1 year post op, implants are in different locations. Could I be bottoming out?

Question

I had a breast augmentation november 2022 - 295cc moderate soft touch implant. I'm concerned that the implants seem to be in different locations on my chest. Am I bottoming out?

Carlos Marciales, MD · Answer

Hello, you must remember that the breasts are asymmetrical, and there are people with more marked asymmetries, when a patient has a breast augmentation, they are only increasing the size of the breasts, the shape, location of the breast and nipple will be the same, the sine will be the same only bigger, In your before photos you can see that difference in the shape of your breasts, which persists with the implants.

Fernando Ovalle Jr., MD · Answer

Hello and thank you for your question!

It appears that you have had a good result and from the photos available, I do not see a cause for concern. It is normal that implants and the breast tissues "settle" over time and some "stretch" of the lower breast pole will occur (lengthening of the nipple-fold distance). However, unless this "stretch" and distance between the nipple to fold becomes excessive or if there has been a loss/effacement of the IMF (inframammary fold) anatomy resulting in a "double bubble", then it is hard to say the implants are "bottoming out."  Of course, if there is any concern, the best recommendation is to have an in person exam by a board certified plastic surgeon, ideally the surgeon who performed your surgery if possible.

Camille Cash, MD · Answer

An in person examination is recommended to determine if you are bottoming out.  This occurs when the implant begins to settle too low.  Patients notice the position of the nipple rising and may see the incision if in the inframammary fold shift.  I encourage you to return to your surgeon for an evaluation.  If you are bottoming out, adding bioabsorbable mesh can help to support the weight of the implants.  I've included a video that I hope you find helpful.

Bao Ngoc N. Tran, MD · Answer

Hi Your breast folds were different at baseline with the right being lower by about 1cm. This could have been fixed by lower the left side at the time of surgery. I don’t think this was done and therefore your implants rest in the folds which are not even. Again this is due to your baseline anatomy.

Marcos Lopez, MD · Answer

Thanks for your question. It is hard to tell just from pictures but I think you are correct about bottoming out. If you look at your early pictures, your breast folds are approximately even. When you look at the last photo, the fold on the left of the photo (your right I believe) is lower than the fold on the other side. This is likely from the implant sitting a bit lower on your chest on that side. Everyone has slight differences at baseline and it is not something that needs surgery unless it continues to worsen or is bothersome to you. If needed, the pocket can be revised and some surgeons will use mesh to support the implant if needed.

Mats Hagstrom, MD (license on probation) · Answer

All women have pressed a symmetry. For most individuals, the left breast sits higher on the chest wall than the right side. This was true for you as well based on your preoperative pictures. Your left breast should always sit higher on your chest wall because that is baseline.
Your implants are central to eat breast. Plastic surgeons cannot move breast on the chest wall, and each implant should be placed central to that breast. Don’t compare breast position because they’re never equal on anyone. 
Your implants look perfect, and I see no evidence of bottoming out.
To me, it looks like you have a textbook perfect outcome.
Best,
Mats Hagstrom, MD

1 year post op, implants are in different locations. Could I be bottoming out?

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