Post-Revision for Bottoming Out Implants Happening again. What do I do?

Thank you for your question. A large portion of my practice is dedicated to breast revision surgery and have been in practice over 28 years. I wrote the very first paper on capsulorrhaphy over 20 years ago. I find that many surgeons perform capsulorrhaphy incorrectly, and therefore often have failures. I have fixed many patients over the years who have failed from previous capsulorrhaphies. Do not give up, you should be able to have an excellent result. Best wishes to you.

At this point, I suggest you consider finding another provider.
There are three variables that determine the quality of breast augmentation surgery. The first is the patient’s candidacy for the procedure. The second is the choice of implants and the third is the correct anatomic placement of the implants.
Surgeons should avoid violating the infra memory fold so implants do not bottom out.
Correcting the deformity of the bottom out implants is not easy or straightforward.
You should always confirm that your provider has experience doing any procedure they are recommending.
Do this by asking them to show you before, and after pictures of previous patients who’ve had the same procedure.
For those considering primary augmentation Always ask providers what their most common reason for revision surgery is and what their revision policy is.
Deformity can be correct and successfully, but requires having a surgeon who has experience and skill doing the procedure. Like I said, it’s not straightforward or easy to do so you need to find a provider that has a proven track record.
Look for plastic surgeons who have a decades of experience with their practice being oriented towards a lot of breast augmentation surgery.
Most communities will have certain providers attempt to do a lot of breast augmentation surgery.
Tom Pousti MD in the San Diego area is known for doing very high-quality secondary breast, implant surgery. There are plenty of others.
To find the right provider, I generally recommend patients have multiple in person consultations.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who have similar body characteristics to your own.
An experience provider should have no difficulty showing you the before and after pictures of at least 50 previous patients.
This may not be the case for revision surgery, which is not as common as primary breast augmentation.
Ultimately, it’s your choice if you want to stay with your current provider but based on what you describe, I think your current surgeon doesn’t have the skill or experience necessary to do this procedure well on a consistent basis. These are assumptions based on incomplete information so use your own judgment.
Knowing to cut bait and transfer the care to another provider is not always easy or straightforward.
It certainly doesn’t hurt to have a few in person consultations with other providers to see what they have to say.
Best,
Mats Hagstrom, MD