Are my implants bottoming out and would I benefit from a revision? (photos)

Question

Over a year since my BA (290cc under muscle silicone) and I hate how far apart they are and feel like they have dropped too low. Is this normal or are they bottoming out and do I need a revision? Current photos and pre BA attached.

Daniel Barrett, MD · Answer

Dear nicolascott16,
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

James M. Economides, MD, FACS · Answer

From your photos it does not appear as if the implants have bottomed out. They have likely settled over time, however, the projecting portion of the implant appears to be centered under the nipples and you do not appear to have a "double bubble" phenomenon that you may see in implants that have bottomed out. The double bubble refers to the appearance of the implant that has fallen below the fold of the breast. As always, it is best to discuss with your surgeon who is most familiar with your surgery.

Miguel Mota, MD · Answer

Hello and thank you for posting with before and after photos. They are very helpful. I can see from your before photos that your breasts were already far apart so in this case the issue is mostly due to patient anatomy. This is very hard to correct with small implants that do not need a lift. Placing the implants closer to each other would reduce the space, but it would also make your nipples face outwards. Other options for filling out the space between your breasts would be larger implants or wider implants. In any case your results are very good!

As for the bottoming out issue, I’m not sure they are actually bottoming out but, they do seem to be a little low. Surgical revision of the breast fold and the implant pocket with implant exchange (If you wish to change size), is the only way to correct this issue. This might mean new scars as well.

In my option, regardless of these issues, you have great results and your breasts still look breast. I would only recommend revision if this bothers you a great deal. If not, you can avoid surgery and extra scars for now.

Best of luck,
Dr. Miguel Mota

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Nothing replaces an in-person examination but it appears in some of your photographs that you have bottomed out.  Although I would not expect many further changes after a year's time, a surgical revision would be required to correct their appearance.

Camille Cash, MD · Answer

Your pre op photos suggest that you have more fullness to your breasts below the nipple naturally.  If you are bottoming out, it is mild.  The distance between the breasts is due to your anatomy.  You may be able to improve this somewhat with surgery, but it is important to discuss expectations with your surgeon.

Connie Hiers, MD, FACS · Answer

You have some bottoming out which can be corrected with an internal bra of mesh for better support. This can also be useful in tightening your lateral pockets so that your implants do not push out to the sides as much.  You appear to have little breast tissue to support the implants. Don't go larger. You still will have the gap between your breasts since this is your anatomy.  If you have any donor fat, it could be added to the inner part of your breasts to help decrease the gap.

Douglas Taranow, DO, FACOS · Answer

Dear Nicola,
I can understand why you are less than satisfied.  First, your breasts are very nice, but there are areas for improvement.  Yes, you have bottomed out just a bit with less upper pole fullness.  Yes, you have wide cleavage which is partially due to your pre-op anatomy.  Your breasts are wide and go laterally possibly due to lack of medial (midline) dissection of your pocket and the fact that your ribs have an acute curve lateral (where the implants sit on the ribs and slowly descend downward [due to gravity] and laterally due to the rib curvature).  
A revision augmentation with dissection of the medial pocket to improve cleavage, plication (suturing) of the lateral and possibly lower capsule/pocket to both raise the implants and give better cleavage.  Possibly changing the implants to a different shape may also aid in gaining cleavage.
Best wishes.
Dr. Taranow

Derek Fletcher, MD · Answer

The most difficult aspect of the breast to adjust or change is the breast footprint. It can rarely be moved more than 1-1.5 cm toward the midline. Think of it like the foundation of a house. Placing the implant under the muscle was not the wrong location for your breast augmentation. But, the muscle origin from the sternum dictates how close or far from the midline the surgeon can create the breast implant pocket. Women with breasts that naturally developed a lateral foot print without cleavage who have a sub muscular augmentation, rarely achieve close cleavage. I always discuss this before surgery because it is important to know what the operation can and can't achieve. 
Your implants have settled slightly low and the irregular inner contour is due to the pec muscle restricting the implant shape. You may be a candidate for revision. An in person exam is necessary to determine what combination of techniques are necessary to achieve your goals.

Mark Eberbach, MD · Answer

Your results are nice. You do have more "bottom boob" but this may be your natural anatomy.

You may achieve more upper fullness with a larger implant or if bottomed out with a capsule tightening.

Think hard on that since you have a pretty result already.

George Lefkovits, MD - Account Suspended · Answer

You appear to have Pectum excavatum which means that your sternum near the inner aspect of your breasts is somewhat caved in. It is very difficult to bring the implants closer to the center because of this irregularity. Discuss this with your plastic surgeon.

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