Best Way to Fix Bottomed out Breast Implant?

Best Way to Fix Bottomed out Breast Implant? Wat at 6-9 months and then perform a caspuslorrhaphy. Slight overcorrectionis necessary and support in the post-operative period.

"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. However, it is best to consult with your Plastic Surgeon to better confirm with an in-person exam.

"Bottoming out" can occur for several reasons, not unusual with heavier saline implants, especially if the fold beneath your breast was adjusted lower at surgery to accomodate the implant. The best approach is to wait at least 6-9 months to allow the capsular tissue to mature/strengthen to allow permanent suture repair of those tissues to hold the implant up into the proper position with less chance of it reoccuring.The fix is fairly easy and predictable but does require a trip to the operating room again.Stay in touch with your plastic surgeon regarding possible revision. 

In order to repair bottoming out implants I will either close the pocket with internal sutures or restore and support the breast pocket using Strattice™ Reconstructive Tissue Matrix (sterile tissue derived from porcine skin), which is designed to support tissue regeneration. Strattice secures the implant location to reduce future migration problems. After your breast implants bottoming out repair surgery, your breasts will look elevated and symmetrical again. 

I have attached a link to more information about bottoming out implants for you to review. Good luck!

Surgery is the only effective remedy. Revision surgery is almost always more complex than breast augmentation. Correction techniques vary based on your plastic surgeon’s experience and skill sets. Always choose a board certified plastic surgeon with expensive revision experience as even in the best of hands recurrence is frequent especially if larger implants are used. Repair techniques include some of the following techniques and recommendations:Textured implants (“Velcro effect”)Use of Smaller ImplantsMaximum Submuscular Position (not just the pectoralis major but abdominis rectus below and serratus anterior on the side)Capsulorrhaphy (tightening the pocket by sewing in-folded capsular tissue together)Use of Biologic fabrics and other materials such as Acellular Dermal Matrix, “ADM” Alloderm, Strattice, “Silk” and others that can be used to reinforce the bottom of the pocket.Change of position of implant to a new pocket location “neo pectoral pocket”Internal Ryan Procedure (sutures binding the inferior mammary fold to stronger underlying tissues (e.g. fascial, periosteal)Removal of Implants and replacement of volume using your own fat (Fat Transfer).

Thank you for your question. Your still in your recovery period from your surgery.  I would wait 6 months.  Use underwire bra.  If there is a significant difference in the inframammary folds, after this time, then you may need a revision. A revison would entail a caspuslorrhaphy and internal sutures to elevated and fixate the inframmary fold.   Discuss your concerns with your Board Certified Plastic Surgeon. Best wishes.