Bottomed Out... Should I Replace my Implants with Smaller Ones? (photo)

I recently had a BA with 375cc silicone UHP unders. I have been unhappy with their placement since early on; they are too low and too far apart. My surgeon recommended a capsulorrhaphy at my 3 month follow up. I think my current implants may be too big for my frame and may have caused me to bottom out. My doctor says he thinks the size is okay, but I'm afraid to have the repair just to have it happen again. What is your opinion, should I downsize when I have a revision? Any other suggestions?

Doctor Answers 12

Downsize with revision

Yes, it does look like you bottomed out, and it is often a good idea to downsize so that when the fold is restored, there is not as much weight on the repair and the pocket does not have to be enlarged significantly to accommodate the same implant.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Bottomed Out... Should I Replace my Implants with Smaller Ones?

I am sorry to hear about the complication you have experienced. Yes, I think that capsulorraphy will be indicated;  if you will be happy with your breast size with smaller breasts implants, then it makes sense to do so.   I find also that restriction of activity postoperatively is very important when it comes to avoidance of recurrent breast implant displacement/malposition.

 I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,501 reviews

Bottomed Out... Should I Replace my Implants with Smaller Ones?

If you are OK with downsizing, I concur with the suggestion. Any repair is more likely to be "permanent" with less stress applied.  All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Bottoming Out Can Be Difficult To Correct

This can be a difficult problem to correct.  Smaller implants with a capsulorraphy may help.   A better solution would probably be to use an acellular dermal matrix product with smaller or the same sized implants, but this would add significantly to your expense.  Good luck!

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Correcting a bottoming out problem

Bottoming out is a Consequence of not enough soft tissue support at the base of the breast.  The problem is that time, weight, and gravity are not on your side.  The distance from your crease the nipple has increased causing the nipple to project upward.  In general if plan a doesn't work plan B should be don't do plan A again.  Switching to a smaller sized implants and placing fold sutures to support the Lower pole of the breast are all good ideas.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Bottomed Out... Should I Replace my Implants with Smaller Ones?

        Smaller implants will always put less stress on the capsulorrhaphy to help fix the bottoming out.  Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast augmentation revisions each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Revision of breast augmentation to improve 'bottoming out'

I'd recommend supporting the implants with a 'internal bra' composed of Strattice, a useful biomaterial used in breast reconstruction. This will help improve positioning - bottoming out and lateralization, in your case.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

Breast implant revision

You may want to switch from ultra high profile to high or even moderate plus which will narrow space between breasts a bit, of course one should not cut the muscle and create synmastia. You should do well with capsulorraphy of the lower pocket. Good Luck!

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 60 reviews

Breast Augmentation

I agree with previous recommendations that smaller implants with a revision can be a good solution.  Your tissues have shown some difficulty supporting the implant weight and smaller implants would make support easier.  That combined with a procedure to re-establish the crease beneath your breast and reinforce it to make it stronger would be the way to go.  I hope this info is helpful.

Ronald H. Stefani Jr, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 2 reviews

Bottoming out with reasonable implant size

I think your size fits you nicely... and you could probably keep your size.  With capsulorrhaphies, they can work effectively (and without acellular dermal matrices) but it requires you wear an underwire cut-out bra 24-7 (yes, even when you shower) for up to 2 months.  Surgeon technique is paramount in ending up with a good result.  Surgeons that simply throw some sutures in there without support are destined for failure.  You may want to consider having your implants placed more medially as well but it will cause your nipple to rotate outwards.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 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.