Bigger Breast Implants Required After Bottoming Out?

Question

Do I have to go bigger in breast implant size after bottoming out becuase the breast pocket is too large?

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).The procedure is performed under general anesthesia on an outpatient basis most often using an existing scar or making an incision beneath the breast. Recovery is similar to your original breast augmentation procedure. Use of taping after surgery and prolonged use of a support bra is often recommended. It is far more important to pick the best plastic surgeon rather than trying to pick the best procedure as they are in the best position to guide you to the right decision.

Christopher V. Pelletiere, MD · Answer

Generally speaking, when someone has bottomed out, you try not to add any more weight to the area. The pocket has been stretched, but instead of trying to fill the entire pocket, the goal is to repair the pocket and secure everything internally. Sometimes, this actually means decreasing the size of the implant so that there is not as much weight on the inframammary fold area. Adding a larger implant would merely serve to add more stress to the inframammary area.

Farbod Esmailian, MD · Answer

No that is not the solution.  What needs to be done is a capsulorrhaphy and placement of a smaller implant.  Otherwise the implant needs to be remove and the capsulorrhaphy before, which is repairing the stretched out part of the crease and then later coming back to place an implant.
Good luck.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Correction of &ldquo;bottoming out&rdquo; of breast implants does not necessarily involve use of larger breast implants.

	One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (&ldquo;riding high&rdquo;), inferiorly (&ldquo;bottoming out&rdquo;), medially (&ldquo;symmastia or uni-boob&rdquo;) or laterally (falling outward into the axilla).

	Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. This is corrected by &ldquo;raising&rdquo; the inframammary fold using internal sutures. This is done after careful measurements are made from the areola to the &ldquo;new&rdquo; inframammary fold.

	I would suggest in person consultation with board-certified plastic surgeons well-versed with revisionary breast surgery.

	Best wishes.

Steven Wallach, MD · Answer

Bottoming out occurs when the implant falls below the natural breast fold. This can be caused by heavy implants. I would not recommend larger implants this may just make it worse.

John P. Di Saia, MD · Answer

Hello,
Usually, the solution is a pocket repair of some sort and replacement of implants that are usually smaller. Larger implants will probably have the tendency to make the repair fail. Weight is the traditional cause of the "Bottoming out." More weight is usually equal to more problems.

Michael C. Edwards, MD, FACS · Answer

Placing larger implants is not the solution to repair bottoming out. The pocket that has stretched on the bottom needs to be repaired internally and going with too large of an implant after that repair can over tax the internal suturing possibly making it recur.
Dr Edwards

Jeffrey Zwiren, MD · Answer

Time, weight and gravity are not on your side. It makes no sense to go to a larger size. Your bottoming out problem will only recur at a potentially faster rate than the first time. If anything a smaller implant is indicated, take the excessive weight off of your skin. This is the etiology of the problem in the first place. Your soft tissue just can not support the excess weight.

George J. Beraka, MD (retired) · Answer

Hi.
When bottoming out occurs after breast augmentation, the implant pockets are too low and need to be reconstructed. The size of the breast implants is not the problem.

Bigger Breast Implants Required After Bottoming Out?

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