Bottoming out Or Inferior Lateral Migration of the Implant? (photo)

I am 5 weeks after breast augumentation with 325cc submuscular smooth round HP silicone implants. I have a weird feeling in my left breast like is heavier and sagging. I also feel my left breast more under my arm than I feel the other one. The breasts look far from each other and I don't have too much upper pole fullness.I haven't done any strenuos exercises or heavy lifting and have followed all my post op instructions. Please, I need opinions and advice. Will I need a revision? Thank you!

Doctor Answers 9

Five weeks post surgery

Your breasts look good after five weeks.. They will go through more changes over the next few months so give them time to heal.  Remember, cleavage is a component of your anatomy and hard to get real close if you did not start that way.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

5 Weeks after Breast Augmentation - Revision?

   Breast augmentation surgery is frequently a compromise with preexisting asymmetry, chest wall constraints, volume demands, etc.  You cannot change one relationship without changing the others.  5 weeks is too early to make decisions about the result.  Wait at least 3 months, if not 6 months. 

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Bottoming out Or Inferior Lateral Migration of the Implant?

I see on your before posted photo a slight asymmetry to your breasts as for shape and N/A location. Your left N/A is more laterally place, this is an anatomic variant to you. So if you increase volume these differences are magnified. Especially the lateral displacement of the left N/A. This is not to say that the dissection of the pocket was done equally, which I think it was not. But over all the result is acceptable for the appearance before the surgery. Yes revision could improve. I might consider fat gratifying to even out the differences. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Breast Implant Migration

Your result looks good for 5 weeks. Keep in mind that your breasts with continue to change for several months post-op. While there are some minor differences between the right and left, this is normal.

The implants appear to be well placed relative to each breast. They may appear far apart but that is because you have a narrow chest and your breasts were naturally far apart even on your pre op photo. The implants won't change the spacing of your nipples. 

Both the tightness and fullness are likely to improve over time as the post op edema and tissue changes resolve.

I wouldn't worry about a revision at this time.

Eugene J. Sidoti, Jr., MD
Scarsdale Plastic Surgeon
4.7 out of 5 stars 3 reviews

Breast Implant Bottoming Out

Thanks for asking that question!  Based on your pictures, I don't think the implants look so different.  Perhaps they look worse in person, but remember it is normal to see some differences between the breasts.  I am assuming you are right-handed based on the pictures as you have more upper pole fullness on that side, and that also is to be expected and usually improves within the first 3 to 4 months following augmentation.  I don't see any dire need for revisions at this point and encourage you to be patient.  As for the wide spacing between the breasts, only a wider diameter breast implant can alleviate that, and you can discuss this with your surgeon.  Best wishes!

Brian Howard, MD (retired)
Alpharetta Plastic Surgeon
4.3 out of 5 stars 19 reviews

Are you going to need revision surgery?

You should probably wait until 3-6 months after your surgery to consider a revision. Your final result will settle in by then. Discuss your concerns with your plastic surgeon!

Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.
Bottoming out and Side Boobs Contributing Factors:
  1. Larger/Heavier Implants
  2. Implants placed above the pectoralis muscle
  3. Chronically not wearing a bra when upright
  4. Over dissection of the Implant Pocket
  5. Smooth Implants
  6. Large swings of weight including pregnancy
  7. Skin and soft tissue laxity, loss of elasticity

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Implant Positioning

Hi Notsolucky.  If you take a closer look at your before photo you will notice that your breasts sit more lateral (nipple areola complex) on your chest wall.  Your breast are also positioned further apart (hence no cleavage).  This is always 'enhanced' when you place an implant.  I think that your results look great in regards to what your surgeon was working with or started with.  I am sure that your surgeon took measurements of your breast width to make sure that the best implant was chosen in regards to what would fit best in your chest wall.  High Profile implants are more narrow than other options.  So, I do not think that implant is too wide for you.  I believe you are in the transitioning stage of getting use to your 'new look'.  Give them time and they will begin to settle down and feel great.   

Shelby Brantley, MD
Jackson Plastic Surgeon
4.6 out of 5 stars 29 reviews

Breast augmentation results look normal for 5 weeks

Thank you for your question and photographs. I do not see evidence of bottoming out at this stage. I think your results look normal for 5 weeks

.Your breasts will get softer. Hopefully your plastic surgeon will improve breast implant displacement exercises which I personally would emphasize pushing the implants to gather to help reduce the lateral displacement of your implants.

It is far too early to be concerned about needing a revision. Keep open communication with your plastic surgeon.

Post op augmentation migration of implant or bottoming

Hi,  You are only several weeks out from your procedure and you are having some nice changes.  I think you DO have upper pole fullness but you can see that most plastic surgeons would recommend to you to be patient and see how the changes go for 6 months or more.  The cleavage is genetic and should not be changed surgically except in few circumstances.  It is a dangerous place to try to alter and get a nice result.  Notice too that your surgeon changed your crease to accomodate your implants.  I would have also done this so the "new" crease has to form in support of the implants.  I think you are developing acceptably but any worries should be given to your ps and discuss things openly to allow you to know that if things do not settle the way you can, then there would be options that can be presented to you understanding that there are risks with any reoperation.  If you were my patient, I would want you to be a year from your surgical date before we make any revision decisions and from your pictures, I doubt that this is going to be a discussion you and your ps will need to choose.

Steven M. Lynch, MD
Albany Plastic Surgeon
5.0 out of 5 stars 18 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.