Bottoming out of both sides of implants - do I need a 3rd revision? (photos)

Question

I've had two surgeries to repair the bottoming out of both sides of my implants. My doctor blames my lack of fat and prior breast lift/ reduction. During the first repair, my doctor attempted to re-suture the pocket and adhere things more intensely. During the second repair, I paid for the strattice material to be added. That repair was a year and a half ago. I'm just so disappointed and at a loss. Can this just not be fixed??? Or should I seek out another in person consult?

Gerald Minniti, MD, FACS · Answer

Although not the ideal support, Strattice, or any other ADM, should have done the job.  You'll need someone else's hand to fix you for good.

Gary M. Horndeski, MD · Answer

You underwent a Wise pattern lift, reduction and placement of implants. Unfortunately, your implants are only supported by the mechanical strength of your skin envelope. You will need a revision of the breast lift with smaller implants.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

Your result is quite good except that there is too much skin around the outer part of the breast. This can easily be corrected by just excusing about a one inch wide strip of skin replacing the old scar.  It should not be a big deal. Otherwise your result is great !

Daniel Barrett, MD · Answer

Dear alisall,
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
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Aleksandr Shteynberg, MD · Answer

Hello alisall. 
Bottomed-out implants may happen with larger implants, disrupted inframammary fold, and thinner skin flaps. It seems that your surgeon tried to stabilize pockets with acceptable procedures twice. At this point, I think getting a second opinion is the next reasonable step.Additional pictures with both breasts in the view and views of the second breast are helpful to appreciate the problem. In-person consultation, especially with multiple prior surgeries is more informative and productive for both a patient and a surgeon. 
Best.
A. Shteynberg, M.D., F.A.C.S.Diplomate, American Board of Plastic SurgeryNew York, NY.

Connie Hiers, MD, FACS · Answer

Your implants are probably too heavy for the amount of tissue you have left. I would consider going down in side and retightening your pockets.

Kamran Khoobehi, MD · Answer

I am sorry that you are having issues with your breast surgeries. You will need revision to support the inframammary fold ligaments.

Jason Pozner, MD · Answer

Can you find out if a large piece of strattice was used or a small strip. If a large piece it may be able to be corrected by resuturing to resupport the tissues. If a small piece I would use galaflex mesh for support. Correction is not that difficult or with a lengthy recovery

Darryl J. Blinski, MD · Answer

After your surgical journey I think the best option is not only in person examinations with only boarded PSs whom do revisions but also 'start over' concept. Remove the implants and capsules if  any, liposuction, fat grafting t breasts in series of surgeries to build up the volume. Expect fees per surgery in the $10,000 per operation.

Bottoming out of both sides of implants - do I need a 3rd revision? (photos)

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