Best Way to Fix Bottomed out Breast Implant?

Question

I got breast implants on February 26th, so almost 8 weeks. I had concerns about my left breast (when looking at me) from about 4 weeks post op.  Today, I went to my PS and the Nurse stated that it looked like it had bottomed out. I am a thin patient )105lbs, 5ft2in. 34A pre-op and did 330cc implant filled to 380cc. My breasts before were very symmetrical though!  Dr. said that we will wait at least 6 mths before we decide on anything. He would never say to me bottoming out though. What is best way 2 fix it?

Otto Joseph Placik, MD · Answer

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.

Jed H. Horowitz, MD, FACS · Answer

"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.

David J. Levens, MD · Answer

"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.

Jimmy S. Firouz, MD, FACS · Answer

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!

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

Larry S. Nichter, MD, MS, FACS · Answer

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).

Jeff Angobaldo, MD · Answer

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.

Richard J. Bruneteau, MD · Answer

It’s not unusual for patients to note implant
malposition in the immediate post-operative period. In many cases, this is
transient and related to swelling and muscle spasm. For this reason, revisional
surgery should be delayed for at least 6 months following surgery. Prior to
this time, corrective surgery involves trying to hit a moving target because
wound healing is such a dynamic process. At six months, muscle spasm, skin
tightening, swelling and inflammation associated with wound healing have
improved sufficiently to obtain a good result.Your right breast implant has drifted downward, but it’s
only been two months since your surgery; for this reason, revisional surgery
should be delayed for an additional four months. At that time, if the problem
is still present, corrective surgery can be undertaken. Correction would
require a procedure known as capsuloraphy. This procedure involves placing
sutures in the lower breast pocket to raise the height of the inframammary
fold. The procedure provides correction of the problem and is associated with
high satisfaction rates.If you’re concerned about implant malposition, it’s
important to consult your plastic surgeon. Your surgeon should be able to
formulate a plan that addresses your concerns.

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question!  Given your history as well as symmetry and shape issues, consideration for pocket revision is reasonable.  A capsulorrhaphy would be needed for revision of your breast pocket. If you do need such, the use of a dermal matrix or mesh may be considered if your tissue now has significant laxity that is failing in support or a significant deformity in which recreation of the breast pocket is required along with adding additional support and coverage of the implant.  Certainly, the larger the implant, the heavier the weight...thus, it may be useful to consider placement of a matrix or mesh.  Otherwise, capsulorrhaphy for pocket revision using your native tissue should suffice.  It has been used safely and effectively to correct synmastia, restore the inframammary fold, mask implant issues (e.g., rippling, wrinkling, etc.), support the implant within a "sling", and improve aesthetic results in revisionary breast implant and reconstructive procedures.  However, only by physical examination would one be able to make recommendations on the benefits over the risk of using a matrix or mesh in your situation. Consult with a plastic surgeon well-versed in breast procedures who will assist you in deciding which procedure(s) will be the right for you.  Best wishes!  Hope that this helps!

Earl Stephenson, Jr., MD, DDS, MBA · Answer

In my opinion the bottoming out is when a significant portion of the implant sits in the lower portion of the breast creating an unaesthetic breast.  Looking at your picture it appears to me that the pockets may have slightly different dimensions producing two different breast shapes.  Both are acceptable individually.  You may need to decide which breast shape you prefer and match the other to that shape.  I would heed the advice of your surgeon to wait. Continue follow up with your surgeon.   There may be some more changes in shape.  
Dr. ES

W. Tracy Hankins, MD · Answer

“bottoming out” is the term used to describe the condition which occurs when the breast tends to look as if it has descended on the chest wall after previous surgery, whether the surgery involved implants, a lift, or a reduction. In the case of “bottomed out” implants, sutures can often be placed in the lower pole of the breast to re-elevate the breast on the chest wall. This is called a capsullorraphy and can achieve excellent tresults in the correction of “bottomed-out implants.

Best Way to Fix Bottomed out Breast Implant?

Answers (16)

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