along the lower pole of the breast. Patients in your situation often complain of discomfort in the area of implant malposition. 
Generally, signs of breast implant bottoming out include: 
1. Breast implant "sits" too low on the chest wall.
2.  Excessive palpability or visibility of the breast implant along the lower breast pole.
3.  Nipple/areola complex seems to be sitting relatively high, because the breast implants have settled too low. 
4. Discomfort along the lower breast pole (secondary to pressure from the underlying implant).
5. Relative paucity of upper pole breast implant volume compared to lower pole volume.
6. Increased visibility of a infra mammary fold scar (higher on the breast mound).
I think you will likely benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair).  Fat grafting is not the solution. Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh. This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly.  Any associated issues with positioning of nipple/areola complexes and visibility of the inframmammary fold scars should improve with this operation.There are several important "factors" involved in this type of revisionary breast surgery. Most important (in my opinion): plastic surgeon experience level.     In other words, experience level and technical expertise play the biggest role when it comes to successful  outcomes with this type of revisionary breast surgery.   Careful attention to postoperative activity limitations as well as use of appropriate postoperative support of dressing/garments are also important.
 I hope this  helps.