Bottomed out implants - is this correctable? (Photo)

Question

It has been 4 months since I had a breast implant surgery procedure with a lift. I a Not happy with the way the have settled low on my chest and seem droopy. The nipple position also seems like it is too high on the breast and all the tissue fell below the nipple and almost down toward my belly button. My surgeon performed a lift and put in 750 cc. The last picture is what I wished they looked like when I am holding them up. Is this correctable are the bottomed out?

Robert M. Wald, Jr., MD · Answer

Bottoming out or lowering of the infra mammary fold occurs following breast augmentation with large implants and elastic skin. Even with a lift, this occurs. To correct this, a revision surgery using gala flex as internal bra will help maintain the position of your implants. Realize, that in time, further stretch of the tissue will occur and possible repeat surgery may be necessary in the future.

Randal Haworth, MD, FACS · Answer

It is not uncommon for breast implants to take several months to fully settle and for the final results to be visible. However, based on the pictures you provided, it seems that you may be experiencing a condition known as "bottoming out," where the implants have dropped too low on the chest and are positioned too far below the nipple.

This can occur due to a variety of reasons, such as surgical technique, implant size, or postoperative complications. Additionally, the high nipple position you mentioned may also be a result of the same issue.

Fortunately, corrective surgery is often possible to address this issue. However, it is important to discuss your concerns with your surgeon, who can evaluate your individual situation and recommend the most appropriate course of action.

In some cases, a revision surgery may be necessary to correct the position of the implants and adjust the breast tissue. This may involve using a different type or size of implant, modifying the surgical technique, or reinforcing the breast tissue with sutures.

During the consultation, your surgeon can also discuss the potential risks and benefits of the corrective surgery and help you understand what to expect during the recovery period. With proper treatment and care, it is possible to achieve the desired results and regain your confidence in your appearance.

I hope this helps,
best of luck !

Daniel Barrett, MD · Answer

Dear Polite7523,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Wayne I. Yamahata, MD · Answer

The implants can be repositioned higher in your chest with either internal sutures or the use of a mesh. The underlying issue is the weight of your breasts and the effects of gravity. You may want to consider smaller implants to reduce the risks of this problem repeating itself.

Gianfranco Frojo, MD · Answer

I would recommend downsizing implants, placing an internal bra (Galaflex) and performing another lift (likely just a horizontal mastopexy to decrease the distance from the nipples to the breast fold). You should see a board-eligible or board-certified plastic surgeon with extensive training in aesthetic plastic surgery of the breast. Best of luck

Richard Baxter, MD · Answer

It is clear that the implants need support, especially as they are rather large and heavy. This requires adding something such as a Galaflex internal bra.

Gary M. Horndeski, MD · Answer

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.

Best Wishes,

Gary Horndeski, M.D.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. A large portion of my practice is dedicated to revisionary breast surgery Over many years, I developed a technique called "Reductive Augmentation" in which an internal bra-capsulorrhaphy, mastopexy - lift, and removal of inferior pole breast tissue is performed. This procedure is particularly suitable for patients who would like a more round appearing breast and upper pole fullness. I have treated many patients with very similar breast issues as yours. I published this technique in the International Journal of Aesthetic Surgery in 2017. Best wishes to you.

Gerald Minniti, MD, FACS · Answer

The current informed thoughts about augmentation mastopexy are regarding the use of resorbable mesh to support the implants during the healing phase so that the resultant implant capsule can support the implant without soft tissue stretch. This is even more important with extra large implants. You will need a revision surgery to tighten the capsule, replace the implants, support the implants with mesh, and possibly remove more skin from the inframammary fold.

Steven Mapula, MD · Answer

In my opinion, 750cc is far too large as the weight of the implant alone with predispose it to bottoming out without added support. A revision with added mesh for support as well as a skin excision would help you achieve the desired result. I would also advocate for a smaller implant for less weight.

Bottomed out implants - is this correctable? (Photo)

Answers (16)

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