Why does my right boob keep bottoming out? Should I take the implants out & do fat transfer? (Photos)

There is some confusion about what an internal bra is, so it is important to know what you have had done in order to make a recommendation. I define an internal bra as the addition of a layer of support with a material such as Galaflex mesh or ADM such as Strattice. It is not simply suturing the capsule, which is correctly called a capsulorrhaphy. The confusion arises because some surgeons call a capsulorrhaphy an internal bra if they use permanent sutures, but that doesn't add the type of support you need. I doubt you would be happy with explantation and fat grafting.

Hello !

I’m really sorry for your experience.

Breast implant bottoming out can occur due to various factors, such as:

-The implant is too large for the pocket, resulting in excessive pressure on the inframammary fold.
-Inadequate repair of the inframammary fold after lowering it to accommodate a larger implant, causing it to buckle under the implant's weight and pressure.
-Thin or weak breast tissue that cannot support the implant adequately, especially in the case of larger implants.

Breast tissue thinning and loss of elasticity can result from various factors, including genetics, pregnancy, weight fluctuations, aging, smoking, alcohol consumption, previous breast augmentation surgery, and poor diet.

Breast revision surgery is the preferred treatment for correcting breast implants that have shifted or become malpositioned. To reinforce weakened tissue, a synthetic mesh scaffold is frequently implanted in the breast (which is sometimes referred as an « internal bra »). It can also be corrected by forming a new implant pocket and restoring the integrity of the inframammary fold.


It is best to consult with your plastic surgeon to find out what the best method would be and why the last one didn’t work out.

Best of luck !

You might benefit from downsizing the implant to a smaller volume but more implant height (a lower profile smaller implant). You may just have too large of implants for the soft tissue support that you currently have. Large implants can continue to create stretch deformities of the nipple-to-fold distance and/or "bottom out" the inframammary fold due to force of gravity/stretch over time. I would truly see an expert in breast revision surgery in order to ensure that you get a very comprehensive plan.

One of your implants is sliding down what creates visible asymmetry; it happens more frequently with large implants like in your case. Lifting and fixing inframammary fold on that side would create symmetry and prevent further displacement, migration of the implant. You may also consider smaller imlants? In person consultation with a board certified plastic surgeon is recommended. Good luck.

Thanks for your question, I’m sorry to hear how discouraging this must be for you. Fat transfer is not a smart or wise idea for 30-50% of the fat will inevitably die. Clumps of dead fat may be felt on a self-monthly breast exam or show up on a mammogram and affect the screening and give the patient unnecessary worry. You may have a capsular contracture, but I am unable to confirm that from pictures alone. It is not uncommon that implants move or malposition over time. Implants are NOT safe devices and they’re full of problems.
 

Your implants are too heavy for the skin envelope to hold. At this time, I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Dear Sage.xo,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

I'm so sorry to hear about your issues. With large implants and skin that is quite elastic, bottoming out can occur. You are correct, that a mesh or internal support can improve this problem but it can still occur. Removing the implants will correct this problem but smaller breasts will be the result. Fat grafting helps, but will only improve the breast size a half cup. Realize if you redo the breasts again with more internal support, it can happen again. Please discuss this with your plastic surgeon.

I can understand your frustration at this problem. There is an internal bra which is made of an absorbable mesh which can be placed around your implant. This holds the implant up while the capsule heals around it. You will also likely need capsulorrhaphy which means tightening up of the capsule to make the pocket smaller. Right now the pocket is too large especially at the bottom so the implant has too much room and has moved down causing the bottomed out look. Please visit with a board-certified plastic surgeon as your case is complex. Good luck!

The location of an implant on the breast is determined first and foremost by the pre-existing position of the breast on the chest. Other factors that can contribute to the final position are the implant's weight compared to the implant's support.