Possible Bottoming Out? (pic)

Hello, I had breast augmentation almost nine months ago outside of the country (because I was living outside of the country) and I have been feeling that the right side has been starting to bottom out a month or two ago. I consulted a plastic surgeon a while ago, but he didn't seem too concerned about the lowering of the breast fold. In fact, he suggested to lower the other side by injecting fat to the crease. Does it seem like its bottoming out and is it severe? Will it get a lot worse?

Doctor Answers 10

Breast asymmetry

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The photo deso show some assymetry and it may be worse than the photos becauseon  the one side that looks lower  your arm is up ( this would likf the implant sometimes.)

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Bottoming out after breast augmentation?

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From your photo (although it is hard to see), it does appear that you have asymmetry with respect to the folds of your breasts. A pre-op photo would be helpful as women can have this preoperatively. How much this will progress is variable and largely depends upon whether this is pre-existing or not. If this is a new finding and something you would like to correct, there are surgical options to help improve the symmetry of your breasts. This would need to be evaluated in person, and best suited to the original surgeon. Best of luck, Vincent Marin, MD
San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 52 reviews

Bottoming out?

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Your breasts should not change much at 9 months out if there are no other issues involved.  With that said, if you are ok with the way your breasts look then obviously there is nothing that needs to be done.  If you do not like the way your breasts look the next question is which breast do you prefer.  If you like the right breast (in the mirror view) than the left should be lowered as well as opened up more towards the midline.  If its the other way around the lower portion of the lower of the two breasts will have to be sutured (repaired).  A third option if you would like slightly larger breasts is to replace both implants, opening the higher breast pocket and maintaining the other.  

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Bottoming out?

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Very poorly done photo. But it looks like a minor issue but in person examination can aid you in determining the next step. 

Possible Bottoming Out? (pic)Answer:

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Your right breast (mirror) does seem just a bit lower but not too bad actually. And the nipples do seem very even, and that is the mark that most patients use. At 9 months they probably are not going to change much and I don’t think it worth it to go back into surgery and I have no experience with fat under the breast but it seems not right…. But if you seek correction remember, for most surgeons, it’s easier to lower an implant than raise one!

John J. Corey, MD
Phoenix Plastic Surgeon
4.7 out of 5 stars 48 reviews

Breast Augmentation, Bottoming Out

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Your question is interesting because there are two totally opposite but right answers. In your picture, there are some patients that would like the look of the right breast, others would like the look of the left side. Either one can be the right look, just not together. It's a pretty easy problem to correct and it can be done either by a "capsulotomy" to lower the higher breast or a "capsulorhaphy" to raise the lower breast.  Your surgeon should be well versed in either so just decide which way you want to go. You will get a more symmetric look, I think, if you avoid the fat graft.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Solutions for "bottoming out"

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Your photos hint at the problem but a proper consultation with a Plastic Surgeon is essential before any advice is meaningful. Having more than one opinion would also make sense so that you can better evaluate your options.

The shape of the breast after augmentation surgery is constantly evolving. Your breast folds and implant positions are asymmetrical and correcting this will involve additional surgery. This surgery will have small but real risks and no guarantee of producing a permanent solution. Giving you this honest feedback is not meant to discourage you but rather to inform you properly so you can decide if further surgery makes sense to you.

Contrary to one of the other opinions offered, there is no surgical approach that consistently eliminates the risk of developing asymmetries, lower breast stretching out, etc. Different techniques, including sub-fascial pockets have not proven to be superior for all patients.

My advice would be to have another consultation and then watch and wait for 6-12 months to see if the asymmetry worsens or better yet, stabilizes and improves. In any event, this time will allow you and your surgeon to be more confident in what revisional surgery can accomplish. Although I suspect that your currently lower fold will continue to stretch, your higher and currently preferred breast may stretch and decrease the differences that you see.

Dr. Mosher

Mathew C. Mosher, MD
Vancouver Plastic Surgeon
4.5 out of 5 stars 34 reviews

Revising implant bottoming out with cold subfascial placement delivers a beautiful lasting result

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The problem is indeed that your left implant has dropped to low.  in the picture, your left shoulder is elevated as is your arm.  Both of these actions have the effect of raising your left breast and it is still several centimeters too low.  This is a progressive deformity resulting from the combination of two factors :  submuscular(or dual plane) placement and violation of the tight attachments at your native inframammary fold.  Placing breast implants under the muscle creates a few aesthetic problems. If you look at your picture, your breasts are too far apart at midline to have a natural appearance.  any time your arm moves this appearance will widen and worsen.  This is the reult of releasing the inferior portion of the pectoralis major muscle.  The more superior origins will not allow the implant to sit in a natural place and the continual forces of the muscle constantly push the implant down and out.  When this is combined with excessive undermining of the inframammary fold, the deformity that you are seeing results and continues to progress.  This is a very common finding with submuscular placement.  To understand these forces better, stand in front of a mirror topless, put your hands on your hips and push down onto your hip bones firmly.  You will see both breasts move down and out.  these forces over time always cause lowering, lateral displacement, thinning of the breast tissue and stretching of the skin.  This is the reason that I use a unique technique in my practice called 'cold-subfascial augmentation.' THis technique leaves the muscle alone and out of the equation but should not be confused with 'above the muscle' which I would also not recommend.  The cold-subfascial augmentation harnesses the strong structural power of the pectoral fascia to create a truly natural breast shape and act as a living structurally sound brassiere inside the breast protecting the breast from the pressure of the implant and forces of gravity.  

I have seen many patients with identical problems to the one you present and in my opinion there is only one good solution- changing placement to a new cold-subfascial plane.  All of the native inferior support of your breast is now violated and conventional techniques like capsulorrhaphy and neosubpectoral placement rely on structurally unsound scar that will surely stretch and recur.  There are several mesh and biological products people use to restore support but these in my opinion do not offer lasting support or add new risks or unnatural feeling/appearance.  In my experience, revising breasts such as yours with a subfascial plane can create a more beautiful and lasting augmentation then your original before the problems started.  I hope this helps!  

All the best,

Rian Maercks M.D.

Implant bottoming out

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Although it is a little hard to tell from the photograph that you provided, it does appear that your right implant is sitting lower than the left. It is hard to tell since your right arm is up taking the picture in the mirror which reverses your image.  It would be easier to tell if both arms were down in the same position.  I don't like the idea of fat injections to correct implant malposition.  It is possible that you may need to have the right implant repositioned and the lower pocket imbricated on itself to keep it up.  This is generally a fairly minor procedure with a quick recovery.

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 40 reviews

Bottoming Out?

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Thank you for the question.

Unfortunately, the picture you provided is  hard to evaluate; a closer photograph with both arms at the side would be helpful If you are feeling the implant much more so on the right side than the left then it may have settled more so on the right side.

If the asymmetry concerns you then it can be corrected using a internal suture technique (capsulorrhaphy). It is important to remember our that some breast asymmetry is likely to exist despite your surgeon's best efforts.

I hope this helps.

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.