Bottoming out breast deformity post implants and lift. Post-revision questions. (Photo)

Roughly 3 months post-op been progressively getting worse since 5 weeks post-op...I had 495cc Sientra silicone (gummy bear) implants placed under muscle. I realize that I will likely be heading towards a revision and will discuss that with my PS in two weeks. My questions are, how long do I need to wait for a revision? Also, what is the recovery like after the revision? Will it be similar to the first augmentation as far as waiting period to lift things and return to a normal lifestyle?

Doctor Answers 6

Addressing Breast Deformity & Bottoming Out

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"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.

Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.
This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold. 

Stretch #Deformity occurs when the breast fold is in the correct position, however, the length of the tissue between the nipple and the fold stretches. This may be due to the patient’s soft tissue inelasticity and/or the size or shape of the implant that is used. Skin laxity can change with age, pregnancy, weight changes, or heredity. 
Correction of this problem usually includes skin excision as part of a mastopexy (breast lift/reshaping).
It may be necessary to use ADM to further support the breast tissue if too thin. Your procedures should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery.

Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Bottoming out breast deformity post implants and lift. Post-revision questions.

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I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”).


I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair) and/or breast lifting surgery. 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. Associated issues with positioning of nipple/areola complexes should improve with this operation.  

Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery. 

I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.

Split muscle technique to correct animation deformity

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Your animation deformity and bottoming out/double bubble are two aspects of the same problem. It can be corrected by converting to the split muscle plane (not dual plane) along with capsule revisions. Several examples and resources on my site.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Breast aug, revision, sientra, bottoming out

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Thank you for your question. Typically having bottoming as shown in your photos is going to require a revision procedure. If you were my patient, I would place an ADM or Strattice along the lower pole to hold the implant in place. I also typically in my patients try to put in a slightly smaller implant placed in order to have less stress or weight on the lower pole of your breast.  It looks from your photos that the fold (lower portion of the breast) has been disrupted. By placing the Strattice, this can help correct this deformity. I would agree with talking to your plastic surgeon about your concerns. I am also in Ashland and would be happy to see you for a consultation in person to help address your concerns further.

Margo Herron, MD
Medford Plastic Surgeon

I would do it now

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From your photographs, if you are my patient, I would recommend that you proceed at any time with a revision of the bottom of your capsule. With the animation deformity that appears to be on the left side I would probably recommend a large piece of Strattice attached to the muscle and down to the bottom of the capsule to act as a hammock and prevent inferior migration of the implant again. The same procedure would be done on the right side as well. Depending on what needs to be done the instructions of what to do and not do will need to be given to you by your plastic surgeon. Best of luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 58 reviews

Revisions for breasts and tummy procedures

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are usually done after waiting 6 months but some surgeons may proceed sooner, depending on what the problem is.  You should write down all of your concerns so that everything is covered and addressed to your satisfaction but it appears you can benefit from revisions to produce perkier and more rejuvenated outcomes.  Recovery from revisions will vary, depending on what is done and your surgeon is best equipped to let you know what to expect from what procedures you will be having done.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.