Bottomed Out or Low Pocket?

This picture is one week post op. There is an obvious difference but my PL said things are looking great and on track and not to be worried. I asked him about my right breast and he explained that is my dominant side, so the muscle is smashing down on the implant forcing it to have that appearance whereas my left side is riding high because it is a weaker muscle. It looked this way directly after surgery. I felt confident with that answer but worry still. My placement is partially under the muscle 425 filled to 460. I was asymmetric. The pre op photos show’s a slightly larger left breast but this breast had some milk left in it from 11 months nursing of. The other breast was dry as it dried up at nine months of nursing. I had the augment 2 months after I stopped breastfeeding all together. I’m worried but realize it’s only one week post op. What should I expect?

Doctor Answers 11

You will need to have smaller implant and revision

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I am sorry that you have the result that is perfect. I would say that you had mild sagging and your surgeon tried to give lift by duel plain implant placement and also using larger implant than your breast could support. Your right breast has separation of the ligaments for the inframamary fold and this will not get better with waiting. Your left breast has already started that have ptosis of the breast tissue off the implant. Please go back to your surgeon and if he can not see the problems, get  second opinion .

New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

Furthur surgery

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Suggest that you stay with your surgeon during the first few post op months and then seek another opinion locally from an experienced surgeon.

Leland Deane, MD, FACS
Long Island Plastic Surgeon
5.0 out of 5 stars 52 reviews

Double bubble vs. bottoming out breast implants

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You have what appears to be a double bubble problem on the right, and unfortunately I would not expect it to get a lot better with time. There is a good option to correct it, which is conversion to a split muscle technique. I would be happy to send you some information about that if you like, since it is important to understand how the muscle release is part of the problem and therefore needs to be considered in planning a correction.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Double bubble trouble

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You have what looks like implant malposition worse on the right than the left.  The implant is below your fold cauysing a double bubble. The implants may have been too big for the pocket and the right one is way below the original fold. 

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Bottoming Out VS. Breast Implant Over-Dissection

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This is NOT a case of Breast "bottoming out". Such a process is gradual and is not seen immediately after the surgery. When performing a breast Augmentation, the incision / scar is placed along the intended location of the (new) breast fold (which means that when placing an overly large implant in a small breasted woman and especially one with a high and or tight natural breast fold, care must be taken to avoid a double bubble deformity. In your case, the scars appear low (at the level of your old chest tube scars from ? heart surgery) and there appears to be a fluid collection from the incision to the right breast implant topic. Such collection should be aspirated and I would recommend conservative taping of the breast skin to the chest along with the use of an ace strap to promote adherence. IF this does not correct the problem revision surgery may be required.

Peter a Aldea, MD
Memphis, Tennessee

Peter A. Aldea, MD
Memphis Plastic Surgeon

Bottoming Out versus Implant Malposition

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Hello Kay Girl,

I am sorry that this has happened to you.  This is not bottoming out, nor is it your dominant muscle pushing on the right implant.  This is implant malposition. And it is rather significant on the right side, and one could argue that you have a small degree of implant malposition on the left, with the appearance of the inframammary fold elevated off your chest wall.

There is a tremendous amount of pressure on the thin tissues that the right implant is pushing on, indicated by the redish appearance.  This is something that should be taken care of sooner than later, to prevent more tissue thinning and  expansion.

Correction will be more complicated than the breast augmentation, and should entail modification/closing the pocket that the implants are in using permanent internal sutures.  Additionally, smaller implants should be replaced, as these are too large for your anatomy and are partially the reason you are in this predicament.  Finally, there is an element of breast sagging that might need to be addressed once the new implants are placed in their reconstructed pockets, and this should be addressed with a breast lift if that is the case. (It is difficult for me to say with certainty regarding breast lift by only looking at your photos, however.)

Needless to say, you should get a few consultations with revision breast experts: surgeons with a reputatiion for correcting breast implant problems.  More than likely they will be certified by the American Board of Plastic Surgery and members of the American Society for Aesthetic Plastic Surgery.

This is a fixable problem and you can look forward to pretty breasts someday soon.  Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews


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Thanks for the photos.  A preop photo would also be helpful. You have a double bubble deformity on the right.  I am sorry to say this will not  get better with conservative measures.  You will need surgery to correct this deformity.  There is no reason to wait to get this corrected.  Good luck.

Todd B. Koch, MD
Buffalo Plastic Surgeon
4.6 out of 5 stars 37 reviews

Bottomed Out or Low Pocket

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"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.

It is best to consult with your Plastic Surgeon with an in-person exam, to better confirm if this is actually your case. However, if there are any causes of concern, ask questions of your surgeon or their nursing staff.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Bottomed out or low pocket

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There are a variety of issues here.  The right implant is sitting lower than the left.  A double bubble can be seen on the right and a small double bubble looks like it may be developing on the left.  It is best to aggressively support the lower pole of the right breast with taping and or firm fitting bra continuously for the next several weeks in an attempt to improve the right implant position. It is possible that the left implant will drop into the same postion as the right providing you with symmetry.  I would not rush into surgery too quickly.  It is best to let things settle down and then reassess your needs.

Beverly Friedlander, MD
Short Hills Plastic Surgeon
4.8 out of 5 stars 19 reviews

Right Implant is Low and Can be Fixed

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With the fullness below the natural breast crease, and less fullness on top, the photograph shows the right implant sitting too low.

  1. It may be worth trying to correct this malposition by aggressively limiting the implant positioning to the crease with taping, under-wire bra, and/or special garment/strap. This might work early post-op, before the capsule starts to form.
  2. The alternative is surgical: early on, the repair might be relatively simple with a well placed reinforcing stitch or two placed at the crease.  This can be done through a breast crease incision or through the skin with a temporary "bolster."
  3. Once a capsule forms, the malposition can be corrected with capsulorrhaphy, surgery to reshape the capsule by closing the part below the crease.

Please understand, these comments are meant to be helpful, but the best choice for you must come from a proper discussion of alternatives with your surgeon.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 46 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.