Breast implant bottoming out? (Photo)

Question

I had a breast augmentation in May, so going on 4 months ago now. I originally had concerns about my right breast appearing to not be dropping. I’ve since noticed that it appears my left breast is actually what I should be concerned about. It appears to me that it’s bottoming out. I’ve discussed this with my PS and he says they “look great” and I should “take the win!” I’m not happy with how odd they look. Looking for another opinion.

Gerald Minniti, MD, FACS · Answer

Wait a few more months and you'll be ready for a revision surgery. At that time, you should find another surgeon who is expert in revision breast surgery to perform the necessary capsulorrhaphy and mesh (aka internal bra) to reposition the implants into a pleasing place on your chest wall. Just tell your current surgeon you're taking the win elsewhere.

Bora Ok, MD · Answer

Hello, thanks for your question. I am not seen prominent signs of bottoming out, it may be minor if at all. However, I think that a smaller implant or a teardrop implant may give a more natural result. I would advise you to wait for a couple of more months before a revision surgery, if by that time you're still unsatisfied with your results. Best of luck!

Daniel Barrett, MD · Answer

Dear Cute418775,
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

Irena Karanetz, MD · Answer

Hello,

Thank you for the question and photos.

Based on your photos, it does appear the Left breast implant is lower positioned than the Right breast implant.

However, you are still in the early stages of wound healing.  The final wound healing process takes up to 1 year to be fully completed, so for now I would recommend to continue with conservative scar massage management prior to undergoing any revision surgery.

I would also encourage you to discuss your concerns again with your Plastic Surgeon.

I hope this helps.
Best regards, Dr. Karanetz

Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon

Gianfranco Frojo, MD · Answer

Without a preoperative photo, knowledge of type of implant/implant position, and a physical exam...it is quite challenging to make a solid professional opinion regarding your outcome. It appears that the nipple to breast fold distance is elongated on both breasts, significantly more noticeable on the left. There are many reasons why this could be happening. I recommend waiting a full year from the time of the initial surgery and then finding a board-eligible or board-certified plastic surgeon with adequate plastic surgery training and ideally aesthetic surgery fellowship training (accredited by The Aesthetic Society).

Connie Hiers, MD, FACS · Answer

You are bottoming out some. Do wear a good supporting underwire bra while you are awake. Perhaps it will not become worse.

Camille Cash, MD · Answer

You will want to wait until you are at least six months from surgery before considering a revision.  From the submitted photos it does appear that the implants are starting to shift.  You may want to consider smaller implants or mesh to support the tissues.

Douglas J. Raskin, MD (retired) · Answer

Greetings, 
I think that it would be helpful for you to see your pre-operative photos which may reveal whether the left breast was lower before your surgery.  Breast enlargements tend to provide you with a larger version of your unoperated breasts. 
You can always revisit with your plastic surgeon (or get a second opinion) to see if there is any further care (non-surgical this early) that would improve your appearance. Your photos look like you have had a very natural result with the asymmetry you noted.
 Best Regards,

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