About Breast Implants "Bottoming Out"
"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.
Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.
This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold. Your board-certified plastic surgeon will discuss which approach is best suitable for you based your current implants. I suggest you see your board-certified surgeon to discuss in more detail.
Is this considered bottoming out and what can be done to correct it?
The left implant may be bottoming out. Check your pre op photos to see if the left breast wa shigher pre op. If it was your surgeon likely tried to create symmetry by lowering the left pocket. See your surgeon if you are bottoming out a pocket revision is possible. see link below:
Bottomed out implant
When a breast implant migrates below the original placement
location with the bottom of the implant just above the infra-mammary crease, we
call this “bottoming out.” There are several causes of this downward migration
of the breast implant. Usually, some attempt had been made to lower the crease
to accommodate a breast implant whose base diameter is larger than would
otherwise fit in the natural breast. If not done correctly, the anatomic
attachment of the skin of the breast to the chest wall can be obliterated.
There is then nothing to hold the implant up. With the weight of the implant,
and constant gravity, maybe lack of support by lack of wearing a bra
continuously, the implant can settle downward. One of the earliest symptoms, in
my patients, has been the feeling that the breast has to be constantly adjusted
or just feels heavy. We look for the incision line, which was previously placed
at the crease, to have migrated upward onto the breast. When we see this early
on in the postoperative phase, it will never get better with time and will
require a secondary repair. While some plastic surgeons may rely on suturing
techniques only, I have found that unless we un-weight the implant by making it
smaller or strengthen the tissues below by making them less stretchy, that the
same implant just sutured over time will recur it's bottomed out position. I
have used part of the capsule as well as the lining of the deep muscles and
bone to rotate upward to hold the breast implant in a higher position and
therefore obliterating the extra space that has been created between the
correct infra-mammary crease and the one created by the downward displacement
of the implant. I call this a three flap technique as the skin, the capsule and
fascia, as well as a dermal flap all contribute to creating a hammock like
support of the lower portion of the pocket. When these tissues are insufficient
to hold the implant up or a previous attempt has been made with sutures, I will
oftentimes rely on the addition of another type of tissue called an a- cellular
dermal matrix, of which my preference is Strattice. This Strattice or pigskin
does not stretch and can be sewn in to the bottom of the new location of the
crease to support it just like a hammock would. Although this is costly, I
consider this an insurance policy against having to redo this again. I would
recommend that you try and find a plastic surgeon with experience in
revisionary cosmetic breast surgery. Good luck.
Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.
Bottoming out and Side Boobs Contributing Factors:
- Larger/Heavier Implants
- Implants placed above the pectoralis muscle
- Chronically not wearing a bra when upright
- Over dissection of the Implant Pocket
- Smooth Implants
- Large swings of weight including pregnancy
- Skin and soft tissue laxity, loss of elasticity