Am I bottoming out or Is this double bubble? (photos)

Question

1st pic is pre-op, 2nd and 3rd pic 2 days post-op and remaining pics are current state. December 2020 I got a lift and SRF-560 under the muscle implants. 3 months post op I noticed the separation from my implant when lifting my arm and was told to wait until 1 yr post op. I'm now 14 months post, deformity is still very apparent, and I've now lost upper pole fullness with high profile implants. Is this bottoming out? Double bubble? What revisions would be needed to correct?

Gary M. Horndeski, MD · Answer

The lift that was performed was inadequate and did not actually lift the breasts up but only your areolas.  You also did not need implants at the same time.  At this time, your breasts are very low and your volume is largely inferior.  The technique I recommend is 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.

Richard Baxter, MD · Answer

The double contour you see can be either the original bottom crease (inframammary fold) or related to the insertion of the pectoral muscle into the capsule where it can settle after being cut with the dual plane method. If you see any pulling up of the crease when you contract the muscle then that is the cause. It is called animation deformity. That can be corrected by re-attaching the muscle behind the implant, by converting to either the split muscle plane or subfascial. Three things to know:
1. Re-suturing the capsule may not work because the nipple position is low, and shortening the distance between the bottom and the nipple will look worse.
2. An internal bra is the addition of a layer of supporting material such as Galaflex mesh or Strattice. Sutures are only as strong as the tissue they are sewn into.
3. Consult an expert familiar with revision breast surgery. Your situation has several things going on and one simple solution may not be adequate.

Daniel Barrett, MD · Answer

Dear bmerritt6583,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Donald R. Revis Jr, MD · Answer

Good afternoon,
You have a little bottoming out with a double bubble. You need the Original Internal Bra, my strong permanent internal suturing technique which corrects both bottoming out and double bubble and will provide excellent long term support. I first developed this technique over 20 years ago, and today it is the most common revision procedure I perform, at least 5-6 times a week- it works and it lasts.

Connie Hiers, MD, FACS · Answer

Your heavy implants have sagged some and are bottoming out some. This is why you don't have as much upper pole fullness.  I would recommend tightening the lower pocket and going with smaller implants. The lift might need to be tightened as well.

Am I bottoming out or Is this double bubble? (photos)

Answers (5)

Answer: Bottoming Out / Double Bubble / The Original Internal Bra

Answer: Bottoming Out / Double Bubble / The Original Internal Bra

Answer: Implants

Answer: Implants

Recommended reading

Everything you need to know about Breast Implant Revision

Our mission is to create a world where every investment in modern beauty is Worth It.

Am I bottoming out or Is this double bubble? (photos)

Answers (5)

Answer: Bottoming Out / Double Bubble / The Original Internal Bra

Answer: Bottoming Out / Double Bubble / The Original Internal Bra

Answer: Implants

Answer: Implants

Browse related questions

Recommended reading

Everything you need to know about Breast Implant Revision

Our mission is to create a world where every investment in modern beauty is Worth It.