Breast Augmentation Bottoming Out? (photo)

I am on week 5 after my breast augmentation and I measured my left crease from my belly button up and my right crease - my left is 1 inch lower. Plus it's visible. The doctor said he did a lot more dissection on my left breast. My right is actually filled 25 cc MORE than my left but my left has looked larger from the start. Very concerned about bottoming out, and the fact that they look so different. I'm putting up a pre-op photo too.

Doctor Answers 14

Actually its the opposite!!!

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Your left breast appears well positioned and natural.  The right breast implant is "too high" probably because of tightening of the capsule postoperatively.  The surgery was initially done correctly but due to the implant moving higher and the right breast being more saggy to begin with, the result is that the right breast is no longer sitting above the implant.  Wearing the breast band (Bando) and massaging may help a bit but despite your best efforts, you may eventually require revisional surgery to reposition the right breast implant and get the results you desire. 

One more thing, to get the breasts to look really symmetric I would also reduce the size of the right areola and slide it higher to match the position and size of the left areola.

Good luck...

Manhattan Plastic Surgeon

Breast implant asymmetry and bottoming out

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It is important to understand that an augmentation will not correct all of the asymmetries that you had preoperatively. It is difficult to tell from the pre-op image if your right breast fold is lower or if you just have glandular ptosis (breast gland sags over fold). Either way, the areola is lower on the right pre-op and I would expect it to be lower postop, since a lift was not performed. 

It would be helpful to have other views (side), but in my opinion, the left breast does not look bottomed out. The nipple looks fairly central on your left breast mound.You probably have less fullness in the upper pole of your left breast now because swelling has decreased from the 9 day pic.  Your breast folds look to be about the same height 9 days out. Your left breast definitely appears to have a lower fold than the right side 5 weeks out, but I propose it may be more an issue of the right crease moving up. This happens when the right implant has moved up-- a superior malposition. This can result from the lower pocket healing together too much or from early capsular contracture. 

Sometimes an implant stabilizer band can improve a superior malposition if it is addressed early after surgery. Address the issue with your surgeon. If you do not feel he/she is addressing the issue adequately, seek a second opinion.

Best wishes,

Michael Vennemeyer

Breast Augmentation Bottoming Out?

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Thanks for the posting of the photos. I would not say a left true "bottoming out" but more a poorly done operation with no attention to details of the pre operative breasts appearance and sizes. Revcision only choice Sorry. 

Bottoming out

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There is some degree of asymmetry in all breasts before and after surgery.It is not uncommon for breasts to look different early after surgery. There is a different anount of swelling in each and they dont heal at the same rate. My advice to you is to allow passage of time. The healing is not complete for around 9 months to one year after surgery.

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon

Right implant is too high and looks smaller

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Your left breast is perfect. It is not bottoming out. The right implant is at least a centimeter too high. You need to push constantly down above the right implant with a breast band. One half of the time you should have the band above both implants and the other half of the time above the right implant and UNDER the left implant but always under the armpits and low in the back.

It is interesting that the illusion of size depends entirely on the distance from the nipple to the infra-mammary fold. The lower the implant and the more skin that you can see between the nipple and the fold, the larger the breast appears. In your case, if you are able to lower the right implant enough, they will both appear to be the same size. If you are unable to lower the right implant; a donut mastopexy will accomplish a very acceptable result, both in symmetry and size.

Louis R. Mandris, MD
Rancho Cucamonga Plastic Surgeon

Asymmetry not unusual early after surgery

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Dear Createuser.  Again thanks for the photos which help enormously in determining the possible problem.  You are right in that there are some differences in terms of the breasts which are greater than on day nine.  Healing is a slow process and different in every patient.  At 5 weeks I would certainly not consider operating unless it was a true emergency.

What I see now is either a high riding implant (one that didn't settle) or a capsular contracture.  If the implant is hard or firm and doesn't move freely or feel soft it probably is a capsule.  If the implant moves and is soft then the lower pole on the bottom of the breast may have closed off.  The other possibility is that the left implant is dropping and needs to be elevated and the pocket repaired. 

You need to see your plastic surgeon and ask him these questions even though he/she may not do anything just yet.  This way you could get your questions answered and of course no photo compares to a physical examination.  Good luck and let us know how you are doing.  Dr. Schuster in Boca Raton.

Breast asymmetry after breast augmentation

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Thank you for the question and for providing the photos. While it is hard to make a definitive determination without an exam the photos certainly help.

When you look at your pre-op photos, there is some asymmetry of both the volume and position of your breasts. Your right nipple areolar complex and nipple, as well as the inframammary crease, is lower on the right side. Breast augmentation can sometimes magnify preexisting asymmetry or at least bring our attention to it. While it sounds like your surgeon tried to correct this, I would agree that some asymmetry still exists. The most visible aspect of the asymmetry on the photos is in the areolar postion.

I do not see any evidence of bottoming out. This would be uncommon this early in your recovery. There are options to improve your asymmetry, which would likely involve elevating your right areola to match the left side. However, this would involve additional scarring and should be discussed with your plastic surgeon. 

That being said, I would advise waiting for your breasts to more fully recovery and heal. They will continue to change over the next several weeks, and you can then better discuss the options to make your breasts look the way that you would like.

Best of luck.

Jeff Rockmore

Asymmetry After Breast Augmentation

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Thank you for the excellent photos and description of your concerns.  It does appear that you have a pre-existing asymmetry in your breast fold positions that persists after the augmentation.  This is to be expected unless something is done during the surgery to address this asymmetry.

You correctly noticed that your left breast has more visible skin than the right side when looking from the front view.  Although this is not necessarily 'bottoming-out,' it does lead to a more obvious asymmetry.  If, after 3 months, this asymmetry remains, it can be easily corrected by either lowering the right breast crease (which will also raise the nipple-areola so that they are even) or raising the left breast crease (which will also lower the nipple-areola so that they are even) to improve symmetry.

Talk with your plastic surgeon about your concerns.  Best wishes for a beautiful result!

Post Operative Asymmetry

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Thank you for the question and the pictures provided. If you look at your pre-operative pictures, although not as good as an in-person exam, you can see that your right nipple areolar complex and the left inframammary fold are lower to begin with. Therefore an augmentation alone will only augment, not correct, your asymmetries potentially making them more noticeable.

You are still at the early stages of healing and can be seen in your latest photo your right breast implant has not quite settled in comparison to the left side. This is fairly normal and will most likely improve over the next 2 months or so. I do not see any bottoming out at this time.

Continue to follow up with your plastic surgeon, make sure that you voice your concerns, and be patient. Also just as important continue to follow the post operative instructions/advice given by your surgeon.

Best of luck.

Breast Augmentation Bottoming Out?

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On reviewing the pre-op photos, the right nipple and areola are lower than the left, and the skin envelopes are also rather different. Since no breast lift was done, this asymmetry is still, as expected, present in the post op photos. 

The other component of the asymmetry is related to the different pace of settling of the implants, which is a common occurrence  Allow at least 3 months for the implants to drop before being concerned about the need for a revision procedure. 

Bottoming out occurs when the lowest part of the implant is below the breast fold. If that has occurred, it is not apparent on these photos. 


Continue follow up with your surgeon, continue massage, and any other post-op instructions you received. Thank you for your question, for the useful photos.  Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.