1 BA & 2 Bottom Outs?

2004 had first BA 420cc's no problems. July 2012 had another BA to 700cc's. By Oct 2012 the implant started to show through the bottom of the breast. Dec 2012 surgeon did a revision attaching to my rib. NEVER AGAIN, it hurt terrible. By July 3rd 2013 I completely bottomed out. What is my next option? Reduce implant size to 550cc?

Doctor Answers 8

Bottom Out

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Photos would help us offer better advice. With a recurrence of bottoming out, I would advice using smaller implants and rebuilding the breast support with Strattice, an acellular dermal matrix. I would think about as small an implant as would be acceptable to you.

All the best. 

Seattle Plastic Surgeon

Correction Of Recurrence Bottoming Out after Breast Augmentation?

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I am sorry to hear about the complications you have experienced after breast augmentation surgery. Based on your description of implant displacement, you will likely benefit from capsulorraphy ( possibly with the addition of acellular dermal matrix). One of the keys to success will be careful selection of plastic surgeon;  the outcome of revisionary breast surgery does depend on plastic surgeon experience level. Also, limiting postoperative activity, in my opinion, is very important when it comes to the outcome of these types of procedures.

 I hope this, and the attached link, helps.

Bottoming out after a very large breast augmentation.

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There are specific landmarks in breasts, for example the folds under the breasts. By going to a larger implant the fold under the breast was lowered to accommodate the size. You obviously have to be carefully evaluated by a plastic surgeon very experienced in breast surgery. There are many solutions to the problem, but it is likely that you have to accept a smaller implant in combination with other procedures. For example you may require a different kind of implant with a textured surface, the use of an ADM, a breast lift or other procedures.

Treatment of bottoming out depends on the circumstances.

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Without photographs or specifics about how the breast augmentation was performed it's impossible to give you good advice. Consider reposting the photographs any specific description of your operation.

Bottoming out problem

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There is no question that you need to go to a smaller sized implant and have an inferior capsulepexy. It may also be beneficial to consider an ADM like Strettice to support the breast implant like a hammock. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Bottoming out

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Sounds like your tissues can not handle such large implants. You may want to go with smaller implants and a repair.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Strattice internal bra for correction of bottoming out

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Large implants such as yours are associated with a higher probability of bottoming out, because the weight puts pressure on the bottom part of the breast resulting in thinning and loss of support. Definitive correction therefore involves reinforcing the thin tissue with something like Strattice, which will form an internal bra. Downsizing will also help.

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

Recurrence of Bottoming Out With Large Implants

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Very sorry to hear about your problems. This almost undoubtedly results from the large implant size – skin stretching along with loss of natural support at the inframammary fold.  This is an example of one of several adverse outcomes that stem form large implants volumes. Because your bottoming out has recurred, you will require a more extensive procedure to provide correction the second time around.

700cc is a large implant size for almost all women. Changing to a smaller implant size will help by reducing stress on the skin and the inframammary fold. Your surgeon can give you an idea of how decreases in implant volume will affect the appearance of your breasts. The decrease you mention should certainly help.

The lower breast and inframammary fold can be supported further with the addition of a layer of Strattice, and acellular dermal matrix (ADM) that will increase the strength of the repair.  Unfortunately, since the inframammary fold needs to be anchored to the chest wall, the repair/ reconstruction will require suture placement similar to what you had before.

Best wishes, Ken Dembny

Kenneth Dembny, II, MD
Milwaukee Plastic Surgeon
4.9 out of 5 stars 36 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.